When I got my first job out of graduate school, my grandmother demanded that I provide her with a 3x5 index card explaining my job in a few bullet points. She pinned it to the wall next to her kitchen phone and referenced it proudly when sharing with friends and family what her middle granddaughter was doing with all that education. Nana has been gone for a while now, but I still have a mental index card I use when trying to explain to people outside my professional circle what it is that I do for a living. Statehouse advocacy is one of the easiest parts of my role to explain, so in the summer
----- knowing the legislature has adjourned
------ people often ask me how I fill my time.
There are many answers to that question, but in short, summer is regulatory season. After the session concludes, Administration officials in Vermont also spend less time in the Statehouse, so that's when most of the "rulemaking" takes place. At this writing, we expect to see a proposed home health designation rule
----- Vermont's criteria for deeming a home health and hospice agency qualified to provide services
----- any day now. The Vermont Department of Health is working on some revisions to the opioid prescription rule, which has an impact on our hospice patients. The Department of Vermont Health Access has released a home health payment rule outlining new documentation requirements (known as Medicaid Face-to-Face) imposed by their federal partners, and a telehealth rule that includes a section on telemonitoring.
July is also the time of year when the federal Centers for Medicare and Medicaid Services (CMS) releases a draft home health prospective payment system (PPS) rule for public comment. This rule outlines how CMS plans to pay home health agencies, usually over the next two years, based on Congressional guidance and the relatively broad authority of the agency. It is the vehicle through which Medicare reimbursement to home health agencies has been slashed over the last decade or so. Needless to say, it's an important document.
This year's proposed rule weighs in at about 600 pages. It lays out the schedule for phasing out the "rural add-on" payments that
----- while expected
----- is deeply worrisome. Our nurses, therapists and aides travel more miles than their more urban counterparts, and they cannot see as many patients in a single day. The rural add-on reflected these added costs and its planned phase-out was one of the biggest disappointments of the Bipartisan Budget Act of 2018. The rule also calls for a major overhaul of the entire home health payment system in 2020
----- and the initial analysis by our national partners suggests that the overhaul will result in another Medicare cut overall. The VNAs of Vermont will be working closely with our national partners, members and regional financial experts to analyze the impact on Vermont's home health system.
It's a lot to think about and I'm grateful to have hobbies that help me unwind and view the issues with a fresh perspective. For me, summer is also about mountain biking. I have a wonderful group of women with whom I ride one evening a week and my husband and teenage son are also avid riders, so that's how we usually fill our weekends. The picture above shows me on my bike posed with Governor Phil Scott. Through my participation in Vermont's statewide mountain bike association, I had the opportunity to join the Governor and some of his cabinet members last week as they explored Caledonia County's Kingdom Trails as part of their Capitol for a Day tour. Nana would be horrified by the bruises and scrapes I routinely sport at this time of year. But she'd have put that picture next to her phone.