2021 VCP Legislative Updates
Legislative Update for April 14, 2021 – H.315 the Quick One-time Bill Passes the Full Legislature; Senate Health and Welfare Hears Proposal on Secure Residential; House Judiciary Committee Continues Testimony on S.3; Senate Health and Welfare Learns about All Payer Model Improvement Plan; Senator Health and Welfare Considers Health Reform Options; Joint Resolution Related to Racism as a Public Health Emergency by House Human Services; House Human Services Committee Passes H.225; House Education Hears Testimony on S16, Creating a Taskforce on Exclusionary Discipline Reform
Legislative Update for April 6, 2021 – ARPA; Senate Health and Welfare Reviews House Budget Bill with Joint Fiscal Office’s Stephanie Barrett; House Judiciary Committee Takes on S.3 on Competency and Insanity Defense; Senate Health and Welfare Takes up H.153 on Rates for Medicaid Community Based Services; Senate Health and Welfare Presents Report on Managing Health Expenditures; Senate Health and Welfare Hears from Representative Lippert on Health Equity Bill; House Education Committee Takes Testimony on School Exclusionary Discipline; Senate Health and Welfare heard testimony on H.104 on Interstate Telehealth; House Human Services Takes Up Decriminalizing Small Amounts of Buprenorphine with H225; H. 329 – Amending the Prohibitions Against Discrimination Reviewed by House General Committee
Legislative Update for March 30, 2021 – Fiscal Year 2022 (FY22) Budget Bill Passes House of Representatives; H.153 Passes the House as Amended by the House Appropriations Committee; H.315 Quick One-Time Bill Passed by Full Legislature; Steve Klein Provides Senate Health and Welfare with Overview of ARPA; H.438, The Capital Bill Passes House of Representatives; House General, Housing and Military Affairs Passes Resolution Offering Eugenics Apology; Senate Health and Welfare Hears update on All Payer Model (APM); H.210 Health Equity Bill Passes House of Representatives; S.117 Health Care Flexibilities Bill Ready for Governor’s Signature; Senate Passes S.3
Legislative Update for March 23, 2021 – House Appropriations Committee Completes Work on FY22 Budget Bill; House Appropriations Adjusts Medicaid Rate Review for Community-based Providers; Senate Passes H.315 Quick One-Time Appropriations Bill; Administration’s Response to Senate on H.315; Substance Use Disorder System of Care Redesign Reviewed by House Human Services; Corrections and Institutions Considers Proposal for Secure Residential; House Health Care Completes Testimony on Secure Residential Residence; Senate Institutions Committee Receives Testimony on Secure Residential Residence; Regulatory Flexibilities Bill is Reviewed by House Health Care Committee; Senate Judiciary Committee Continues Consideration of S.3; House General, Housing and Military Affairs Continues Work on Eugenics with JRH2; Disability Advocacy Day Legislative Panel
Legislative Update for March 17, 2021 – Briefing on Federal Relief Funding; House Appropriations Committee Marks Up the FY22 Budget; House Human Services Addresses Medicaid Reimbursement Rates for Community-based Providers; Senate Appropriations Committee Reviews H.315 – One-time Bill; Senate Health and Welfare Reviews One-time Bill H.315; House Health Care Committee Listens to Proposal for New Expanded Secure Residential Facility; Senate Judiciary Committee Finalizes S.3 on Competency to Stand Trial and Insanity Defense; House Health Care Committee Hears More Testimony on H.210 the Racial Disparities Bill; House Health Care Committee Passes Bill on Interstate Practice of Telehealth; Senate Addresses Regulatory Flexibilities; House General, Housing and Military Affairs Considers Eugenics Apology and Next Steps to Address It
Legislative Update for March 3, 2021 – House Health Care Committee Recommendations to the Appropriations Committee; House Human Services Reviews Medicaid Reimbursement Rates for Community-based Services; Mental Health Commissioner Squirrell Presents Residential Needs to House Health Care Committee; House Committee on Corrections and Institutions on Sequential Intercept; Senate Health and Welfare Looks at Audio-Only; House Health Care Committee Considers Legislative Priorities; House Health Consider H.104 to Allow use of Telemedicine Across State Lines for Mental Health Care; Representative Donahue Introduces H.46 to Expand Reporting on Involuntary Mental Health Procedures; House Health Care Testimony on Health Disparities and H.210 the Health Equity Bill
Legislative Update for February 24, 2021 – House Human Service Committee FY22 Budget Requests; House Health Care Committee Receives Testimony on One-time investments from DMH Commissioner; House Health Care Budget Discussion; The House Appropriations Adopts Recommendations of Health Care Committee for One-time Funding; Senate Appropriations Committee Hears Further Testimony from Department of Mental Health; Senate Health and Welfare on Audio-Only; House Health Care Committee Accepts Testimony on Health Equity Bill
Legislative Update for February 16, 2021 – Department of Mental Health Budget Presented to Senate Appropriations and House Health Care; Senate Health and Welfare Receives Update on Federal COVID Funds; Disability Rights Vermont Testifies in House Health Care Committee; House Health Care Learns about Health Care Disparities; House Health Care Considers Bill to Address Health Care Disparities; House Health Care Committee Discusses FY22 Budget; Extending COVID-19 Flexibilities, including Audio-Only Care ; School Discipline Advisory Council; House Human Services Committee Walks through Bill on Involuntary Sterilization; What’s happening next: Recovery Day February 17, 2021; VHCC Legislative Kick off February 17, 2021
