2015 Health Care Agenda

This year’s health care agenda at the statehouse was an especially busy one for the Vermont Medical Society – albeit with a different set of issues from the ones it was expecting.  
 
On Dec. 17, 2014, Governor Peter Shumlin surprised many observers by ending his administration’s four-year effort to enact and implement a single-payer health care system in Vermont.  Key to his decision was a 2014 study by the Governor’s staff and consultants predicting that the single-payer plan would require new payroll taxes of 11.5 percent for employers and increased income taxes of up to 9.5 percent for individuals.
 
In withdrawing his single-payer plan the Governor stated: ”I have learned that the limitations of state-based financing, the limitations of federal law, the limitations of our tax capacity, and the sensitivity of our economy make that unwise and untenable at this time.”
 
In lieu of the single-payer plan, on January 15, as a part of his annual budget address the Governor advanced the following five-part health care agenda for the upcoming legislative session: 

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S.139 - Health Care Reform

S.139 serves as the vehicle for the Governor’s above initiatives, as well as a number of other provisions in the bill’s 62 sections.   
 
The most significant provision in the bill supports Vermont moving forward on an “all-payer” waiver.  The Green Mountain Care Board is currently working with the administration to submit a Medicare waiver application to CMS that will change how Vermont providers are reimbursed by Medicare beginning in 2017.  A work group has been formed that includes representation from VMS and it is meeting weekly to provide input on the waiver design, which may be submitted as early as this summer. Much of the discussion has focused on Maryland’s Medicare waiver.   

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S. 108 – Physician-Assisted Suicide or Aid in Dying

A bill repealing a 2016 sunset on the Vermont physician-assisted suicide or aid in dying law that was enacted in 2013 has passed the Senate and House and is expected to be signed into law by the Governor.  The effect of this bill is to maintain the current requirements in the physician assisted suicide law.  Not all patients are eligible to participate in this process and there are 15 legal requirements that physicians must follow in order to write a lethal prescription for a patient without incurring legal liability.  Physicians are not required to participate in the aid in dying process.    


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S. 8 - Interstate Licensing Compact Held Over to 2016

The Interstate Compact bill did not pass this year.  VMS plans to work with the Vermont Board of Medical Practice (VBMP) over the summer and fall to resolve VMS members’ questions and to formulate a position on the bill for VMS.  VMS expects that the bill may be taken up next year. 
 

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Mental Health – Patients Waiting in Emergency Departments 

VMS remains very concerned about mental health patients waiting in emergency departments and has met with the department of Mental Health about this important issue.  The Department believes that as the new mental health system comes on line, the situation will improve.  An article on this issue will be included in the next VMS Green Mountain Physician.  

H. 492 – Capital Construction Bill – Secure Residential Facility 

The Capital bill included $50,000 for a plan to site and design a secure residential facility that could be used as a step down facility for patients in a Level 1 Inpatient hospital who no longer need inpatient medical care.  The plan must analyze the operating costs, staffing, and options for the management and ownership of the facility.  This plan must be presented to the legislature before February 1,2016, and will be used by the legislature to determine whether to appropriate funds for this facility.

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H.141 Organ Donor Taskforce extended 

H. 141 will extend the work of the Organ and Tissue Donation Working Group through June of 2020.  The charge of the group is to develop recommendations to the Vermont General Assembly and the Governor.

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H. 489 - License Fees for Physicians, Physician Assistants and Anesthesiologist Assistants to Increase in 2016 

License renewal fees for physicians will increase from $500 to $525 in 2016.  The fee will continue to include $25 for the Vermont Practitioner Health Program that is operated by VMS. Fees for initial license applications for physicians will increase from $625 to $650, and fees for limited temporary licenses for residents will increase from $115 to $120.  Fees for physician assistants will increase from $170 to $225.  Physician assistants have changed from a certification model to a licensing model and will no longer be required to obtain additional certificates for additional sites where they work. 

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S. 62 Surrogate Consent to DNR Orders and COLST Orders/DNR Identification Rules held over until next year

S. 62, which establishes a process for identification of surrogates and authorizes them to consent to Do Not Resuscitate (DNR) orders and Clinician Orders for Life Sustaining Treatment (COLST) passed the Senate, but did not pass the House this year.  The House Human Services Committee has agreed that it will be taken up next year.  The bill requires surrogates to be family members or individuals with a close relationship to the patient.  Vermont is one of a handful of states that does not have a law addressing health care decision making for patients who do not have either agents appointed in an advance directive or guardians appointed by the probate court. 

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Department of Health Releases Final Proposed Rules – Vermont Prescription Monitoring and Prescribing Opioids 

The Department of Health incorporated many of VMS’ comments in the final version of the proposed Prescription Monitoring and Opioid Prescribing Rules.  Both rules clearly exclude prescriptions for cancer and end-of-life pain from the requirements of the VPMS rule and the opioid prescribing rule.  This was one of the issues of most concern to VMS members.   The rules will be reviewed by the Legislative Committee on Administrative Rules before they become effective.  

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Vermont Board of Medical Practice Investigative Procedures 

In April, the VMS Council met with representatives of the Vermont Board of Medical Practice (Board) to discuss changes to the Board’s investigative procedures.   The Board has drafted proposed rules clarifying its investigative procedures.  The draft rules address a number of VMS’ due process concerns, but there are remaining points of disagreement.   VMS expects that the Board will begin the formal rulemaking process in the late summer or fall and VMS members will have an opportunity to comment in that process and testify at a public hearing. 

Philosophical Exemptions to Immunizations Eliminated

Thanks to everyone’s extraordinary efforts legislation was passed that, if signed by the Governor, will eliminate the philosophical exemption to immunizations for school entry beginning on July 1, 2016.
 
Governor Shumlin signed the bill May 28^th. 
 
The American Academy of Pediatrics, Vermont Academy of Family Physicians and Vermont Medical Society worked seamlessly together on this important initiative along with strong partnership from the University of Vermont Medical Center, Vermont Association of Hospitals and Health Systems, March of Dimes, and the Vermont-NEA, among many other groups and individuals.  A special thanks to Mia Hockett, M.D., her daughter Merin and their strong following of supporters.
 

S.141 – An act relating to possession of firearms signed in to law

S.141 (Act 14) was signed in to law by Governor Peter Shumlin on Friday, May 1, 2015.
 
The Act aims to help prevent gun violence by:

• Prohibiting violent felons from possessing firearms;
• Requiring the timely submission of court records that disqualify individuals from possessing firearms by the state to the National Instant Background Check System database; and
• Creating a study group to investigate the viability of a suicide prevention program modeled on the New Hampshire Gun Shop Project.

 
The act can be read in its entirety at: http://bit.ly/1Q9Shqk.