Vermont Medical Society 2022 Mid-Session Legislative Bulletin
The VMS Policy team has prepared this Mid-Session 2022 VMS Legislative Bulletin to provide you with the status of State legislation from the 2022 session covering topics relevant to healthcare including: the COVID-19 emergency, health reform, insurance regulation, public health, scope of practice, mental health and regulating the practice of medicine. This report provides a comprehensive status update on important 2021/2022 health care legislation and largely focuses on the bills that passed, were vetoed or received considerable action. If you are interested in an update on legislation that is not listed in this report, please reach out to VMS policy staff. 

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, Stephanie Winters, VMS Deputy Executive Director, Jill Sudhoff-Guerin, VMS Policy & Communications Consultant, 

COVID-19 Emergency

H.654 Extends COVID-19 Regulatory Flexibilities; Transitions to Telehealth Registration 
H. 654/Act 85 has been passed by both the House and the Senate and was signed by Governor Phil Scott on March 22, 2022. VMS strongly supported and participated in the passage of this legislation. The bill extends a number of COVID-19 health care regulatory flexibilities that were originally enacted in 2020 and extended in 2021. Key among them, the bill provides an extension for out of state providers to practice telehealth in our state without a Vermont license, so long as they are licensed to practice in another state. Rather than a full waiver of licensure, H.654 requires out of state clinicians to register with the Office of Professional Regulation (OPR) or the Board of Medical Practice by March 31, 2022 and the registrations will be valid until June 30, 3023. Given the short timeframe for this to occur, OPR will allow for delayed enforcement of this provision, while encouraging compliance to ensure providers can follow through on the requirements without disrupting care for Vermonters. These registrations will be available for no fee.  Read more regarding the ongoing licensing flexibilities allowed by Act 85 from OPR here and the Board of Medical Practice here.
Other key provisions VMS advocated for include allowing health care professionals to continue to refill buprenorphine prescriptions without requiring an office visit (i.e. via telehealth) and to continue licensing flexibilities for out-of-state health care providers providing care physically in Vermont – see more details below.
Other flexibilities extended to March 31, 2023 include:
  • Sec. 1: The Agency of Human Services shall consider modifying existing rules or adopting emergency rules to protect access to health care services;
  • Sec 4: Permits the Secretary of Human Services to waive or permit variances a number of State rules and standards governing providers of health care services including the Hospital Licensing Rule, Hospital Reporting Rule, Nursing Home Licensing and Operating Rule and more;
  • Sec. 5: Permits the Green Mountain Care Board to waive or permit variances from State laws, guidance, and standards; requires the GMCB to consider hospitals’ extraordinary labor costs and investments in the hospital budget process;
  • Sec. 6: The Department of Vermont Health Access shall relax provider enrollment requirements for the Medicaid program, and the Department of Financial Regulation shall direct health insurers to relax provider credentialing requirements for health insurance plans;
  • Sec. 8: The Department of Financial Regulation shall have the authority to adopt emergency rules to address coverage of COVID-19 testing, treatments and prevention;
  • Sec. 9: Health insurance plans and Vermont Medicaid shall allow early refills of chronic maintenance medications to maintain a 30-day supply;
  • Sec. 12: Health care professionals can renew a buprenorphine prescription without requiring and office visit;
  • Sec. 13: AHS can reimburse long-term care facilities for bed-hold days;
  • Sec. 17: A health care professional who holds a valid license in another state can provide health care services to a patient located in Vermont as (1) a volunteer with the Medical Reserve Corps or (2) for up to six months as part of the staff of a health care facility.  The health care professional must register with OPR or the Board of Medical Practice;
  • Sec. 18: Allows health care professionals whose license became inactive not more than three years earlier to provide services to a patient located in Vermont using telehealth; as a volunteer member of the Medical Reserve Corps; or as part of the staff of a licensed facility after registering with OPR or the Board of Medical Practice;
  • Sec. 19: Board of Medical Practice and Office of Professional Regulation may issue temporary licenses to individuals whose license became inactive between 3 and 10 years ago;
  • Sec. 20: The Director of OPR or Executive Director of the Board of Medical Practice may exercise the full powers and authorities of a licensing board if the board cannot be convened to transact business;
  • Sec. 21: The Director of Professional Regulation and the Commissioner of Health may issue such orders governing regulated professional activities and practices as may be necessary to protect the public health, safety, and welfare. If the Director or Commissioner finds that a professional practice, act, offering, therapy, or procedure by persons licensed or required to be licensed by Title 26 of the Vermont Statutes Annotated is exploitative, deceptive, or detrimental to the public health, safety, or welfare, or a combination of these, the Director or Commissioner may issue an order to cease and desist from the applicable activity;
  • Sec. 22: Allows waiver of providing telehealth services via a HIPAA-compliant connection to the extent their waiver is permitted by federal law or guidance regarding enforcement discretion;
  • The Board of Medical Practice or its Executive Director may issue a temporary license to a physician, physician assistant, or podiatrist who is licensed in good standing in another state;
  • Pharmacists shall have the authority to order SARS-CoV testing;
  • DFR shall have the authority to issue emergency rules to address health insurance coverage of and reimbursement for telephone calls used to determine whether an office visit or other service is needed; and
  • Remote witnesses can be used to execute an Advance Directive.
Members can contact for any further information about these regulatory changes.