Legislative Update for February 10, 2021 – Mental Health Advocacy Day – A Virtual Success; House Human Services Receives Overview of Agency of Human Services Budget Request; Department of Disabilities Aging and Independent Living (DAIL) Budget Request ; House Appropriations Committee Hears Mental Health Budget; Department of Children and Families (DCF) Budget Testimony to House Appropriations Committee; Vermont Care Partners Provides Overview of DA/SSAs to House Health Care Committee; Senate Institutions Committee Accepts Mental Health Advocacy Day Testimony; House Health Care and Senate Health and Welfare Listen to Testimony on Extending Flexibilities; House Health Care Learns about Mental Health; Audio-Only Care in House Health Care; Senate Health and Welfare on Continuing COVID-19 Flexibilities; Joint Hearing of Senate Judiciary and House Human Services: Roundtable Discussion on “Aggressive Behavior of Juveniles/Danger to Staff” ; Senate Health and Welfare Take Testimony in Honor of Mental Health Advocacy Day; Justice Reinvestment II Report Presented to Multiple Committees; Committee on General, Housing and Military Affairs take Mental Health Advocacy Day Testimony
Legislative Update for February 2, 2021 – Senate Health and Welfare Hears Overviews from Health Care Providers; House Appropriations Committee Hears Agency of Human Services Budget Overview; House Appropriations Committee Hears DAIL Budget Overview; Senate Health and Welfare Hears Overview of Health Reform; House Health Care Committee Studies Health Reform; Woodside Update 1/26/2021 in Senate Judiciary ;Families First Prevention Services Act (FFPSA) Discussed in House Human Services; Audio-Only Care in House Health Care 1/26/21 and 1/29/21; Homelessness Awareness Day 1/27/21; ADVOCACY OPPORTUNITY – Public Hearing on the FY22 Budget; Information on Your Senators and Representatives; Action Circles Calendar
Legislative Update for January 25, 2021 – Senate Institutions Committee Receives Update on Mental Health Plans; House Human Services, House Health Care and Senate Health and Welfare Briefed on Federal Funds; House Appropriations Committee Reviews Revenue Forecast; Senate Health and Welfare Receives Overview from AHS Secretary Mike Smith; House Human Services Learns about Addiction; The Senate Extends Timeframe for CRF Appropriations; ADVOCACY EVENTS and INFORMATON
Legislative Update for January 19, 2021 – New Biennium; Pressures and Challenges of 2022 the Budget – Expect a State of Flux; House Appropriations Receives Overview of AHS CRF Expenditures; House and Senate Committees on Health and Human Services Learn about CRF; House Human Services Hears Introductory Remarks by AHS Secretary Mike Smith; Human Service Committee Review of Potential Legislation; Senate Judiciary Committee Plan to Return to Insanity and Competency Issues; Advocacy Events and Information (Mental Health Advocacy Day – Monday, February 1, 2021 / Vermont Virtual Homelessness Awareness Day and Vigil Wednesday, January 27, 2021); Information on Your Senators and Representatives; Action Circles Calendar
2020 VCP Legislative Updates
Overview of Progress and Achievements
- FY21 Appropriations – Act 154 (H.969)
- Health Care and Human Services Appropriations from the Coronavirus Relief Fund Act 136 (H.965)
- CRF Resources for Broadband Connectivity, Housing, and Economic Relief Act 137 (H.966)
- Health Reform – Act 140 (S.160)
- Vermont’s Response to COVID-19 – Act 91 (H.742)
- Governmental Structures Protecting the Public Health, Safety and Welfare – Act 166 (S.124)
Summary of Budget and Policy Legislation
Budget Overview – Act 154 (H.969); Mental Health Budget Remains in DMH; Corona Virus Relief Funds (CRF); Mental Health and Public Safety; Woodside Juvenile Detention Facility
Health Care and Human Services Appropriations from the Coronavirus Relief Fund Act 136 (H.965); COVID-19 Funding and Assistance for Broadband Connectivity, Housing, and Economic Relief Act 137 (H.966); Miscellaneous Health Care Bill – Act 140 (H.960); Vermont’s Response to COVID-19 – Act 91 (H.742); Justice Reinvestment Act 148 (S.338); Governmental Structures Protecting the Public Health, Safety and Welfare – Act 166 (S.124); Workers Compensation and COVID Act 150 (S342)
Legislative Update for October 7, 2020 – Legislature Finalizes the Fiscal Year 2021 Budget – Budget Overview; Fiscal Year 2022 Pressures; Corona Virus Relief Funds (CRF); Mental Health Budget Remains in DMH; Mental Health and Public Safety; Justice Reinvestment; Woodside Juvenile Detention Facility / Other Legislation – S.124 Directs the Criminal Justice Council to Address Racism and Improve Mental Health Supports
Legislative Update for September 24, 2020 – Legislature Focuses on Finalizing the Fiscal Year 2021 Budget; Senate Health and Welfare Reviews DAIL Budget; House Health Care Reviews Public Safety Proposal for Mental Health Workers in State Police Barracks; Senate Health and Welfare Considers Public Safety Proposal; House Health Care Committee Develops Budget Amendment for DPS Proposal; Senate Adjusts Woodside Proposal in the Budget; CRF for Designated and Specialized Service Agencies; House Appropriations Hears Commissioner Greshin’s Opinion on Senate Budget Bill; Senate Health and Welfare and House Health Care Joint Meeting on CRF; Senate Health and Welfare and Senate Appropriations Reviews OneCare Funding for Primary Care; Senate Finance Committee Addresses Broadband
