Bill to Create Forensic Mental Health System Passes the Senate
S.183, which aims to create a forensic mental health system in Vermont, passed the Senate on March 10, 2020 and was referred to the House Judiciary Committee on March 12, before the Statehouse shutdown. Although this bill was not deemed critical during the COVID pandemic, it is a priority for VMS and the Vermont Psychiatric Association (VPA) and proposes tangible improvements to Vermont's systems of care for individuals with mental illness and justice involvement. The Senate-passed bill includes these provisions:
- Requires evaluations regarding competency to stand trial and sanity at the time of the alleged offense to be presented in separate reports. The sanity evaluation will only be initiated if the person is deemed competent to stand trial.
- When a person is found incompetent to stand trial, legal counsel will be assigned from Vermont Legal Aid.
- The Department of Mental Health (DMH) will be entitled to appear and call witnesses when a person is found incompetent to stand trial.
- 10 days before being released from the custody of DMH, the Commissioner will inform the State's Attorney of the County where the prosecution took place. The State's Attorney will provide notice to any victim of the offense.
- Directs DMH and the Department of Corrections to prepare an assessment of the quality of mental health services delivered in Vermont's correctional facilities.
- Creates a comprehensive work group to study what other states have done to create forensic mental health systems
Further action on this bill in 2020 is uncertain, but the VMS will continue to advocate for it to pass.
VMS Position: Support
Status: Passed the Senate, In House Judiciary Committee
(Back to the top)
|
|
Stem Cell Clinic Bill Unlikely to Advance
S.252, a bill requiring patients to receive a notice informing them that stem cell products are not approved by the FDA before they are administered, passed the Senate Health and Welfare Committee in mid-March, 2020, but has not yet been considered by the full Senate. This bill, which is a VMS-supported bill , was informed by the VMS Resolution regarding Stem Cell Clinics adopted in 2019. The legislation intends to bring awareness to the potential health risks to Vermont patients from stem cell clinics that promote unregulated and unproven stem cell products, claiming they help improve a number of conditions It is unclear if the Senate floor will consider the proposal in the August/September legislative session.
VMS Position: Support
Status: On Notice Calendar in Senate
(Back to the top)
|
|
|
Board of Medical Practice Employer Disciplinary Reporting Bill Passes
H.438, updates the procedures of the Board of Medical Practice and the licensure of physicians and podiatrists. The bill includes changes to the requirements for reporting disciplinary actions taken by employers against physicians. VMS worked with the Board of Medical Practice to resolve initial concerns with the proposal, and was comfortable with the final language, as adopted. Section 1317 of the Act spells out which disciplinary actions by employers must be reported to the Board. It includes reporting acts or omissions of a licensee that occur in the course of practice and result in one or more of the following:
- Resignation, leave of absence, termination, or nonrenewal of an employment relationship or contract
- Revocation, suspension, restriction, relinquishment, or nonrenewal of a right or privilege.
- Written discipline that constitutes a censure, reprimand, or admonition, if it is the second or subsequent censure, reprimand, or admonition within a 12-month period for the same or related acts or omissions that previously resulted in written censure, reprimand, or admonition.
- Fine or any other form of monetary penalty imposed as a form of discipline.
- Required education, remedial counseling, or monitoring that is imposed as a result of a completed, contested disciplinary process.
Employers would have to report such actions within 30 days following the date on which the disciplinary action was taken.
VMS Position: Monitor
Status: Signed into Law July, 1, 2020. Effective Immediately.
(Back to the top)
|
|
Bill to Prohibit Genetic Discrimination Advances to the House
S.197, a bill that would prohibit discrimination based on an individual’s genetic information in relation to employment, labor relations, insurance coverage, and the provision of social and medical services passed the Senate on May 27, 2020 and was referred to the House Health Care Committee. This bill prevents insurance coverage being conditioned on genetic testing results from the member or employee or results from a family member's genetic test.