VMS Position: Support
Status: Signed into Law, Effective Immediately. 
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H. 655 Creates Ongoing Licensure Flexibilities for Telehealth Practice
H. 654/Act 85, described above, creates a system of registration to provide telehealth services to Vermont patients between March 31, 2022 and June 30, 2023. H. 655 lays out the framework for ongoing telehealth registration and licensure beyond June 2023. The bill passed the House on March 16th and has been referred to the Senate Committee on Health & Welfare. To see a comprehensive summary of the bill prepared by the Office of Professional Regulation, click here. The bill would create a short-term limited registration for telehealth as well as a telehealth license. Telehealth registration would be available for professionals seeing up to 10 patients via telehealth, last up to 120 days and be non-renewable. Telehealth licensure would be available for professionals seeing up to 20 patients, be valid for up to 2 years and be renewable. Professionals seeing more than 20 patients could seek a full Vermont license directly or via a compact. VMS was an active participant in the Telehealth Task Force created by Act 21 of 2021 that informed this legislation and supports the balance created in the legislation between facilitating continuity of care and ensuring sufficient state regulation and oversight of professionals caring for Vermont patients. 

VMS Position: Support
Status: Passed the House, Advances to the Senate Health and Welfare Committee.
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Health Financing/Health Reform

FY23 Budget Passes the House - Primary Care Physician Scholarship Fully Funded
Vermont representatives spent most of last week on the House floor and completed their work on the mammoth $8 billion-dollar FY23 spending package as drafted in H.740 by the House Appropriations Committee. There was very little debate on the spending bill that passed the House by a vote of 135-4 and uses the remaining federal American Rescue Plan (ARPA) dollars to fund one-time projects and initiatives. The budget package includes funding for H.703, the workforce development bill, along with funding for other bills that have passed the House but cannot advance without spending approval. 

The House passed budget prioritizes access to health care and mental health services with significant investments in designated agencies and community mental health services, mobile crisis outreach services, recovery treatment centers and substance use disorder treatment more broadly. The bill also provides funding for the new role of a Suicide Prevention Manager which will be housed within the Governor's Office. Workforce remains a top priority, as the medical incentive primary care scholarship was fully funded, along with expanded funding for nursing scholarships and nurse educator loan repayment. Health reform is moving beyond analysis into action as the Legislature is not satisfied with how long it is taking to achieve delivery system reform and so is providing roughly $4 million directly to the Agency of Human Services and $1 million to the Green Mountain Care Board to design a global hospital budget system and for a community-inclusive redesign of Vermont’s health care system (as also proposed by the Senate in S. 285).

The spending package includes $12,576,731 million for an increase to Medicaid reimbursement rates through their alignment with the 2022 Medicare Physician Fee Schedule methodology. It also includes $612,500 in additional funds for the Tobacco Control Program and the same amount for expanded funding for prevention coalitions (a reduction from $3.5 million originally proposed in the Governor's recommended budget.)

Also, Sec. E.314.1 requires the Department of Mental Health to report to the House Health Care and Senate Health and Welfare Committees on January 15, 2023 regarding the progress of the health care system in improving the patient experience of care for individuals encountering lengthy emergency departments waits for admission for inpatient psychiatric treatment.