Legislative Update for September 2, 2020 – Legislature Reconvenes with a Focus on Finalizing the Fiscal Year 2020 Budget; Scott Administration Proposes FY21 Budget Restatement with Few Changes; House Health Care and Senate Health and Welfare Committees Take Testimony on the FY21 Budget; Appropriations Committees Deliberates Budget and Takes Public Testimony; Department Budget Testimony – Department of Mental Health Overview; DAIL Budget Overview; DVHA Budget Overview; Department of Health Budget Overview; Joint Fiscal Oversight Committee Considers Woodside; House Health Care Committee Considers Mental Health Funding; Senate Committees Supportive of Embedded Workers at State Police Barracks; Senate Appropriations Considers Hazard Pay; Education
Legislative Update for July 1, 2020 – Legislative and Funding Overview; Legislature Approves First Quarter Appropriation Bill H.961; Senate Adjusts the House CRF Bill H.965 for Health and Human Services; Legislature Passes H.966 to fund Broadband, Housing and Economic Relief with CRF; Legislature Passes Miscellaneous Health Care Bill; Workers Compensation Legislation Passes Legislature; Secretary of Education Dan French Addresses How Schools Shall Reopen
Legislative Update for June 23, 2020 – House Passes CRF Bill for Health Providers H.965; Senate Health and Welfare Committee Begins Deliberation of CRF for Health Providers in H.965; Senate Appropriations Committee Reviews the work of the Senate Health and Welfare Committee on H.965; Senate Amends First Quarter of FY21 Budget with Plan for Mental Health Workers in State Trooper Barracks; Senate Judiciary Committee Take Testimony on S.219 Law Enforcement Bill; Senate Plans to Amend S.218 on the DMH 10-year Plan to an Act Establishing the Mental Health Integration Council; House of Representatives Passes H.966 CRF (corona virus relief fund) for Broadband, Connectivity and Housing; Senate Health and Welfare Amends Health Care Bill Further
Legislative Update for June 16, 2020 – House of Representatives Considers Appropriation of Corona Virus Relief Funds CRF; Vermont Care Partners Advocacy on CRF; House Appropriations Works Through CRF Appropriations Recommendations; House Appropriations Receives Proposal from House Health Care Committee; House Health Care Committee Recommendations on CRF to House Appropriations Committee; Broadband Discussed by Senate Finance; CRF to address Housing and Homelessness; Senate Health and Welfare Begins Consideration of CRF; Mental Health Commissioner Squirrell Presents to Senate Health and Welfare on Brattleboro Retreat; Senate Judiciary Committee Begins Work on Addressing Police Brutality Concerns; House Education Committee Learns about Success Beyond Six Challenges; Legislative Process for FY21
Legislative Update for June 8, 2020 – Legislative Process for Fiscal Decisions; CRF Appropriation Deliberations; House Health Care Committee Takes Testimony from the Chair of the Green Mountain Care Board; Coalition of Health Care Providers Make Recommendations to the House Health Care Committee on June 3rd ; Secretary Smith Testifies about the CRF to Human Service and Health Care Committees on June 3rd and 4th; House Health Care Committee Continues Deliberations of CRF Expenditures on June 5th;Brattleboro Retreat to Receive Additional Funding; Judiciary Committee
Legislative Update for June 2, 2020 – Opportunity for Further COVID-19 Funding; Health Care Providers Testify to the House Health Care Committee and Senate Health and Welfare Committee; Highlights of Information Presented to Appropriations Committees; Finance Commissioner Adam Greshin Presents FY21 First Quarter Skinny Bill to House Appropriations Committee; AHS CFO Sara Clark Presents to House Appropriations Committee; House Appropriations Committee Budget Discussions; Budget Adjustment Bill Ready for Governor Scott’s Signature; Telehealth Options Studied by Senate Health and Welfare; House Human Services Hears DCF testimony on Woodside and COVID Residential Programs
Legislative Update for May 19, 2020 – House Appropriation Receives Briefing on FY21 Budget Request; Updates of Federal Funding; Budget Adjustment Bill at Finish Line in the House; House Human Services Learns about the New Budget Adjustment Proposal for AHS; Senate Health and Welfare and House Health Care Committees Receive Budget Update from AHS; Senate Health and Welfare Considers Extension of COVID-19 Health Care Measures
Legislative Update for May 11, 2020 – Update of the New Fiscal Realities; Essential Employee Hazard Grant Program Gains Support; Health Committees Review Telehealth; House General, Housing and Military Affairs Addresses Homelessness; Senate Health and Welfare Develops Legislation to Plan for After the Pandemic is Past the Disaster Stage; Senate Caucus
Legislative Update for April 28, 2020 – The Legislature Makes Adjustments in Response to the COVID-19 Pandemic; Update of the New Fiscal Realities; Joint Fiscal Committee Adopts Conditions for the Acceptance of the Coronavirus Relief Funds to Vermont; Special Education Discussed by House Education Committee; Children’s Integrated Services
