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The 2017-2018 legislative biennium was gaveled in amidst unprecedented change and uncertainty in the broader environment. Vermont is experiencing more turnover in leadership than anyone can recall from other years - a new governor, a new speaker of the house and a new senate president pro tempore.

 

The optimism, energy and new perspective that new leaders usually bring to their roles has been somewhat overshadowed by the uncertainty and anxiety about federal dollars wrought by the unexpected results of the presidential race. Vermont is a state that relies heavily on federal funding, and few states have embraced the Affordable Care Act as Vermont has. For those of us working on health care reform, we are proceeding for now as though the all-payer model will continue to form the foundation of Vermont's health care planning, but that may change.

 

In the simplest terms, the all-payer model is an agreement between Vermont and the federal government to move away from paying providers for what they do (tests, visits and procedures) toward paying for how well they take care of people. Changing the payment model is not an end itself. The real goal is reducing the cost of healthcare and improving the care Vermonters receive by preventing the need for the most expensive and complex services (like hospitalizations) to the greatest extent possible.

 

The success or failure of Vermont's ambitious health care goals will, to a large extent, rest on the work of VNAs and other community providers. Few are as adept at taking care of the whole person as our VNA clinicians; they integrate the social and emotional realities of each person with their health care needs and goals every day. Our clinicians can spot trouble brewing for an individual long before that person calls their primary care practice - or an ambulance. When working with a patient to make sense of a complex medication regimen, we can open the medicine cabinet. For individuals in rural Vermont for whom transportation is a barrier to care, we go to them. There is so much more we can do.

 

But Vermont's VNAs are deeply challenged financially. The federal government is ratcheting down reimbursement and Vermont's Medicaid program - which covers approximately a third of our patients - pays less than the cost of care. Over the past decade, Medicaid reimbursement rates have failed to keep pace even with inflation. Most VNAs would be in the red if not for their extensive fundraising efforts. These financial realities make it harder to recruit and retain the staff we need to take care of more Vermonters as our population ages and more care is diverted away from the hospital. Home care is a great value - the same amount of money will buy about 5 days in a hospital, 39 days in a nursing home and 138 days of home care. Despite that, Vermont has failed to adequately invest in its community system that cares for some of Vermont's most vulnerable. The VNAs of Vermont will be working hard this legislative session to convince lawmakers and the Administration that as they make tough choices about how to spend limited resources, they invest in the Vermonters that we serve.

 

Vermont Update

Watch this space for updates on health care reform, the goings-on in the statehouse, and the activities of state government.

 

 

On the regulatory front, the VNAs of Vermont and other stakeholders are developing comments on a preliminary draft of a new home health "designation rule" developed by the Department of Disabilities, Aging and Independent Living (DAIL). The designation rule outlines the requirements that VNAs must meet in order to be certified by the state to provide home health services. The rule will go out for formal public comment in the next month or so and we will share that version when it becomes available.

 

Federal Update

Like all provider groups, we are following the progress of the repeal of the Affordable Care Act and potential changes to Medicare and Medicaid closely. As details emerge and the impact on our ability to serve Vermonters becomes more clear, we will report that here.

 

On the regulatory front, the Centers for Medicare and Medicaid Services just released a final rule that defines the Home Health Conditions of Participation (HHCoPs). The Home Health Conditions of Participation are the federal requirements with which providers must comply to maintain Medicare and Medicaid certification. Many of the rules have been unchanged since their inception, so this is a major development. Among other things, t he rule expands the standards for patient rights, care planning, and care coordination, and includes two new CoPs - one for a quality assessment and performance improvement (QAPI) program and another for an infection control program. The revised HHCoPs go into effect July 13, 2017. The National Association for Home Care and Hospice (NAHC) is hosting a webinar for members and non-members (for a fee) on January 25 entitled What do the New Home Health CoPs Mean to You?. Click here to register.