VMS Position: Support
Status: Passed the House, Advances to the Senate.
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FY22 Budget Adjustment Signed By the Governor - Increases FY22 Spending by $367 Million
The Governor signed the FY22 Budget Adjustment into law, which increases the current fiscal year’s state spending immediately – through June 2022 - by $367 million. The spending package as signed:  

  • Provides the Department of Vermont Health Access (DVHA) with $4,716,275 (gross) for the increase to Medicaid’s RBRVS reimbursement rates in order to maintain its alignment with the Medicare fee schedule. This alignment provides a bump in payments for primary care services that began in January, and is sustained through the FY23 Budget until December 2022;   
  • Includes the legislature’s intent to pursue federal approval of Medicaid coverage for 12-months of post-partum care. The State will begin the CMS application process in April of 2022;  
  • Funds eight FTE positions and provides $200,000 to the Cannabis Control Board, along transferring $850,000 from the General Fund to the Cannabis Regulation Fund; 
  • Provides $25 million in one-time funds for an Agency of Human Services to address circumstances due to COVID-19; 
  • Includes language to allow AHS to distribute funds from the Health Care Provider Stabilization Grant Program to eligible providers as an alternative to using American Rescue Plan dollars;
  • Provides $60 million to the Agency of Human Services in healthcare workforce recruitment and retention funding. The first round of $45 million going to AHS will provide $2,000 per FTE for long-term care facilities, home health agencies, designated agencies, adult day providers and substance use treatment providers. The second round of $15 million will be for other health care providers with a "demonstrated need" and could provide funding for hospitals, independent medical practices, hospital-owned medical practices, designated and specialized services agencies, FQHCs and other health care providers.  VMS will share more information about this program as it becomes available; 
  • Provides $25 million in financial support to healthcare providers to prevent disruptions or business closures due to COVID-19; 
  • Distributes $500,000 to the Green Mountain Care Board for a consultant to perform a benchmarking analysis comparing Vermont’s health care costs to national, peers, and better performers and to perform an analysis of avoidable utilization and low value care. 
VMS Position: Support
Status: Signed into Law, Effective Immediately.  
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Historic Workforce Development Bill Passes the House
With Vermont facing extreme workforce shortages in almost every sector, H.703 is a workforce development bill that was drafted in a similar manner to the state budget, in that each House policy Committee provided workforce recommendations for careers, businesses and trades within their jurisdiction to the House Commerce Committee. The Commerce Committee then considered whether to add it to a combined workforce proposal after ensuring that the funding is available in the FY23 Budget. This historical investment into Vermont educational opportunities and career training programs was passed by the House in tandem with the FY23 budget and now advances to the Senate. The bill expresses legislative intent to “retain and recruit health care workers in Vermont by reinforcing the current health care workforce and sustaining workers into the future” and includes these health care workforce initiatives:  

  • $3 million for increased compensation for nursing school faculty and staff; 
  • $2.4 million for hospital-employed nurses to be preceptors for nursing school students and $500k for Nurse Educator Forgivable Loan and Loan Repayment program; 
  • Requires the Director of Health Care Reform to develop an action plan to increase clinical placement opportunities for nursing students and establishing sustainable funding models for nurse preceptors; 
  • $3 million to VSAC in nursing pipeline programs to allow current staff to upskill to become a higher-level nursing professional; 
  • Expands the current nursing scholarship program to a forgivable loan program for nurses who agree to work in Vermont; 
  • $2 million to provide loan repayment for nurses and physician assistants who live and work in Vermont and who graduated within past five years; 
  • Directs the Green Mountain Care Board (GMCB) to review hospital salary spread and what hospitals invest in workforce development; 
  • $1 million to the Office of Health Reform to operate a statewide Health Care Workforce Data Center; 
  • Requires the Office of Professional Regulation to report on barriers to mental health and substance abuse clinician licensing; 
  • $170,000 for the creation of the Health Care Workforce Coordinator position in the Office of Health Reform; 
  • Directs the Department of Financial Regulation (DFR) to explore the feasibility of requiring health insurers to access clinical data from the Vermont Health Information Exchange to support prior authorization requests; 
  • Requires DFR to direct health insurers to provide prior authorization information to DFR in a standardized format so DFR can look at opportunities for aligning and streamlining prior authorization request processes; and  
  • Requires DFR and the GMCB to recommend by January 15, 2023 statutory changes needed to align and streamline prior authorization across health insurers. 

VMS Position: Support
Status: Passed by the House, Advances to the Senate Economic Development Committee

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VMS Position: Monitor Status: Died in the House Health Care Committee.
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Primary Care bill Incorporated Into Broader Health Reform Bill
S.244, a VMS priority bill aimed at strengthening primary care, failed to advance fully intact in the Senate Health and Welfare Committee this session. Components of this bill have been incorporated into S.285 and the budget bills, as described below. The VMS policy team will continue our advocacy on these investments that are needed now to support primary care: 