Legislative Update for April 17, 2020 – The Legislature Makes Adjustments to Respond to the COVID-19 Pandemic; Act 95 Addresses COVID-19; Legislature Explores New Financial Realities; House Health Care and Senate Health and Welfare Hear from Secretary Smith on Response to Covid-19; DMH Testimony at House Health Care on March 27th; Senate Health and Welfare Returns to S.290; House Health Care Committee House Education Hears Testimony from Four School Superintendents; House Education Hears Testimony on School Mental Health; AOE Special Ed Guidance; Justice Reinvestment Bill Continues Moving Forward
Legislative Update for March 6, 2020 – House Appropriations Committee Deliberates the FY21 Budget Recommendations; Senate Health and Welfare Returns to Rutland Mobile Response Bill; Justice Reinvestment Bill Passes the Senate; S.183 on Insanity and Competency Ready for Passage by the Senate
Legislative Update for February 25, 2020 – Senate Health and Welfare Hears Vermont Care Partners Request for Financial Review; House Appropriations Committee Takes Testimony from Human Service Advocates; House Health Care Budget letter; House Human Services Committee Budget Letter; Senate Health and Welfare Reviews S.302 Mobile Response Bill; Senate Judiciary Committee at the Finish line with S.183 on Insanity and Competency; Senate Health and Welfare Reviews S.183 on Insanity and Competency Legal Issues; Senate Appropriations Committee Reviews Justice Reinvestment Bill S.388; Senate Judiciary Considers Closure of Woodside; House Human Services Studies Woodside; Senate Health and Welfare Hears Vision 2030 Report Presented by Mental Health Commissioner
Legislative Update for February 18, 2020 – House Appropriations Committee Discusses Public Hearing Testimony; Senate Appropriations Hears Budget Testimony on Mental Health; House Health Care Hears about Department of Mental Health (DMH) Performance Measures; Senate Judiciary Committee Continues to Study Insanity and Incompetency Legislation; House Health Care Committee Learns about the Mental Health Residential Continuum; House Health Care Studies Suicide; Board of Education & Agency of Education Rule Making Authority Under Study; Budget Adjustment Bill, H.760, Nears Finish Line with House and Senate Amendments
Legislative Update for February 10, 2020 – House Committee on Appropriations Hears Mental Health Budget Proposal for FY20; Mental Health Budget Presented to House Health Care Committee; Senate Judiciary Committee Finalizes the Justice Reinvestment Bill; Senate Appropriations Committee Hears Health Department Budget Proposal; Senate Health and Welfare Takes First Testimony on S.302 Mobile Response for Youth in Rutland; New version of S.183 Taken up by Senate Judiciary Committee; S. 290 on Health Care Reform Implementation Reviewed by Senate Health and Welfare Committee
Legislative Update for February 4, 2020 – Save The Dates; Mental Health Advocacy Day Make a Strong Statement of Support for Community Mental Health; House Human Services Takes a full Morning of Testimony on Mental Health; Senate Institutions Learns about Intensive Residential Recovery Proposal; House Human Services Learns about experiences with Developmental Disability and Substance Use; House General, Housing and Military Affairs Learns about the Experience of Homelessness; Senate Judiciary Begins Work on Justice Reinvestment Bill; Human Services Secretary Mike Smith Presents FY21 Budget to House Appropriation Committee; AHS Budget Highlights: Initiatives (base funding will annualize, one time funding will not); Two Committees look at Use of Force by Law Enforcement; House Appropriations Committee Hears Department of Children and Families FY21 Budget Proposal; House Health Care Committee Receives Update on Secure Residential Development
Legislative Update for January 27, 2020 – Save the Dates; Governor Scott’s Budget Address; Senate Judiciary Committee Continues Testimony on Insanity Plea; House Health Care Learns about Institutions for Mental Diseases (IMDs);Council of State Government Presents Justice Reinvestment II; House Human Services Hears OneCare Overview
Legislative Update for January 21, 2020 – House Human Services Learns about Developmental Disability Services; Senate Judiciary Committee Begins Study of Insanity Defense as Proposed in S.183; House Corrections and Institutions Studies Woodside; GMCB Reviews their Analysis of the Brattleboro Retreat Finances at House Health Care; House Appropriations and Health Care Committee Learns about All Payer Model; House Health Care and Senate Health and Welfare Jointly Receive Testimony from OneCare; Senate Health and Welfare Hears Rural Health Task Force Report; Senate Institutions Gets Update on Secure Residential facility; State Revenue Forecast increases by $44 Million
Legislative Update for January 13, 2020 – Save the Dates; House Corrections and Institutions Hears from Incoming Human Services Secretary Mike Smith; Mental Health Commissioner Squirrell Updates the House Corrections and Institutions Committee; AHS Secretary Smith Presents Budget Adjustment Request to Senate Appropriations Committee; Governor’s Scott Presents State of the State Speech; House Appropriations Hears Mental Health Overview on January 9th; Senate Education Committee Plans Revisions to State funding of Schools; Justice Reinvestment
Legislative Update for January 6, 2020 – Vermont Care Partners Legislative Agenda; Mental Health Advocacy Day and Advocacy Webinar; Budget Adjustment and Fiscal Issues; OneCare and Delivery System Reform Funding; Woodside Juvenile Detention Center Discussed at Justice Oversight; Save the Dates
Make Your Voice Heard! Mental Health Advocacy Day is January 29th Please join us at the State House on Wednesday, January 29, 2020 @ 8:00 a.m.
