Bill to Create Forensic Mental Health System Passes the Senate
S.183, which aimed to create a forensic mental health system in Vermont, passed the Senate on March 10, 2020, but did not advance during the State 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 included these provisions:
- Requirement for 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 from the County where the prosecution took place. The State's Attorney will be charged to 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.
The VMS will continue to advocate for this proposal in 2021.
VMS Position: Support
Status: Passed the Senate, Died, In House Judiciary Committee
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Stem Cell Clinic Bill Did Not 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, died on the Senate calendar without being considered by the full Senate. This VMS-supported bill was informed by the 2019 VMS Resolution regarding Stem Cell Clinics adopted in 2019 and did pass the Senate Health and Welfare Committee before stalling on the Senate floor. The legislation aimed 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. VMS will work to garner legislative support in order to get the proposal re-introduced in the 2021 legislative session.
VMS Position: Support
Status: Died On Notice Calendar in Senate
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Board of Medical Practice Employer Disciplinary Reporting Bill Passes
Act 126/H.438, updates the procedures of the Board of Medical Practice and the licensure of physicians and podiatrists. This legislation 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.
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Bill to Prohibit Genetic Discrimination
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, but died upon adjournment after it failed to receive a hearing in the House Health Care Committee. This bill aims to prevent insurance coverage from 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, Died in House Health Care Committee
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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
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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. The legislation failed to advance this session, 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
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Professional Regulation/Scope of Practice
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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
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OPR Bill Aimed at Authorizing Pharmacy Prescribing Passes Senate
S.220, the 2020 Office of Professional Regulation (OPR) bill that includes language expanding the scope of practice of pharmacists to give them limited prescribing authority, was amended and passed by both the House and Senate September 17, 2020. The bill requires 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.
The final bill allows pharmacists to provide COVID-19 tests for asymptomatic Vermonters. VDH 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. Currently, Kinney Drugs and Walgreens in Essex and Brattleboro VT are offering COVID tests. The bill sunsets the SARS-CoV testing authority on July 1, 2021. A separate section of the bill (Section 3108), which VMS also supports, requires the Office of Professional Regulation to complete a study of any scope of practice expansion proposals. The bill was sent to the Governor's Desk October 6 and he is expected to sign it.
VMS Position: Support
Status: Passed the House and the Senate, Sent to the Governor's Desk.
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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
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Bill to Decriminalize Bupernorphine Possession Fails in the House
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. The version that passed the House Human Services Committee would have decriminalized possession of 224 mg or less of bupernorphine, with the goal of saving as many opioid users from overdosing on heroin and/or fentanyl as possible. The VMS took 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).
VMS Position: Monitor
Status: Died, Did Not Make Crossover, Ordered to lie in the House
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Mental Health Clinicians Added to Maternal Mortality Board
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
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Youth Contraception Bill Signed Into Law
H.663 passed the legislature and was signed into law by the Governor on October 5,2020. This new law aims to expand access to contraceptives and related education for young Vermonters to prevent or reduce unintended pregnancies and sexually transmitted diseases across the State. Pediatrician Barb Frankowski, M.D., and UVMMC resident Allison Walker testified in support of this legislation. The legislation requires all schools across the State to provide condoms free of charge and requires the Departments of Education and Health to report to the legislature in regards to providing equitable health education across the State. Before final passage, the House removed a section authorizing pharmacists to prescribe hormonal contraceptives which overlapped with the pharmacy prescribing authority created in S. 220. The House also removed a proposal that had been in a separate Senate bill that would have required all Vermont schools to provide menstrual hygiene products freely for all students who need them. The VMS will continue to advocate for Vermont students to have equitable access to menstrual hygiene products in 2021.
VMS Position: Support
Status: Passed the House and Senate, Governor Signed the Bill October 5, 2020. Primarily Effective on July 1, 2021, excepting the report is due November 1, 2020.
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Global Warming Solutions Act Goes Into Law After Veto Override
H.688, a bill known as the Global Warming Solutions Act, was vetoed by the Governor on September 15, 2020, but has become law after both the House and the Senate successfully overrode his veto prior to legislative adjournment. This law, a House Democrat priority, creates 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 version that passed requires 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. 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. To read the Governor's veto message click here.
VMS Position: Support
Status: Legislature Overrode the Governor's Veto, Effective Upon Passage.
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Commercial Marijuana Bill On Governor's Desk
S.54, a bill that would create a commercial market for marijuana in Vermont, was passed by the legislature and awaits action by the Governor. Thank you for all of your advocacy on this bill and your responses to our action alerts urging the Governor to veto this bill. VMS’ continued opposition is due to the removal of the advertising prohibition included in the House-passed bill and a lack of a minimum prevention investment. The bill as passed the legislature now includes:
- 30% of the cannabis excise tax revenue will be dedicated to funding substance misuse prevention programming, with a cap of $10 million.
- Advertising or mass marketing will be determined by the Cannabis Control Board in consultation with the Office of the Attorney General and the Department of Health.
- A limit on THC and flavored cannabis products is required.
- Health warnings created by the Cannabis Control Board with oversight by the Department of Health and adopted by rule.
- No primary enforcement of the use of seat belts.
- Roadside saliva testing.
- Medical marijuana registry to move to the Cannabis Control Board.
- Allowing municipalities the right to opt-in to sales.
- 6% sales tax to be directed by the Agency of Education to quality afterschool programming.
The Vermont Medical Society (VMS) and American Academy of Pediatrics, Vermont Chapter (AAPVT) remain opposed to the creation of any non-medical commercial system for retail sales of marijuana because of the negative health impacts on the Vermont population, especially youth and young adults. The Governor has approximately 24 hrs to decide whether to sign this legislation, veto the bill or let it go into law without his signature, he has said he has not decided at this time. The VMS will be continue to monitor this legislation closely.
VMS Position: Oppose
Status: Passed the House and Senate, in Conference Committee
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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 did not receive action in the House this session. VMS and the American Academy of Pediatrics (AAP) Vermont Chapter will continue to advocate for this important concept in 2021. 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
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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.
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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 on 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
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Flavored Tobacco Ban Bill Hit 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 Senate Finance Committee held one hearing on the bill in August, but failed to revive the proposal 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. The VMS will work with public health champions on this proposal in 2021.
VMS Position: Support
Status: Died, In Senate Finance Committee
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Universal Afterschool Funding Included in the Budget
S.335, a bill to create a taskforce for Universal Afterschool Access, passed the Senate, but failed to move forward in the House. 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. During the State of Emergency, it became clear that in order for Vermont parents to return to employment and for children to have care during gaps in hybrid learning the State worked with Afterschool Vermont and other groups to form childcare hubs across the State.
The FY2021 Budget allocated approximately $50 million in CRF funding for universal afterschool programming related to the State of Emergency, not the prevention models that VMS and AAPVT had been advocating for. The VMS will continue to monitor the hubs and to advocate for sustainable funding for statewide prevention programming to be delivered during afterschool activities. S.54, the bill to commercialize cannabis, if signed into law also directs the Agency of Education to direct a 6% sales tax to quality afterschool programming.
VMS Position: Support
Status: Passed the Senate, Died, In House Education Committee
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