  • Pay Parity for Audio-only Telehealth Services 
  • Increase Primary Care Spend to 12 percent of Total Health Care Spend (goal of increasing commercial health insurer spending through Blueprint payments included in S. 285)
  • Increase Medicaid Reimbursement Rates for Primary Care Services (included in FY22 Budget Adjustment and FY23 Budget)
  • Create the position of Chief Clinical Officer for Primary Care at the Green Mountain Care Board (consultant to advise GMCB regarding primary care included in S. 285)
  • Expand Blueprint for Health payments (recommendations regarding increasing Blueprint payments included in S. 285)
VMS Position: Support Status: Died in Senate Health and Welfare Committee. (Back to the top)

S.285 Advances Hospital Global Budget Planning, Payment Reform, Blueprint for Health 
S. 285 has become the vehicle this session for conversations around the future of health reform and payment design in Vermont.  The bill grew out of several studies commissioned over the summer and fall, including: a report by Donna Kinzer to the legislature’s Health Reform Oversight Committee regarding the evolution of Vermont’s health care regulatory system; work by the Legislature’s Task Force on Affordable, Accessible Health Care  culminating in a report by Joshua Slen; and a report by the Green Mountain Care Board regarding hospital sustainability planning. One area with overlap between the reports that has gain traction among the legislative committees of jurisdiction is to explore the possibility of implementing hospital global budgets in Vermont. 
The Senate is currently reviewing proposed amendments to the bill by both the Senate Health & Welfare and Senate Appropriations Committees. If adopted as proposed the bill would dedicate up to $5 million for the following projects:

  • To the Green Mountain Care Board (GMCB) to (1) develop a process, including the meaningful participation of health care providers, payers, and other stakeholders, for establishing and distributing value-based payments, including global payments, from all payers to Vermont hospitals (2) determine how best to incorporate value-based payments, including hospital global payments, into the Board’s hospital budget review, accountable care organization certification and budget review, and other regulatory processes; (3) recommend a methodology for determining the allowable rate of growth in Vermont hospital budgets;
  • To the GMCB in consultation with the Director of Health Care Reform in the Agency of Human Services to engage consultants to facilitate a patient-focused, community-inclusive plan for Vermont’s health care delivery system to reduce inefficiencies, lower costs, improve population health outcomes, and increase access to essential services;
  • To the GMCB to contract with a current or recently retired primary care provider to assist the Board in assessing and strengthening the role of primary care in its regulatory processes and to inform the Board’s efforts in payment reform and delivery system transformation from a primary care perspective;
  • To the Director of Health Care Reform in the Agency of Human Services, in collaboration with the GMCB, to design and develop a proposal for a subsequent agreement with the Centers for Medicare and Medicaid Innovation to secure Medicare’s continued participation in multi-payer alternative payment models in Vermont.  The proposal must include consideration of alternative payment and delivery system approaches for hospital services and community-based providers including primary care.
Additional sections of the bill:
  • Direct the Health Information Exchange (HIE) Steering Committee to continue its work to create one health record for each person that integrates health care claims data with other data types such as social determinants of health;
  • Ask the Director of Health Care Reform in the Agency of Human Services to recommend to the Health Reform Oversight Committee the amounts by which health insurers and Vermont Medicaid should increase the amount of the per-person, per month payments they make toward the shared costs of operating the Blueprint for Health;
  • Creates a working group to consider extending access to long-term home- and community based services and supports to a broader cohort of Vermonters.

VMS has submitted comments at several states regarding the bill, especially focused on the elements related to primary care input and funding. Once through the Senate the bill will also need to be considered by a number of Committees in the House. The House Health Care Committee has already received an introduction to the bill. 

VMS Position: Support
Status: Passed the Senate, Advances to the House.

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Bill to Ease Medical Debt Burden Passes House
 a bill aimed at standardizing and simplifying financial assistance policies that large health care facilities must provide for eligible Vermont patients who need help paying for medically necessary care, passed the House and advances to the Senate.

Under the bill, all large medical facilities would be required to provide free or discounted care to Vermont residents and to individuals who live in Vermont at the time the services are delivered but who lack stable permanent housing, as follows:

  • for an uninsured patient with household income at or below 250 percent of the federal poverty level (FPL), a 100 percent discount from the amount generally billed for the services received, resulting in free care;
  • for an uninsured patient with household income between 250 and 400 percent FPL, a minimum of a 40 percent discount from the amount generally billed for the services received;
  • for a patient with health insurance or other coverage for the services delivered and with household income at or below 250 percent FPL, a waiver of all out-of-pocket costs that would otherwise be due from the patient;
  • for a patient with health insurance or other coverage for the services delivered and with household income between 250 and 400 percent FPL, a minimum of a 40 percent discount on the patient’s out-of-pocket costs; and
  • for patients with household income at or below 600 percent FPL, catastrophic assistance in the event that the large health care facility’s medical bills for a patient’s care exceed 20 percent of the patient’s household income, in which case the facility shall reduce the amount due from the patient to 20 percent of the patient’s household income

The bill also sets out required information for large health care facilities to include in financial assistance policies and steps large health care facilities must take before seeking payment for any emergency or medically necessary health care services. It also requires large health care facilities to publicize their financial assistance policies and prohibits them from selling medical debt.