2019 Legislative Updates
Legislative Agenda for 2020 – Working Draft 1
Maintaining our Commitment to Vermonters
Designated and Specialized Service Agencies (DA/SSAs) are nonprofit community-based agencies doing the work of the state to meet mental health developmental disability and substance use disorder needs of Vermonters. Our comprehensive array of services addresses the social determinants of health including clinical care, community supports and crisis services on a 24/7 basis. By statute, “Vermont’s mental health system shall be adequately funded and financially sustainable to the same degree as other health services.” Yet, the State has not provided adequate funding for our workforce to fully achieve the outcomes the State requires. In 2017 this language was added to the statutes:
18 V.S.A. § 8914 Rates of payments to designated and specialized service agencies (Act 82, 2017)
(a) The Secretary of Human Services shall have sole responsibility for establishing the Departments of Health’s, of Mental Health’s, and of Disabilities, Aging, and Independent Living’s rates of payments for designated and specialized service agencies that are reasonable and adequate to achieve the required outcomes for designated populations. When establishing rates of payment for designated and specialized service agencies, the Secretary shall adjust rates to take into account factors that include:
(1) the reasonable cost of any governmental mandate that has been enacted, adopted, or imposed by any State or federal authority; and
(2) a cost adjustment factor to reflect changes in reasonable costs of goods and services of designated and specialized service agencies, including those attributed to inflation and labor market dynamics.
(b) When establishing rates of payment for designated and specialized service agencies, the Secretary may consider geographic differences in wages, benefits, housing, and real estate costs in each region of the State. (Added 2017, No. 82, § 11, eff. June 15, 2017.)
Vermont Care Partners’ intent is to bring the language of this statute into reality. We will also work in coalition with other human services providers who have similar challenges with being under-resourced.
- Appropriations Bill for Fiscal Year 2020
Increase the Medicaid Reimbursement Rates by 3%
Vermont Care Partners requests a workforce investment for all staff. These funds could be used to target compensation increases to the most critical positions to meet community needs, address local labor market dynamics, and cover health benefit costs.
- After years of insufficient investment in DA/SSAs the State needs to create parity in funding with physical health care and then provide for annual funding increases for DA/SSAs in the context of annual increases for state employees, health care and school employees.
- Designated and Specialized Service Agencies (DA/SSA’s) rates of reimbursement are insufficient to cover costs. There is no direct correlation between payment rates and actual cost of services
- The mental health challenge of patients in Emergency Departments cannot be solved without an investment in the community-based service to ensure adequate access to upstream services and to prevent people from getting stuck in inpatient care due to inadequate resources in the Community
- Staff turnover and vacancy rates are still at critical levels with nearly 1 in 5 licensed clinical positions vacant and over 400 vacancies system wide.
Developmental Services Caseload Budget
Vermont Care Partners wants to ensure adequate funding for services provided to people with intellectual and developmental disabilities, both those currently served and the those people who newly require services. From 2006 to 2016, the number of persons eligible for intellectual and developmental disability waiver services rose by almost 50%. This continual upward trend requires new money, referred to as caseload funds and this new funding is essential each year.
Substance Use Disorder Services
Vermont Care Partners will support and educate on the continuing demand for opiate and other substance use disorder outpatient treatment and the need for reimbursement rates predicated on costs, and expanded access to services. Every single DA is losing money in SUD programs. In FY19 the total system loss was $2.2million on $15.2million in programming for a 15% loss. We support the continuation of the AAP credential to expand the workforce.
Research demonstrates older people with mental illness have twice the medical cost of those who do not have a mental illness and that when mental illness is treated, physical health improves. Shoring up the Eldercare program will save the state money in medical costs for its growing population of folks 60 and older. Additionally, these services prevent use of higher cost care by enabling older Vermonters to remain independent longer and avoid or delay nursing home placement. It’s been 20 years since $250,000 was appropriated for eldercare clinicians to address the growing mental health of elders and the appropriation is now only $235,000 while at the same time elders are facing more and more social isolation leading to rising rates of mental health and addiction service needs as noted in the State Plan on Aging. We recommend adding just $145,000 which is equivalent to a 2% increase over the life of the program. This would improve the ability of Agencies to train, hire and retain qualified specialists to provide community based mental health services. Additionally, we continue to urge the Agency of Human Services to request a waiver from the federal government to enable all masters’ level clinicians (not just MSWs) to be reimbursed by Medicare through the All Payer Model. This would expand the labor pool and help keep the programs fiscally sound.
- Developmental Services Systems Change
The system of care for individuals with intellectual and developmental disabilities is undergoing enormous change. Conflict of Interest Free Case Management requirements of the federal government may lead to different care models and agency responsibilities. Value-based payment will change how services are funded and a new assessment form and process may impact services received by individuals. Vermont Care Partners will educate legislators about the proposed changes, share our recommendations and identify potential risks to the people serviced. Vermont Care Partners supports the development of an ombudsman to assist individuals who use services with questions and concerns. This would be similar to the Vermont Health Advocate and Mental Health Ombudsman which are located at Vermont Legal Aid.
