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: 

• COVID-19 Emergency  
• Health Financing/Health Reform 
• Mental Health 
• Practice of Medicine 
• Insurance Regulation 
• Professional Regulation / Scope of Practice 
• Public Health 

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 & Communications Consultant, jsudhoffguerin@vtmd.org 

• 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.

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 16^th 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. 

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.

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. 

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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Green Mountain Care Board Bill Fails to Advance 
H.498 a bill aimed at updating the Green Mountain Care Board nomination and reappointment process, failed to advance out of the House Health Care Committee. Committee members expressed remorse that they had run out of time to complete work on the bill before the crossover deadline and said they will come back to it in future proposals. The bill aimed to update the process on reporting on certain prescription drug costs; clarify how the Chair of the GMCB and other Board members seek reappointment to the Board; revise the Board’s authority to bill regulated entities; allow the GMCB to collect individually identifiable information in the State’s all-payer claims database; and to impose conditions on the hospital budgets that the Board establishes.  

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)

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.

• 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
H.287, 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.
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