by Devon Green, Sr. Vice President of Policy & Strategy, VAHHS
It’s May, so now we’re all asking the same question—when exactly are we getting out of here? End of the month? Mid-month? I have yet to feel the same urgency that usually comes with May. At the same time, when the session feels interminable is often right when everything rapidly wraps up. With the budget voted out of the Senate and on its way to a conference committee, we’ll probably get a clearer picture on the timeline this week.
Now, on to everything that happened in health care:
Reference-Based Pricing: The House Health Care Committee heard testimony on S.190 and the Green Mountain Care Board’s proposal for individual and small business health insurance plans (QHPs) to reimburse hospitals at a maximum of 250% of Medicare. Although the original estimated impact was over $50M coming out of the Senate, the Green Mountain Care Board updated its numbers to $85M. The Department of Financial Regulation estimated about $112M impact. Blue Cross Blue Shield of Vermont estimated $125M in impact and VAHHS estimated $130M-150M in hospital impact. VAHHS pointed towards the Hospital Affordability Action Plan and cautioned the committee against enacting a policy when the impact is unclear and goes beyond $50M.
Critical Access Hospitals and Medicare Cost Sharing: VAHHS testified in support of Section 11 of S.190 in front of the House Health Care Committee and the Rural Caucus. This section sets up a process to work on a decades-old federal Medicare cost-sharing issue with Critical Access Hospitals through a work group rather than the hospital budget process.
Outsourced Services: Aida Avdic, MD, Chief Medical Officer, Brattleboro Memorial Hospital testified in front of the House Health Care Committee on the history and importance of outsourced services to maintain access to care. VAHHS also testified in support of reporting around outsourced services rather than regulation in S.190. The Green Mountain Care Board also supported reporting at this time.
Primary care: Prior to its public hearing on primary care in Vermont, the House Health Care Committee discussed its options going forward for S.197, including the concept of primary care as a public utility with a common fund. Several members expressed interest in exploring the concept. At the public hearing on Thursday evening, many individuals advocated for an actionable plan for universal primary care.
PAs performing EEs: The Senate Health and Welfare Committee heard testimony from VAHHS in support of H.573, which allows a Physician’s Assistant to perform emergency exams on individuals in need of involuntary mental health treatment. VAHHS emphasized that the legislature passed S.163, which gives PAs admitting and discharging privileges and how their training is similarly rigorous to APRNs. VAHHS also pointed out that excluding PAs from providing this services creates inequity in that PAs provide physical health care services in the Emergency Department while those in mental health crisis and in need of involuntary treatment must wait for a physician.
Data Privacy: Jessa Barnard testified on behalf of the Coalition of Vermont Health Care Organizations for an exemption for HIPAA-covered entities from the data privacy bill, S.71. When the House Committee on Commerce and Economic Development expressed concern about exempting large pharmacy chains, Barnard pointed to language from previous data privacy legislation that had a framework for dealing with larger “hybrid” entities.
DVHA Miscellaneous Bill: The Senate Health and Welfare Committee advanced H.611, which removes a statutory provision around prescription drug manufacturer rebates due to a court decision and adds protections from burdensome reporting requirements for 340B in-house pharmacies. The committee also amended the bill to include commercial insurance coverage of HIV pre-exposure prophylaxis (PrEP) without cost sharing and for Medicaid to cover PrEP ad pos-exposure prophylaxis (PEP) without cost sharing or prior authorization.
AI in Mental Health Care: The Senate Health and Welfare Committee advanced H.816, which prohibits using artificial intelligence for mental health services without intervention from a licensed professional.
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