- Green Mountain Care Board Budget Review of DA/SSAs
The Green Mountain Care Board is charged with reducing the rate of health care cost growth in Vermont while ensuring that the State of Vermont maintains a high quality, coordinated and accessible health care system. They review and approve the budgets of the State’s hospitals, and OneCare Vermont, as well as approving the rates for commercial health insurance, annually. Given their purview of overseeing the State’s health care system, including their responsibility for meeting the terms of the All Payer Model, Vermont Care Partners recommends that the Board review the budgets of the DA/SSAs. Act 53 already added abbreviated budgetary review of the Vermont Psychiatric Care Hospital and the Brattleboro Retreat, plus ambulatory care centers. Fuller knowledge about the full array of Vermont’s health care expenditure will lead to better perspective on health care expenditures, including where investments are most needed.
- Health Reform
Designated and Specialized Service Agencies are already generating millions of dollars of Medicaid savings on a statewide basis through mobile crisis services, crisis beds, substance use disorder services, residential and community-based supports for children, youth and adults, and participation in OneCare and Blueprint Care Collaboratives. These savings can be expanded with the right investments.
- DSR funding has been invested solely into OneCare Vermont, but the APM agreement envisioned investment in community-based services. To-date OneCare has made investments in Care Navigator and service integration pilots, but sustainable investment in community-based services has not materialized.
- The IMD waiver application requires the State to demonstrate maintenance of effort with community-based service. There should be a balance in new spending between new inpatient beds and community-based mental health services given that upstream services will prevent both increased demand for inpatient care and over utilization of hospital emergency departments.
Local pilot programs are achieving savings and promising results through improved care coordination, enhanced referral, integrated care and utilization management – all of which could be expanded
o Northwestern Counseling and Support Services’ collaboration with Northwestern Medical Center decreased Emergency Department use by 61% saving both Medicaid dollars and costs to the medical center.
o Washington County Mental Health Services pilot with Central Vermont Medical Center reduced Emergency Department use by up to 70% for individuals who have a high utilization rates.
o Integrated and coordinated care initiatives with FQHCs, primary care physicians and other health providers are tackling ACES to improve the health of children, youth and adults in all regions of the State.
The expertise, knowledge and relationships with high needs populations is at DA/SSAs who play a critical role in improving health outcomes for Vermonters with complex and costly health needs by addressing the social determinants of health with a whole person-directed approach. National data shows that over 40% of health care costs are related to co-occurring mental health and substance use disorder conditions. In European countries where more resources are directed to human services and the social determinants of health, medical costs are far lower. DA/SSAs could create further Medicaid savings by expanding the scope of populations and services offered
- Emergency Room Back-up and the Build out of Inpatient Psychiatric Beds
The back-ups and long lengths of stay for adults and children in hospital emergency rooms is an egregious situation. Some children are being sent back home while awaiting inpatient care who would benefit from more immediate intervention. Diversion programs are cost-effective approaches to reducing back-ups in emergency rooms. The State is planning to expand the number of inpatient beds but this planning should be done in the context of the full continuum of mental health care.
DAs/SSAs already have a track record – when Vermont expanded the number of crisis bed programs through Act 79, the number of CRT inpatient days dramatically decreased. Crisis beds cost on average $693/day compared to $2,625/day for Vermont Psychiatric Care Hospital. We estimate a savings of $6 million annually just in inpatient services due to the existing crisis bed programs.
We need to shore up funding for the community mental health system, especially crisis and subacute services, as the key to addressing emergency department back up and to avoid building more inpatient beds than we really need. Upstream services are always what people prefer to use and are more cost effective. Downstream services which enable Vermonters to be discharged sooner from inpatient care are also a critical component of the care system.
- Raise reimbursement rates for the designated and specialized services agencies so that salaries are on par with state employees and other health professionals to reduce vacancies and turnover of staff at all levels of care. Outcomes: greater capacity in crisis and stepdown facilities; higher quality and better treatment available in the community to prevent hospitalizations (i.e. case management, outpatient therapy, and community supports); higher capacity for quality crisis interventions in the community to prevent ED visits.
- Expand step-down facilities, secure residential care, intensive residential services, supported housing and peer-based services to reduce the length of stay in inpatient facilities and improve the flow of people through the acute level of care. Additionally, increase capacity for people with gero-psychiatric needs. This could be done by developing a tiered rate system that incentivizes nursing homes to accept people with geriatric and psychiatric needs; increased coordination and shared care management between Choices for Care and DAs; and/or additional funding to establish nursing and/or primary care staffing in designated agency long term residential care homes. Outcome: More capacity for people stuck in inpatient care will open up Level One beds for those waiting in Emergency Departments.
- Designated hospitals should be incentivized to accept high acuity patients, as well as patients who are in Emergency Departments outside their catchment area. A centralized admissions process would allow for inpatient units to provide input on concerns about accepting a high-acuity client, but will ensure that all available inpatient beds are available to be accessed. Outcome: better dispersal of people in need of hospital-level care to available beds.
- Designated agencies, designated hospitals, EDs, and DMH care management should develop a set of communication protocols to track those waiting for hospital placement and those waiting to discharge. These protocols will include internal and system-wide operations. This group should give consideration to including those waiting for voluntary, as well as involuntary treatment. Outcome: by increasing awareness of clients stuck in ED or inpatient hospital settings among direct care staff, case management, and leadership, the instinct to protect against risk will be balanced by a culture of accountability and risk-sharing at all levels of the system, reflecting an attitude of zero tolerance for long waits in Emergency Departments.