VMS Position: Monitor  Status: Passed the House, advances to the Senate Health and Welfare Committee. (Back to the top) 

Mental Health

Peer-Support Certification Program Bill
S.195 would task the Department of Mental Health with the creation a mental health peer support specialist certification program. It would also include a funding request for peer-operated respite models and community centers in subsequent budget proposals and would require that: (1) additional peer-operated respite centers and community centers should be developed with State Medicaid matching funds to provide necessary program capacity; and (2) viable proposals with demonstrable community support are advanced and the Agency finds that these proposals will reduce other State program costs.

VMS Position: Support Status: Passed by the Senate, Advances to the House Human Services Committee
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Mental Health Legislation Aimed at Preventing Emergency Department Wait Times
S.197 started as a bill to create a Coordinated Mental Health Crisis Response Working Group for the purpose of developing and articulating a predictable and coordinated system of response to mental health crises. After much testimony from VMS, community providers and the Department of Mental Health, the bill mophed in to a more comprehensive bill aimed at creating supports for school based mental health services. The bill will be on the Senate Floor for discussion the final week of March and now includes directing the Department of Mental Health in consultation with the Agency of Education, Agency of Human Services and the Department of Public Safety, to complete an inventory of the mental health crisis response on or before January 15, 2023. The inventory must be included in a mobile crisis needs assessment report. The bill would also provide supports to schools and educators by:

  • Requiring AOE to provide statewide COVID-19 recovery supports to educators and school staff;
  • Initiating grants to expand mental health and well-being services to youth; and
  • Requiring a report from the Vermont Interagency Afterschool Youth Task Force.
VMS, AAPVT, VTAFP and VPA provided testimony on both of these bill – see full testimony here.

VMS Position: Support Status: Passed by the Senate, Advances to the House Human Services Committee
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Practice of Medicine

Senate Makes Changes to the Patient End of Life Choices Law
, amends Act 39the Patient End of Life Choices law, and aims to make the process for Vermont patients to access medication to hasten their death less cumbersome. The bill has passed the Senate and has had an initial hearing in the House Human Services Committee. The bill would allow requests for the medication to hasten end of life to be made via telemedicine means and eliminate in-person requirements for oral requests and also aims to eliminate a 48-hr waiting period. 

The bill also adds language that no physician, nurse, pharmacist, or anyone else would be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter. 

VMS Position: Monitor Status: Passed by the Senate, Advances to the House Human Services Committee
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Insurance Regulation

S. 239 Addresses Medicare Supplemental Health Insurance Policies
The Senate Committees on Health & Welfare and Finance took up the issue of enrollment in and coverage by Medicare supplemental insurance policies, especially exploring ways to extend or have additional enrollment periods in supplemental plans.  The bill as now being considered by the full Senate would direct the Department of Financial Regulation (DFR) to convene a group of interested stakeholders to consider issues relating to the availability of, enrollment in, and use of supplemental coverage by individuals enrolled in Medicare or a Medicare Advantage plan.  Among other topics, the group should examine the effects of annual or continuous open enrollment periods for Medicare supplemental coverage available in other states and options for enabling Vermont residents to enroll in Medicare supplemental coverage after their initial open enrollment period ends.  A report would be due from DFR by January 15, 2023.

VMS Position: Monitor
Status: Passes the House, Advances to the Senate Health and Welfare Committee.
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Bill to Add Hearing Aid Coverage to Large Group Plans Passes House
, a bill that requires health plan coverage for hearing aids, has passed the House and had an initial hearing in the Senate Health and Welfare Committee. The bill codifies Vermont Medicaid’s current provision of coverage for hearing aids, aims to require coverage for hearing aids for the plan year starting January 1, 2024 for large group health insurance plans and requires the Department of Financial Regulation to report back on the process of hearing aids being approved by federal regulators as an essential health benefit to be included in Vermont's benchmark plan for the individual and small group markets. The legislature's proposal mimics Medicaid’s current benefit to provide coverage for an annual exam by an audiologist and one hearing aid for each ear every 36-months. Beginning in plan year 2023, the State Employee plan will include coverage for an annual exam by an audiologist and one hearing aid per ear every 60-months. 

VMS Position: Support
Status: Passes the House, Advances to the Senate Health and Welfare Committee.

