Vermont Legislative Update Quick Links
Bill imposing strict liability for chemical management receives first Senate hearing
Minimum wage bill considered in Senate committee
House reviews pharmacy benefit manager role
Senate supportive of home health moratorium extension
Green Mountain Care Board Chair provides update on Springfield Hospital
Panel receives report on prescription drug importation program
OneCare Vermont provides overview to Senate panel
Hospital Association touts contributions to communities
Act 250 modernization in spotlight
Vermont Senate launches legislation aimed at industrial use of PFAS chemicals
House Energy & Technology Committee gets utility education
Bill imposing strict liability for chemical management receives first Senate hearing
The Senate Judiciary Committee held a hearing this week on S.37, a bill that would impose strict liability on a person who releases a toxic substance, even if the release is in compliance with all state and federal permitting requirements. The bill also includes a provision requiring companies to pay medical monitoring costs associated with health risks that can be connected to any permitted or unpermitted release of certain chemicals.
This bill is nearly identical to the Senate version of a bill, S.197, that passed the Legislature in 2018, but which Gov. Scott vetoed. In his veto message, Gov. Scott reiterated his support for individuals and communities harmed by chemicals like PFOA, but stated that the level of liability and uncertainty created by the legislation for employers could prove catastrophic for Vermont’s economy. Moreover, he noted that these standards do not exist anywhere else in the country, making Vermont a substantially less attractive place to create jobs and run a business.
Two environmental attorneys offered strident testimony in favor of the bill, and the committee showed little interest in hearing from affected industries. Hearings will continue next week with expected testimony from the Department of Financial Regulation concerning the bill’s impact on companies’ ability to obtain insurance. The bill is sponsored by Judiciary Committee Chairman Sen. Dick Sears, D-Bennington, and is expected to quickly pass out of committee and then out of the Senate.
Minimum wage bill considered in Senate committee
The Senate Economic Development, Housing and General Affairs committee heard testimony this week on S.23, a bill to increase the minimum wage. Chair Mike Sirotkin, D-Chittenden, the lead sponsor of the bill, told the committee at the beginning of the hearing that “given the support that this issue has, I’m hoping that we don’t have to go to a granular level with this bill,” indicating that it’s likely to move quickly from the committee.
David Cooper from the Economic Policy Institute, a minimum wage expert who testified last year, once again spoke strongly in favor of an increase to a $15 minimum wage. Cooper told the committee about recent research showing that the increase will have little to no negative effect on the business community.
Judy Peterson, University of Vermont Health Network Home Health and Hospice President, told the committee she would like to pay a higher wage to their lower paid entry level workers and would need a Medicaid increase to do that. Sirotkin hoped that the VNA would be able increase salaries on account of their joining the University of Vermont Health Network.
House reviews pharmacy benefit manager role
The House Health Care Committee heard testimony this week from Brian Murphy, Director of Pharmacy and Vendor Management for Blue Cross/Blue Shield of Vermont. Murphy reviewed the role of Pharmacy Benefit Managers in Vermont’s pharmaceutical delivery program. He said that PBMs allow insurers to negotiate better deals with drug manufacturers to help contain drug costs for their consumers. Chair Bill Lippert, D-Hinesburg, questioned Murphy on PBM oversight and indicated that it was an issue that he would like to pursue this session.
Murphy will return to the committee to discuss drug pricing, a priority issue for Lippert.
Senate supportive of home health moratorium extension
On Friday, the Senate Health and Welfare committee reviewed S.14, a bill that would extend the current moratorium on home health agency certificates of need. The bill would extend the moratorium, which expires in 2019, to 2022. The moratorium was originally created to allow the Green Mountain Care Board to determine the need for additional home health agencies in Vermont.
Jill Olson, Executive Director, VNAs of Vermont, an organization representing Vermont’s non- profit home health and hospice agencies, told the committee that that the current system is fully adequate to cover Vermont’s home health needs. She stressed that VNAs do have a workforce shortage, however, and lifting the moratorium could further squeeze the available workforce.