VMS Position: Support
Status: Passed the Senate, In House Health Care Committee
(Back to the top)
|
|
Zero Cost-Sharing for Primary Care Bill Stalls
S.245, a bill to provide zero cost-sharing for primary care, did not advance this session. Louis DiNicola, M.D., Pediatrician, AAPVT Chapter, Vermont Medical Society and Paul Reiss, Vermont Academy of Family Physicians, testified in Senate Finance in support in February 2020.
VMS Position: Support
Status: Died, In Senate Finance Committee
(Back to the top)
|
|
Bill to Limit Insulin Medication Cost-Sharing Advances to the Senate
S.296, a bill to limit cost-sharing for insulin, passed the Senate March 11, 2020 and was referred to the House Health Care Committee. The Senate-passed bill would limit a beneficiary’s total out-of-pocket responsibility for prescription insulin medications to $100.00 per 30-day supply, regardless of the amount, type, or number of insulin medications prescribed.
VMS Position: Support
Status: Passed the Senate, In House Health Care Committee
(Back to the top)
|
|
Senate Finance Committee Holds Fair Contracting Bill
S.309, a bill aimed at requiring fair contracting between physicians and insurers, was brought up for debate several times in the Senate Finance Committee, but did not pass out of the Committee before the Crossover deadline in mid-March. This VMS priority bill would have repealed a current BCBSVT payment policy that holds referring in-network providers financially liable for up to $1,000 for referring to out-of-network care. The VMS, along with health care organizations including the Vermont Association of Hospitals and Health Systems (VAHHS) and HealthFirst, testified in the Committee that this policy essentially serves as a gag rule and threatens the ability for physicians to refer Vermonters to the best care On March 11, 2020, an agreement was reached between most of the interested parties, including VMS, to study the scope of unanticipated out-of-network costs for health care services borne by Vermonters. The agreement also stated that DFR would create a workgroup to discuss mechanisms to reduce patient and employer financial liability for unanticipated out-of-network medical bills and to study surprise billing fixes at both the State and federal level. The parties still disagreed on how to resolve the BCBSVT payment policy while the work group was studying the issue. In the meantime, the bill has failed to advance, because it did not make the Crossover deadline, but the VMS will continue to advocate for more fair contracting terms for referring to and paying for out-of-network care.
VMS Position: Support
Status: Died, Did Not Make Crossover, In Senate Finance Committee
(Back to the top)
|
|
Professional Regulation/Scope of Practice
|
|
|
(Back to the top)
Modernizing Physician Assistant Licensure and Regulation Bill Enacted
Act 123/S.128, legislation streamlining the licensure and regulation of PAs in Vermont, was passed by the legislature and signed by Governor Scott on July 1, 2020. VMS actively supports the changes included in S.128 and began working with the PA Association of Vermont (PAAV) in 2017 to discuss regulatory changes aimed at modernizing PA regulation. The changes include:
- Simplifying documentation and administrative requirements in the PA-physician relationship. The proposal removes the need for delegation agreements with primary and secondary supervising physicians. Instead, PAs are now required to practice according to a practice agreement signed by one practice-identified physician.
- Updating the terminology away from physician “supervision” according to a “delegation agreement.” Instead PA practice will be defined as the practice of medicine by a PA in a practice agreement with a physician.
- Practice agreements will be written by the practice and describe the process between the PA and physician/physician group for communication, availability, decision-making and periodic joint evaluation of the PA’s services and must include an agreement that the PA’s scope of practice shall be limited to medical care that is within the education, training and experience of the PA.
- Removing physician liability for PA practice solely based on being the participating physician who completes a practice agreement. Instead physician assistants are legally liable for their medical decision-making.
- Modernizes language previously found in the PA section of statute regarding delegating activities to other medical technicians or assistants.
VMS Position: Support
Status: Signed into Law July 1, 2020, Effective Immediately, Excepting Sec. 1 - Effective January 1, 2021
|
|
|
OPR Bill Aimed at Authorizing Pharmacy Prescribing Passes Senate
S.220, the 2020 Office of Professional Regulation (OPR) bill that includes language to expand the scope of practice of pharmacists to give them limited prescribing authority passed the Senate June 17, 2020 and was referred to the House Government Operations Committee. The bill would require the Vermont Department of Health (VDH) to approve state protocols for pharmacy prescribing after public comment for:
- opioid antagonists;
- epinephrine auto-injectors;
- tobacco cessation products;
- tuberculin purified protein derivative products;
- self-administered hormonal contraceptives;
- dietary fluoride supplements;
- influenza vaccines;
- emergency prescribing of albuterol or glucagon while contacting EMS;
- tests for SARS-CoV for asymptomatic individuals; and
- an appropriate vaccine to mitigate the effects on public health after finding that existing channels for vaccine administration are insufficient to meet the public health need.
VMS, as well as our primary care partners at the American Academy of Pediatrics Vermont Chapter and Vermont Academy of Family Physicians took part in stakeholder meetings with OPR and the Board of Pharmacy over the fall and have been engaged in providing feedback on the legislative proposal throughout the session and are comfortable with this final proposal. Click here to read the VMS memo of support. Before it passed the Senate, the bill was amended to include tests for SARS-CoV in the pharmacy scope expansion and language intended to allow pharmacies to provide SARS-CoV vaccinations if necessary. VDH has released a Health Advisory on May 21, 2020, authorizing Vermont pharmacists to order and administer COVID-19 tests approved by FDA for pharmacy-based sample collection or administration. Find the Board of Pharmacy COVID-19 Emergency Guidance here. The bill would sunset the SARS-CoV testing authority on July 1, 2021. A separate section of the bill (Section 3108), which VMS also supports, would require the Office of Professional Regulation to complete a study of any scope of practice expansion proposals. The bill will have to be taken up by the House Government Operations Committee in the August/September session if it is to pass this year.
VMS Position: Support
Status: Passed the Senate, In House Government Operations Committee
(Back to the top)
|
|
Paid Family Leave
H.107, a 2019 bill that would have created a state paid family leave program, was vetoed by the Governor January 31, 2020. The bill would have covered up to 12 weeks of paid leave for maternity/paternity bonding and up to 8 weeks to cover care for ill family members. This program would have covered the entire state and differed significantly from the Governor's proposed voluntary paid leave program, which only covered state employees and 6 weeks of leave. In the Governor's veto message he said he could not support the legislation because of the complicated bureaucracy proposed to administer it and the $29 million payroll tax placed on employers and employees. In 2019, the VMS Council voted in support of a resolution that recommends 12 weeks of paid leave for all parents as the evidence shows mental, physical and public health benefits for families.
VMS Position: Support
Status: Vetoed by the Governor
(Back to the top)
|
|
Bill to Decriminalize Bupernorphine Possession Will Not Advance
H.162, a bill aimed at removing buprenorphine from the drug class that carries a misdemeanor crime of possession of a narcotic, was "ordered to lie" before debate in the full House June 3, 2020. Before this order, which effectively stalls the bill, it was amended and passed by the House Human Services Committee March 11, 2020. The version that passed the Committee would have decriminalized possession of 224 mg or less of bupernorphine, with the goal saving as many opioid users from overdosing on heroin and/or fentanyl as possible. The VMS has a neutral position on the bill, due in part to the concern that by effectively legalizing possession of buprenorphine with or without a prescription, diversion rates could spike, which could lead to less clinician-supervised treatment and unintended health care consequences. Understanding the arguments that patients use street buprenorphine to self-medicate and initiate treatment rather than as a drug of abuse, other methods of increasing access to treatment are preferable (such as prescription treatment on demand). This bill could come up during the Fall 2020 session, VMS will continue to monitor.
VMS Position: Monitor
Status: Died, Did Not Make Crossover, Ordered to lie in the House
|
|
Act 142/H.572, a new law that adds a licensed substance use disorder practitioner, a mental health prescribing expert and a licensed social worker to the Maternal Mortality Review Panel passed the legislature and was signed by the Governor July 13, 2020. Before passage, the Senate amended the bill to require the Panel to consider health disparities and social determinants of health, including race and ethnicity in maternal death reviews.
VMS Position: Support
Status: Signed into Law July 13, 2020. Effective Immediately
(Back to the top)
|
|
Youth Contraception Bill Passes House
H.663, a bill aimed at making contraception more available to youth, was passed by the House March 13, 2020 and referred to the Senate Health and Welfare Committee. Pediatrician Barb Frankowski, M.D., and UVMMC resident Allison Walker testified in support of this legislation, which as passed seeks to provide further opportunities for Vermont adolescents to learn about and obtain contraceptives in order to prevent or reduce unintended pregnancies and sexually transmitted diseases. The bill now requires all schools across the State to provide condoms free of charge. The bill also contains provisions authorizing pharmacists to prescribe hormonal contraceptives consistent with a State protocol approved by the Commissioner of Health. This piece of the bill overlaps with the pharmacy prescribing authority created in S. 220 and will need to be reconciled between the two bills. H. 663, a priority for the House Human Services Committee, is likely to advance in the Senate Health and Welfare Committee when the legislature returns from recess.
VMS Position: Support
Status: Passed the House, In Senate Health and Welfare Committee
(Back to the top)
|
|
Global Warming Solutions Act Passes House and Senate
H.688, a bill known as the Global Warming Solutions Act, passed the Senate June 26, 2020, but the legislature adjourned before the House voted to support the Senate changes. This bill, which is a House Democrat priority, proposes to create a legally enforceable system by which Vermont will reduce its statewide greenhouse gas emissions and establishes strategies to mitigate climate risks and build resiliency to climate change. The Senate-passed version would require the state to reduce greenhouse gas pollution to 26% below 2005 levels by 2025. Emissions would need to be 40% below 1990 levels by 2030 and 80% below by 2050. The Governor has not indicated whether he would veto the bill, but expressed major concerns with the bill at the start of the 2020 session. The legislation is likely to advance to a Conference Committee for the House and Senate to iron out differences when lawmakers return in August. In 2019, the VMS adopted a resolution, Reducing Carbon Pollution Emissions in Vermont, urging decision-makers to take actions to reduce carbon emissions to better protect the health of all Vermonters.
VMS Position: Support
Status: Passed the House and Senate, In Conference Committee
(Back to the top)
|
|
Commercial Marijuana Bill Assigned to Conference Committee
S.54, a bill aimed at creating a commercial market for marijuana, passed the House on February 27, 2020 and was sent back to the Senate. The Senate did not concur with the amended bill, which the House passed with a 14% excise tax and 6% sales tax, and directly before the Statehouse shutdown it was assigned to Conference Committee. The Senate-passed bill contained no prevention or education funding, no marketing and advertising restrictions, would have allowed the sale of high-potency edible products and would have required municipalities to vote to “opt out” of allowing retail sale locations. After consistent education and information from VMS and AAPVT members and policy staff, the version that passed the House ultimately included:
- Prevention Funding - 30% of the cannabis revenue would be directed towards the Substance Misuse Prevention Fund, yet this funding is capped at $6 million. The House directs the additional 6% sales tax towards evidence-based afterschool programs, with a focus on the underserved populations of the State.
- Advertising Restrictions - Before it passed the House they voted to remove the ability for any cannabis advertising.
- Cannabis Products - there are now specific potency limitations and THC ceilings for each regulated product; flavored cannabis products are now prohibited.
For more information on the House-passed amendments to the bill click here. It is unclear whether this legislation, which would require a substantial upfront investment by the State to create the salaried Cannabis Control Board, will advance during the public health emergency. It is also questionable whether the legislature will have time to resolve the major differences between the House and Senate versions. The Governor has also indicated he would veto any marijuana commercialization legislation that does not contain his road-side testing requirements. The VMS will be monitoring this bill closely when the legislature returns.
VMS Position: Oppose
Status: Passed the House and Senate, in Conference Committee
(Back to the top)
|
|
(Back to the top)
Bill to Ban the Sale of Crib Bumpers in Vermont
S.65, a bill submitted by the AAP Vermont Chapter in 2019 to ban the sale of padded crib bumpers in Vermont, passed the Senate, but has not received action yet in the House Human Services Committee. VMS and the American Academy of Pediatrics (AAP) Vermont Chapter will continue to advocate for the Committee to take up this important bill. A special thank you to Rebecca Bell, M.D. for her work shedding light on this important safety topic and for her testimony in support of this bill.
VMS Position: Support
Status: Passed the Senate, In House Human Services Committee
|
|
Firearm Legislation Passes
S.169, an omnibus bill of firearm-related proposals, which included a 24-hour waiting period for the purchase of a handgun following a background check, was vetoed by the Governor June 10, 2019. Before the 2020 legislative session House and Senate leadership expressed a willingness to override the Governor's veto. Notice of the override vote was on the Senate calendar for the entire session and continued to be passed over due in part the House not having the 3/4ths majority to override the Governor. A special thank you to Rebecca Bell, M.D. for her dedication to preventing gun-related injuries and her testimony on youth impulsivity and suicide risk.
VMS Position: Support
Status: Vetoed by the Governor. Possible Override Vote
|
|
Racial Equity Bill Enacted
Act 147/S.219, legislation aimed at addressing racial bias and excessive use of force by law enforcement, passed the legislature and was signed into law July 13, 2020. This bill, which urges community policing strategies based around de-escalation and establishing a law enforcement culture that fosters transparency and accountability, was driven by the deaths of George Floyd and Breanna Taylor. On June 2, 2020, the Vermont Medical Society, along with the Vermont Psychiatric Association and the American Academy of Pediatrics Vermont Chapter, released a joint statement denouncing the recent brutal and senseless acts of violence towards Black people by law enforcement officers and acknowledging the impact systemic racism has in driving adverse health outcomes in our State and across the nation.
VMS Position: Support
Status: Signed into Law July 13, 2020. Please Read the Act for Effective Dates
|
|
Senate Bill Requires Schools to Provide Menstrual Hygiene Products
S.224, a bill that includes a VMS-supported proposal requiring all Vermont schools to provide menstrual hygiene products freely for all students who need them, passed the Senate and advances to the House Education Committee.
VMS Position: Support
Status: Passed by the Senate. In House Education Committee.
|
|
Flavored Tobacco Ban Bill Hits Political Impasse
S.288, a bill to ban the sale of flavored tobacco products, started the session as a priority for lawmakers concerned with the sharp spike in the use of JUUL and other flavored vape products. This bill passed the Senate Health and Welfare Committee by a vote of 5-0 and was referred to the Senate Finance Committee where it failed to advance. Before the COVID-19 Statehouse shutdown, some Senators stated that the bill, which includes the prohibition of the sale of menthol products, would infringe on the rights of adults to access their vice of choice. The bill was not voted on in the Senate Finance Committee and is not likely to advance despite emails and compelling testimony from VMS members in support of the bill. Propero Gogo, M.D., cardiologist at UVMMC, spoke at a press conference in support in January, 2020. Rebecca Bell, M.D., Pediatric Intensivist at UVMMC and L.E. Faricy, Pediatric Pulmonologist, also testified in the Senate Health and Welfare Committee on the health impacts of increased youth use of all flavored tobacco products including vaping products. Click here to read their comments.
VMS Position: Support
Status: Died, In Senate Finance Committee
(Back to the top)
|
|
Universal Afterschool Access Bill Passes Senate
S.335, a bill to create a taskforce for Universal Afterschool Access, passed the Senate and advanced to the House Education Committee. The House Education Committee had just begun to take testimony on this bill before the COVID-19 shutdown. VMS Deputy Director, Stephanie Winters, testified that VMS & AAPVT strongly support universal access for all youth to evidence-based, quality afterschool programming as a critical prevention tool. Drawing on evidence from the Iceland Model, this programming has been proven to increase protective factors against risky behaviors for youth. Currently, the funding for the afterschool expansion is included in S.54, the cannabis tax and regulate bill, which directs revenue from the proposed 6% sales and use tax to afterschool programming. The VMS will continue to support this legislation and to urge lawmakers not to rely on marijuana sales for its implementation.
VMS Position: Support
Status: Passed the Senate, In House Education Committee
(Back to the top)
|
|
|
|
|