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Medicaid Bill Includes Prescription Drug Prior Authorization Report
 is a miscellaneous Department of Vermont Health Access bill, which includes a provision allowing the Department, in the event that Congress extends the federal premium tax credits, to require insurance carriers to make all accommodations for eligible Vermont households to receive the assistance within the 2023 plan years. The bill also requires the Commissioner of DVHA to report on the operation of Vermont’s pharmaceutical assistance programs for the most recent State fiscal year and the Department’s use of prior authorizations for prescription drugs. The bill passed the House and has been referred to the Senate Health and Welfare Committee. 

VMS Position: Support Status: Passed the House, advances to the Senate Health and Welfare Committee. (Back to the top) 

Pharmacy Benefit Manager Regulation Bill Passes House
, a bill that aims to better regulate pharmacy benefit managers (PBMs) that contract with Vermont insurers and other entities, has passed the House and advances to the Senate. The Vermont Independent Pharmacists urged support for this bill and said PBMs are paying less than cost. They also cited severe access issues for consumers in getting their medication. There are only two compounding pharmacies in Vermont and there are 17 independent pharmacies in the state, which is down from 42 ten years ago. There are roughly 140 total pharmacies in the State. This bill prohibits any PBMs from requiring a beneficiary purchasing a covered prescription drug to pay an amount greater than: 

(A) the cost-sharing amount under the terms of the health benefit plan; 
(B) the maximum allowable cost for the drug; or 
(C) the amount the covered person would pay for the drug, after application of any known discounts, if the covered person were paying the cash price.

The bill also requires a health insurer or PBM to allow a beneficiary to fill a prescription at the in-network pharmacy of the beneficiary’s choice and cannot impose differential cost-sharing requirements based on the choice of pharmacy or otherwise promote the use of one pharmacy over another. The Department of Financial Regulation must analyze and report back in January, 2023 on potential regulation of pharmacy benefit management and its effects on Vermonters, on pharmacies and pharmacists, and on health insurance in this State.

VMS Position: Support Status: Passed the House, advances to the Senate Health and Welfare Committee.
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Bill to Prohibit Discrimination Based on Genetic Information Passes Senate
S.247, a bill that prohibit discrimination based on one's genetic information, has passed the Senate and has been referred to the House Health Care Committee. This bill aims to prohibit any health insurance or life insurance plans from conditioning coverage on the basis of a beneficiary's genetic information that indicates a potential genetic condition. The bill also prohibits using genetic information or the results of genetic testing as a condition of insurance rates or the renewal of insurance and includes this practice as "unfair discrimination."

VMS Position: Support Status: Passed the Senate, Advances to the House Health Care Committee. (Back to the top)

A Bill Seeking to Delay Medicaid Prior Auth Advances 
(p.78), a bill aimed at providing opioid overdose response services, passed the House floor and advances to the Senate. This bill was a House Human Services Committee bill that would have originally delayed prior authorizations (PAs) for medication-assisted-treatment (MAT) for 60 days, in part because Committee members heard that Medicaid’s PA process for approving mono-buprenorphine products is onerous and presents an unnecessary barrier to treatment. The Department of Vermont Health Access (DVHA) testified that removing all PAs would result in an estimated fiscal impact for the Vermont Medicaid program between $16.97 million and $35 million. These estimates were based on providers moving to treatment formulas not on Medicaid’s preferred drug list and of higher doses than 16 mg for Spoke patients. Before the bill went to the House, the Committee and DVHA landed on a compromise that requires Medicaid to cover at least one medication in each therapeutic class for methadone, buprenorphine, and naltrexone as listed on Medicaid’s preferred drug list without requiring prior authorization, after they are approved by the Drug Utilization Review Board (DURB).  

The bill also requires DVHA to analyze and provide recommendations on MAT and prior authorizations regarding:  

  • Quantity limits and preferred medications for buprenorphine products; 
  • The feasibility and costs for adding mono-buprenorphine products as preferred medications and the current process for verifying adverse effects; 
  • How other states’ Medicaid programs address prior authorization for medication-assisted treatment, including the 60-day deferral of prior authorization implemented by Oregon’s Medicaid program;  
  • The appropriateness and feasibility of removing annual renewal of prior authorization;  
  • The appropriateness of creating parity between hub-and-spoke providers with regard to medication-assisted treatment quantity limits; and  
  • Creating an automatic emergency 72-hour pharmacy override default. 

The Department will need to report their findings to the DURB and to the legislature by January 15, 2023. The bill also: 

  • Expands the locations in which an organized community-based, peer-operated needle exchange programs can operate;
  • Establishes the Overdose Prevention Site Working Group who will examine the feasibility of implementing safe injection sites across the state;
  • Appropriates $450,000 for three pilot programs to provide mobile medication-assisted treatment services.  