The Green Mountain Care Board does not have CON guidelines in place to review applications, and will not until it finishes its Health Resource Allocation Plan in 2020.
Green Mountain Care Board Chair provides update on Springfield Hospital
Green Mountain Care Board Chairman Kevin Mullin appeared before the Senate Health and Welfare Committee on Thursday and spent much of his time discussing the fiscal crisis facing the Springfield Hospital.
Mullin said it is a crisis situation that has rocked the community and the entire state. He said there is intense pressure on rural hospitals in Vermont and across the country. Mullin said when he approached the hospital’s former leadership they denied any issues. Additionally, the hospital’s 2017 audit letter showed no issues. The hospital and board are now waiting for a 2018 audit letter. A forensic audit is also being conducted with results expected by the end of the month.
Mullin said the Board is now looking at all Vermont hospital financials with a new lens and will be asking for monthly reports. He said a number of hospitals have slim margins. Mullin said the Board will have the hospital board chair, along with hospital leadership, attest under oath that the information provided is accurate.
Mullin praised the hospital’s membership in OneCare Vermont, the state’s health care reform effort. Springfield has entered into an agreement with OneCare to be payed a fixed price for multiple payer programs.
Panel receives report on prescription drug importation program
The Senate Health and Welfare Committee held a hearing on Tuesday to review a report on the feasibility to import prescription drugs from Canada. Agency of Human Services Director of Health Care Reform Ena Backus said that after working with the National Academy for State Health Policy and other stakeholders, it was determined that commercial payers in Vermont could see savings of $1-5 million dollars by purchasing prescription drugs from Canada.
Backus said much work remains, including:
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Creating an estimate of upfront and ongoing state expense to operate the program;
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Estimating the total potential savings of a program relative to mark-ups, operating costs, and potential revenue;
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Establishing a clear mechanism to assure savings accrue to consumers;
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Assessing the interest of suppliers and wholesalers to participate in the program;
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Establishing legislative action to assign the appropriate state agencies to operate the program and with corresponding state appropriation; and
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Obtaining approval from the Secretary of the U.S. Department of Health and Human Services.
OneCare Vermont provides overview to Senate panel
The Senate Health and Welfare Committee received an overview of OneCare Vermont from OCV Chief Operating Officer Vicki Loner on Thursday. The all-payer accountable care organization serves as mechanism for a group of providers to come together to take care of a patient population for a fixed price. The goals of the provider-led APM are to improve access to primary care, reduce deaths from suicide and drug overdose, and reduce the prevalence and morbidity of chronic disease.
Addressing questions regarding the OneCare Board, Loner provided the committee with key facts about the board and the network of providers. She said the board covers the entire continuum of health providers, including federally qualified health centers, independent doctors, hospitals, designated mental health agencies, and consumers. She said important issues require a supermajority vote. With over 430 providers in its network, OneCare expects to have 172,000 Vermonters enrolled in 2019.
Loner said OneCare has invested more than $37 million in Vermonter’s delivery system. Investments have been made in primary care practices, complex care coordination, the Developmental and Legal Collaboration for Everyone Pilots (DULCE) – a partnership with the Parent Child Center, and the designated mental health agencies.
Hospital Association touts contributions to communities
The Senate Health and Welfare Committee heard from the Vermont Association of Hospitals and Health Systems Vice President of Government Relations Devon Green on Tuesday on the many contributions hospitals provide to the communities they serve. Green said Vermont has embarked on a bold reform initiative, the all-payer model, and the majority of hospitals are participating. The APM is an agreement between the state of Vermont and the Center for Medicare and Medicaid Services that allows Vermont to explore new ways of financing and delivering health care. The combined contribution from hospitals to community providers totals almost $30 million. Hospitals have built new partnerships and shifted funds to primary care providers, home health agencies and designated mental health agencies.