- Special Education
Our school-based services can be a solution to some of the problems raised by both rising special education costs and increasingly dysregulated student behavior in some of the following ways:
- For both our school-based services and our independent schools, our funding model leverages Medicaid Match so that schools pay only a portion of the cost of behavioral supports that the highest-intensity students require;
- The innovative MTSS [Multi-tiered Services and Supports and PBIS [Positive Behavior Intervention and Supports] contracts that we provide in several schools fit well with a census-based approach because they are designed to support the emotional-behavioral needs of the whole student body preventatively;
- Spending decisions for school-based services should continue to be made at the local level while maintaining current Agency of Human Services, Agency of Education and Department of Mental Health oversight.
- Our 14 therapeutic independent schools should be seen as a necessary part of the continuum of special education services. These are not general education independent schools but schools specifically designed to serve students with emotional, behavioral, and developmental disabilities.
The Workgroup on a census funding model should recommend incentivizing the use of early, preventative behavioral supports and establish a cost effective process for extraordinary cost reimbursement. We can contribute our expertise in building integrated contracts that leverage Medicaid dollars through the mental health system to do both.
Specific advocacy efforts will include:
- Educating on the value of independent therapeutic schools;
- Educating on the value of Success Beyond Six school-based mental health services; and
- Addressing the special education rate criteria process.
- State Holiday Commemorating the Closure of Brandon Training School (H.332)
In November of 1993 Brandon Training School was closed making Vermont the first state in the nation to both close our institution for people with developmental disabilities and establish a totally community-based system of care. This event was a milestone in the history of Vermont and speaks to our continuing values and efforts to promote a Vermont that works for all of us. All Vermonters, including people with disabilities, deserve to live with dignity and respect, and the freedom to make their own life choices. After 25 years Vermont is only one out of 11 states that have closed their institutions in favor of a fully inclusive community-based service system. The decisions of yesterday and our ongoing values should be celebrated and never taken for granted. The proposed holiday would not involve a shutdown of work sites, but simply a day of appreciation for our current services and the progress we have made to achieve full community
- Woodside Juvenile Detention Center
The Agency of Human Services has recently announced its intent to close Woodside Juvenile Detention Facility. This is a major policy decision which will require significant analysis and consideration by state government and stakeholders.
From the perspective of Vermont Care Partners we are increasingly concerned about the growing number of youth with high acuity mental health needs. Some of these youth have been sent to out-of-state facilities because they can’t be served in group home or other community settings due to aggression requiring more secure setting. Some residential programs in Vermont have already felt the burden of the decrease in use of Woodside. It is having a detrimental impact on the milieu in these programs which will continue if programs are asked to manage these very challenging youth exhibiting unsafe and dangerous behaviors. Restraints have increased in some programs as a result. What supports will the State be offering to community-based programs to manage these increased demands and intensity?. A public-private partnership to oversee this programming, as presented in a report to the Legislature in January 2019 by DCF Commissioner Schatz should be considered.
There is also great concern about pushing these youth into to adult corrections. Youth who are 16 and older who commit certain crimes could be charged with a felony and served by the VT Department of Corrections. This would mean creating a separate space for them in the adult jail or sending them out of state. This raises many questions about how to best support youth in these environments and whether these are even appropriate environments for youth.
- Mental Health Services for Offenders and those at risk
Vermont Care Partners supports improving reimbursement rates and expanding community resources to address mental health and substance use disorders of people who at risk or involved in law enforcement and corrections. We will encourage the legislature to take action to create a high quality continuum of services to address individuals at-risk of involvement in law enforcement, individuals who are incarcerated and preventing recidivism of individuals released from incarceration. Proven model programs, such as treatment courts and the Sparrow program, have recently lost grant funding and are struggling to maintain their potential to reduce incarceration and address mental health and substance use disorders that create both individual hardship and public safety risks to our communities. Additionally, the Courts need adequate funding to participate in specialized programming. We are supportive of the recommendation that were be made by Governor’s Opioid Council to establish a Master to oversee court diversion programs.
- Improving the Interface with the Criminal Justice System
There is growing concern about people who are found incompetent to stand trial or not guilty by reason of insanity. Recommendations were made by the ONH (orders of non-hospitalization) taskforce to better support individuals who are found incompetent to stand trial and are put on ONHs which honors their civil rights while addressing safety concerns of the public. We support having the Attorney General’s Office and Vermont Mental Health Law Project present at hospitalization hearings. One of the benefits would be better communication with the designated mental health providers to ensure a smooth and well-informed transition from the courts to community supports. We also support the recommendation to notify prosecutors where treatment is received and notifying them when the initial court order is expired.
Develop housing vouchers for People Served by the DS HCBS Waiver to create independent housing options for people with intellectual and developmental disabilities served in our home and community based services waiver. This would improve choice and self-determination for the many adults who would prefer independent living options.
- Improve the flexibility of the housing vouchers administered by the Department of Mental Health. Restrictive eligibility practices are leaving people in need homeless and housing vouchers underutilized.
- We support the recommendations of the Coalition to End Homelessness
- Create 368 units of supportive housing over five years
- Move forward with Vermont’s Coordinated Entry System prioritizing high risk and high needs people
- Increase the Supply of Affordable rental housing
- Support and expand programs that reduce homelessness
- Suicide Prevention
Vermont has the 11th highest rate of suicide in the country. It is a critical public health crisis. A number of our agencies are participating in the Zero Suicide initiative that has three goals: decreasing risk factors; early recognition of early signs of distress and mental health problems; and knowledge of effective steps to prevent self-harming behavior. This effort should be a State priority.
- Worker Compensation – Sole Contractor
We will monitor this issue, with the hope that it will not resurface and impact shared living providers. Should it resurface our goal will be to maintain the status of shared living providers as independent contractors, not as employees, for the workers compensation purposes.
- Property Tax Reform
We will monitor to avoid any loss of tax exempt status for our facilities.
- Involuntary Psychiatric Treatment
The proposal to speed up the time frame for initiating involuntary treatment is likely to be brought to the Legislature as a tool to reduce emergency room and inpatient flow issues. Vermont Care Partners has not taken a position on the issue in the past and to-date members have not accepted the responsibility to directly administer involuntary medication.
- Involuntary Sterilization
A bill has been introduced to repeal an archaic section of statute, Title 18 Chap 204: Sterilization which allows for the involuntary sterilization of a person with developmental disabilities. The existing statute, a throwback to the eugenics movement, is not in alignment with VCPs values of self-determination and choice. Although there might be some Vermonters who would object to the repeal of this law, Vermont Care Partners supports this bill and see this legislative action as a good opportunity to educate health providers about the rights of individuals with developmental and intellectual disabilities to exercise self-determination.
- Orders of Non-Hospitalization
Vermont Care Partners has reviewed the recommendations of the study committee and it appears that further analysis will be necessary to develop improved approaches to care and should be done with collaboratively with all of the stakeholders.
- Rural Health Task Force Recommendations
The Rural Health Task force will make recommendations on workforce which Vermont Care Partners will consider.
- Minimum Wage
Vermont Care Partners is supportive of increases in the minimum wage as long as Medicaid rates are raised to accommodate the increased costs to community providers. Additionally, funding must also be appropriated to address wage compression so that staff with years of experience and more advanced expertise will have a wage differential from the entry level staff. Our experience with establishing a $14 per hour minimum wage has been positive for the recruitment and retention of entry level staff.
Final Legislative Budget Prioritizes Mental Health Funding
- House Health Care Reviews Capital Bill in Relation to Mental Health Capacity Development
- The House Further Amends Mental Health Legislation
- Appropriations Update
- Combined Independent School and Special Education Bill Approved by Senate
- Trauma Legislation Ready for Conference Committee
- Fiscal Year 2019 Appropriations Bill Passes the Senate
- Senate Health and Welfare Committee Reviews House Changes to S.203 made by the House
- Combined Independent School and Special Education Bill Approved by Senate
- Trauma Legislation Slimmed Dow and Ready to Go
- New Facility Plan Presented at Multiple Legislative Forums
- Senate Appropriations Wades through the Fiscal Year 2019 (FY19) Budget Proposal
- Special Education Bill Approved by Senate Education Committee
- Senate Health and Welfare Updated on S.203 Relating to Systemic Improvements in Mental Health
- House Human Services Continues Deliberations on Trauma Bill
- Senate Appropriations
- Senate Health and Welfare Committee Issues Budget Memo
- House Human Services Accepts Testimony on S261, the ACES Bill
- House Corrections and Institutions Hears Proposal for Mental Health Inpatient Care
- Senate Education Committee Reworks the Special Education Bill
- Minimum Wage
- Upcoming Advocacy Events
- Joint Fiscal Office Gives Budget Overview to Senate Health and Welfare
- Representatives Toll, Hooper and Fagan Discuss House Budget to Senate Appropriations Committee
- Secretary Gobeille Discusses Budget Issues with Senate Appropriations Committee
- House Human Services Continues to Hear Testimony on S261, the ACES bill
- House Human Services Reviews Bill on Education; trauma-informed systems; resilience building House Health Care Receives Overview of ACES Bill
- House Health Care Committee Broadens S.203 to Include Mental Health Parity
- Senate Health and Welfare Takes Time to fully Understand OneCare ACO
- Upcoming Advocacy Events
- Senate Health and Welfare Accepts Testimony on Budget passed by House
- Mental Health Commissioner Bailey Gives Update to Senate Health and Welfare Committee
- Senate Education Plans to Major Adjustments to the House Special Education Bill
- House Human Services Continues Deliberations on ACES
- Senate Health and Welfare Strives to Address Addiction
- Upcoming Advocacy Events
- House of Representatives Passes Budget Bill
- House Passes Special Education Bill and Senate Education Committee Takes it up
- House Human Services Addresses Opiate Addiction
- Senate Health and Welfare Learns about Opioid Treatment in Corrections
- House Human Service Begins Review of ACES bill S.261
- Senate Health and Welfare Learns more about DA Residential Supports
- Upcoming Advocacy Events
- House Appropriations Committee Develops Budget for Approval by the House of Representatives
- Commissioner Bailey Presents to Senate Appropriations Committee
- Senate Health and Welfare Learns about Designated Agency Housing and Support Program
- Minimum Wage Bill Sails through Senate and Begins Consideration in the House
- Senate Poised to Pass Universal Primary Care Study
- House Passes Green Mountain Care Board Legislation
- Trauma Bill Passes the Senate
- Senate Passes Bill to Improve Medication Assisted Treatment for Inmates
- Senate Approves Independent Schools Bill
- Special Education Funding Bill