VMS Position: Support Status: Passed the House, advances to the Senate Health and Welfare Committee.
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Professional Regulation/Scope of Practice

S.158, A Bill to Allow Optometrists to Perform Eye Surgery Will Not Move Forward this Year The Senate Government Operations Committee took testimony for several days on S.158, a bill that would have allowed optometrists to perform eye surgery using scalpels, injections and lasers with minimal training. While modifications to the bill were discussed, the Senate Government Operations Committee ultimately decided to send this issue back to the Office of Professional Regulation to go through a statutory assessment for scope of practice expansions. The Committee noted that they had "hit a brick wall" without a clear path forward and did not have enough support from the full Senate to move a proposal forward. Thank you to all of our members for the outreach and communications to legislators on this bill! It made a difference! The new OPR assessment requires the profession asking for a scope expansion to provide a number of categories of information prior to the OPR undertaking the study. This process will take place next summer/fall and will include stakeholder engagement and public hearings.  The final report will be due back to the legislature in November 2023 for review/possible action in the 2024 legislative session (starting in January). VMS and the Vermont Ophthalmological Society will be engaged in the process and keep you updated. 

Vermont Ophthalmolgoical Society and VMS members provided extensive testimony on this bill which can be viewed here:

Jessie McNally, M.D.

Brian Kim, M.D.

Amy Gregory, M.D.

VMS Position: Oppose
Status: Died in the Senate Government Operations Committee.

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Public Health

Constitutional Amendment to Support the Fundamental Right to Reproductive Liberty
Proposition 5, a constitutional amendment that creates a right to reproductive liberty, passed the House by a vote of 107- 41 in its final legislative stage earlier this session. It will now go before the voters of Vermont as a referendum on the ballot in November 2022. The VMS has taken an active role in advocating for this landmark proposal over the last four years as the process to add an article to Vermont’s constitution happens over two legislative bienniums. 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 had to pass both chambers several times with no further amendments to the language. With state abortion rights being obliterated across the nation, the VMS expects the campaign leading up to the referendum to be expensive and influnced by national political agendas. The VMS will continue to advocate for medical care to be a decision between a patient and their clinician.  
VMS Position: Support Status: Passed, On November, 2022 as referendum.
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Firearm Safety Legislation Takes Multiple Paths this Session S.30 passed the House and Senate in February and was sent to the Governor.  This bill would prohibit firearms in hospitals and close the “Charleston Loophole” by prohibiting a gun sale if a federal background check does not come back in a timely manner.  The Governor vetoed the bill, citing the broadness of the expansion of the time allowed for a federal background check to be completed from 3 days (current law) to unlimited in the bill.  The Governor stated he was open to revisiting the change if law if there was a discrete period of time for background checks to come back. Born from that veto, S.4 was introduced, which prohibits firearms in hospitals and closes the “Charleston Loophole,” but increases the length of time the federal background check system has to respond to 7 days instead of 3. S.4 was signed by Governor Scott on March 25th.

VMS Position: Support
Status: Signed by the Governor, Effective July 1, 2022.
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S. 90 Would Establish an Amyotrophic Lateral Sclerosis Registry
S. 90 has passed the Senate and advances to the House Health Care Committee. The bill directs the Commissioner of Health to establish a uniform statewide population-based amyotrophic lateral sclerosis (ALS) registry for the purpose of determining the incidence of ALS in Vermont. The bill would require all cases of ALS diagnosed or treated in the State to be reported to the Department of Health within 180 days of diagnosis. The Department of Health testified that a registry may not provide the type of data many proponents of the bill are seeking, especially given the small number of cases diagnosed each year in Vermont, and that the costs to establishing the registry (financial, logistical and regulatory) are significant. Should the bill pass the Senate and be taken up in the House, VMS will continue to monitor the progress and work to ensure minimum administrative burdens of a registry.

VMS Position: Monitor
Status: Passed the Senate, Advances to the House Health Care Committee.
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S.206, Planning and Support for Alzheimer’s Disease
S. 206 is an act related to planning and support for individuals and families impacted by Alzheimer’s Disease and related disorders. The bill passed the Senate on March 11th and has now been referred to the House Committee on Human Services. The bill as passed the Senate:

  • Charges the State’s Commission on Alzheimer’s Disease and Related Disorders to advise and provide comments to the Departments of Health and of Disabilities, Aging, and Independent Living (DAIL) regarding the development of the State Plan on Aging as it relates to Alzheimer’s disease and dementia;
  • Requires DAIL’s State Plan on Aging to address the needs of individuals with Alzheimer’s disease and related disorders and to include as an addendum the State Plan on Alzheimer’s Disease and Healthy Aging;
  • Directs the Departments of Health and DAIL to jointly develop and maintain easily accessible electronic, print, and in-person public education materials and programs on Alzheimer’s disease and related disorders that shall serve as a resource for patients, families, caregivers, and health care providers;
  • Directs the Chair of the Commission on Alzheimer’s Disease and Related Disorders to appoint at least three members of the Commission to serve as a work group for the purpose of making recommendations to achieve a dementia-capable workforce and promote and expand educational opportunities for health care and human services providers.

VMS testified in favor of ongoing efforts to improve dementia care in Vermont, including efforts to improve and increase clinical education but expressed concern with several sections of the bill as introduced, which would have mandated continuing medical education as well as mandated certain disclosures to family members of those diagnosed with Alzheimer’s Disease.  These sections were significantly modified and addressed VMS’ concerns. 

VMS Position: Monitor
Status: Passed the Senate, Advances to the House Human Services Committee.
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Cannabis Legislation Passes Without the Lifting of THC Potency Limits
H.548, this session’s Misc. Cannabis bill, has passed the House and has been assigned to the Senate Judiciary Committee. Originally this bill had included a provision that would have removed a 60 percent THC potency limit in solid concentrates that is currently in Vermont statute.  The Cannabis Control Board (CCB) asked for the removal, arguing that by removing the potency limits the State would successfully “bring the illicit market into the regulated cannabis market.” The VMS adopted a policy in the Fall of 2021 that cannabis use, especially with potency greater than 15% THC, is associated with increased urgent and emergency department psychiatric visits, mental health disorders, respiratory distress, cannabis hyperemesis syndrome (uncontrollable vomiting) and poisonings. The bill, which was originally heard in the House Judiciary Committee, was moved to the House Government Operations Committee after VMS argued that removing the potency limits was not a “technical change” as the CCB put forth. The Government Operations Committee, having been the Committee that led the passage of Act 54, defended the potency limits they originally put into place and passed H.548 with the limits still in place. Committee members said, “we need to slow this process down.” The VMS Policy team will continue to defend the THC potency limits as the bill advances in the Senate. Please read the VMS testimony here.  

VMS Position: Oppose Increasing Potency Caps
Status: Passed the House, in Senate Judiciary Committee

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H. 628 Eases Ability to Modify Gender Identity on Birth Certificates
H. 628 directs the Department of Health to adopt rules to implement, administer and/or enforce a simple process by which an individual may amend the marker on a birth certificate to reflect the individual’s gender identity, including a third nonbinary marker. Current Vermont law regarding changing gender on a birth certificate requires the individual to submit an affidavit of a physician that an individual has undergone gender transition. The bill has passed the House and Senate. 

VMS Position: Support
Status: Passed the House and Senate, Advances to the Governor's Desk.
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Bill to Close Child Marriage Loopholes Fails to Advance
a bill seeking to end child marriage, was taken up for debate early in the session in the House Judiciary Committee, yet failed to advance due to concerns regarding underlying emancipation law. The VMS supported this proposal as evidence shows that child marriage before 18, the age of majority, impacts Vermont adolescents’ health, education and economic opportunities, and increases risks of experiencing violence and povertyThe VMS provided this testimony. The Committee has expressed a willingness to take up this proposal in legislative session 2023 when other laws that impact child autonomy and emancipation can be fully vetted. 

VMS Position: Support Status: Died in House Judiciary.
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Opioid Settlement Advisory Committee Legislation
, a bill that creates an Opioid Settlement Advisory Committee, passed the House and has advanced to the Senate Health and Welfare Committee. The Advisory Committee will be housed in the Vermont Department of Health and will help guide the distribution of the estimated $38 million that will be coming to Vermont from the Purdue-Sackler settlement reported in VPR.  As recommended by VMS, the Advisory Committee includes a primary care prescriber with experience providing MAT within the Blueprint for Health hub and spoke model.  The Advisory Committee will consult with individuals with direct lived experience of opioid use disorder, frontline support professionals, the Substance Misuse Advisory Council, and other stakeholders to identify spending priorities related to opioid use disorder prevention, intervention, treatment, recovery services and harm reduction strategies for the purpose of providing recommendations to the Governor, the Department of Health, and the General Assembly on prioritizing spending from the Opioid Abatement Special Fund.  

VMS Position: Support Status: Passed the House, advances to the Senate Health and Welfare Committee.
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