Green said hospitals are making large investments in mental health. The University of Vermont Health Network will provide $21 million towards psychiatric inpatient beds. In addition to the $1.6 million in funding hospitals provide to the designated mental health agencies through OneCare Vermont, the state's accountable care organization, hospitals provide an additional $6.8 million to the designated mental health agencies annually from the disproportionate share hospital payments. DSH payments are payments made to qualified hospitals that serve a large number of Medicaid and uninsured individuals.
Sen. Richard Westman, R-Lamoille, asked Green about the Scott Administration proposal to eliminate state contracts with sheriff departments for supervision of mentally ill patients in hospital emergency departments. Green said, "Sheriffs in the emergency department is a challenging issue. A lot of times emergency departments feel more secure with just the presence of a sheriff. But the Department of Mental Health is concerned about liability for hospitals and decided to cut funding.” She said hospitals would like the funds to be directed to hiring mental health technicians who can be useful in emergency departments to deescalate an individual who is in crisis.
Green discussed hospital workforce needs. With approximately 17,000 employees, hospitals are often the largest employer in their community, but they face major workforce challenges. Green estimates over 3,900 job vacancies in nursing careers over the next two years. Despite paying competitive wages, hospitals struggle with hiring. "Continued cuts from the Administration and the legislature in addition to anemic growth rates from the Green Mountain Care Board will worsen the problem," said Green.
Act 250 modernization in spotlight
Gov. Phil Scott stated in his budget address this week that Act 250 reform is “essential to expanding our economy and restoring the health of our smaller communities.” His vision for the next 50 years of regulation under Vermont’s signature land use law begins with “flexibility” for forestry businesses, working lands enterprises and trail network development within the outdoor economy. He proposed eliminating criteria that are addressed in other State and Federal permits, and he asked legislators to simplify the construction approval process for rural industrial parks, as well as downtowns and village centers.
While Scott advocated a vision of Act 250 that would “breathe new life” into our communities without reducing planning and environmental protection, Rep. Amy Sheldon, D-Addison, outlined a somewhat different vision this week. Sheldon’s focus is environmental protection, and she articulated a need to confront the cumulative impacts of small-scale development, as well as addressing climate change and forest fragmentation. She also supports reconsideration of where and how appeals will be taken from decisions of Act 250 District Commissions, whether and to what extent approvals under other regulatory regimes would give developers a pass under Act 250, and how to incentivize greater regional and municipal planning by exempting projects located in designated centers.
Having served as chair of the Act 250 Commission, and now serving as chair of the House Committee on Natural Resources, Fish and Wildlife, Sheldon will play a critical role in shaping any Act 250 reform legislation.
The committee will begin considering the issue next week.
Vermont Senate launches legislation aimed at industrial use of PFAS chemicals
The Senate Committee on Natural Resources heard testimony this week from the Conservation Law Foundation, Vermont Public Interest Research Group, and Vermont Natural Resources Council, among others, in favor of S.49, which would introduce a wide array of requirements related to per- and polyflouroaklkyl substances, or PFAS, in Vermont. New regulations and monitoring would be required under the Agency of Natural Resources’ drinking water rule, the Vermont Water Quality Standards, and treatment of landfill leachate for PFAS would be required.
Speaking on behalf of CLF, Vermont Director Jen Duggan told the committee that PFAS are a public health perfect storm: bio-accumulative, pervasive in the environment, highly mobile in water and toxic in small amounts. She and other advocates urged the committee to take action on the whole class of PFAS compounds, not just the five compounds currently regulated in Vermont. Because EPA has dropped the ball, states need to step up.
The committee will take additional testimony in the coming weeks, but the bill is expected to move relatively quickly to the floor and pass with substantial support before being sent on to the House.
House Energy & Technology Committee gets utility education
The House Energy and Technology Committee spent several days this week hearing from representatives of the state’s electric utilities. With only three returning members and a new chair, the committee clearly has much to learn. The hearings also gave utilities the opportunity to educate committee members about the utility business.
The utility presentations can be found below:
