By David Mickenberg
- Choices for Care (CFC): CFC is Vermont’s long-term care (LTC) program for low-to moderate-income elders and adults with disabilities. It provides for both nursing home and home-and community-based care for those with financial and clinical needs for the same. The program has been very successful in giving Vermonters a choice as to where to receive services and in saving the state significant dollars.
The final version of the FY ’16 budget (H.490), yielded mixed results for CFC. First, it eliminated funding for case management for Enhanced Residential Care (ERC) and a grant to adult day programs. COVE and its partners fought to keep that money, but the Administration opposed restoring it. Those cuts are of particularly concern to Area Agencies on Aging (AAAs) and other providers of the case management services and will likely lead to reduced staff at those organizations and increased pressures on existing staff and program budgets. It should be noted that those cuts were made while at the same time the nursing home industry received its full statutory increase, which amounted to over $3 million dollars. COVE is continuing the discussion about the need to balance both Home and Community Based Services with residential care such as nursing homes, and how such a balance is reflected in the budget. That will be a conversation COVE will continue over the summer and fall and aggressively push in the legislature next year.
On a positive note, however, COVE worked to have language inserted in the budget requiring the Administration to examine the ongoing problem of delays in CFC eligibility determinations. With more than 60% of Vermonters who apply for CFC services having to wait over 60 days to be found financially eligible for the program, we are concerned that such delays risk elders’ health and ability to continue to age in their homes. We are hopeful that this important language will lead to an action plan to reduce the waiting times for eligibility determinations. COVE will engage with the Administration this summer and fall to ensure that the necessary data are extracted and a plan is developed to end the lengthy delays. Such delays put elders at risk of increased health problems and place serious burdens on families and other care givers struggling to assist their loved ones.
In addition, COVE succeeded in getting language included in S.135 (the Senate health care bill) that requires the Department of Disabilities, Aging and Independent Living (DDAIL) to examine the reimbursement rates for LTC providers. Initially the language did not include Home & Community Based Services (HCBS), but COVE was able to get those providers added. This is a significant victory for the LTC HCBS providers because it will help shed light on the chronic under-funding of those providers. The language will also be important to the discussion of balancing funding needs of HCBS and those of nursing home care.
Finally, COVE and its partners helped secure additional language requiring examinations of whether there are duplications in LTC services in the state, as well as the impact on Adult Days for their increased utilization of CFC savings for the moderate needs group and the consequences if that money were not to continue.
- Low Income Home Energy Assistance Program (LIHEAP): The federal LIHEAP provides assistance paying for home heating for people of all ages, including many elders whose household income does not exceed 150 percent of the federal poverty level.
The Governor’s FY ’16 budget cut LIHEAP by $6 million from last year’s appropriation for FY ‘15. Despite COVE’s and other advocates’ efforts, the House and Senate did not restore the funding. Ultimately the legislature agreed to language which authorized the state to spend up to $5 million in contingency funds to ensure that LIHEAP recipients receive the same level of funding they did in previous years. Over the summer and fall COVE will work with its partners to draw legislators’ attention to the real world impact that this program has, the consequences of not fully funding it, and some options for funding in the future, e.g. an increase in the Gross Receipts Tax.
- Dietary Supplements: A proposal to tax dietary supplements surfaced again toward the end of the session in the Senate revenue bill. COVE joined with its partners to oppose the proposal and Gini Milkey testified at a public hearing, highlighting the impacts of the proposal on elders. The Senate Finance Committee removed the provision and it did not resurface, but we will watch for it next year.
- Transportation: The proposed study of the Elders and Persons with Disability (E&D) Transportation Program remained in the final version of the transportation bill (H.488). That language may be found in Section 12, pages 9-10 of the final bill: http://legislature.vermont.gov/assets/Documents/2016/Docs/BILLS/H-0488/H-0488%20As%20Passed%20by%20Both%20House%20and%20Senate%20Unofficial.pdf
- S. 20 Dental Therapists (formerly called “Licensed Dental Practitioners,”: Recap: This bill would increase access to affordable oral health care for Vermonters of all ages by establishing and regulating a new member of the dental team, a mid-level “Dental Therapist.” S.20 went through three Senate Committees and passed the Senate with a strong final vote of 18 to 8. The Senate-passed version may be found at: http://legislature.vermont.gov/assets/Documents/2016/Docs/BILLS/S-0020/S-0020%20As%20Passed%20by%20the%20Senate%20Unofficial.pdf.
Because S.20 missed crossover, it went to the House Rules Committee, from which it was voted out and sent to House Human Services, the first of three House standing committees to which it must go. Human Services had other priorities, and it was late in the session, so they held a hearing on it on May 6, but will not take further testimony on it this year. We are hopeful that the committee will take it up early in the 2016 session. The Oral Health for All Coalition, of which COVE is a member of the leadership team, will work over the summer and fall to strengthen support for the bill in the House.
- Observation Status: Recap: This is an important issue, as elders are often put on such status instead of being admitted as inpatients, resulting in the hospital stay being covered differently and an inability to access important Medicare funds to be used for care following their release from the hospital. COVE supported this bill and worked with its partners, in particular Vermont Legal Aid, to help advance the issue throughout the session.
Update: Toward the end of the session the House modified the Observation Status provision in S. 139 to target it to Medicare beneficiaries. It also included a provision to look at the commercial market and report back to the legislature regarding observation status notice for commercial payers. The House passed version of the Observation Status bill was included in the final version of S.139, a big victory for elders and other Vermonters who now can make informed decisions about care that can have serious financial consequences. Language in the final bill is in Sections 4-6 on pages 3-5 at this link: http://legislature.vermont.gov/assets/Documents/2016/Docs/BILLS/S-0139/S-0139%20As%20Passed%20by%20Both%20House%20and%20Senate%20Unofficial.pdf.
- Vulnerable Adult Fatality Review Team (originally H.46): Recap: This issue was discussed in the context of the budget, and the Senate Appropriations Committee had a lengthy debate about it during the appropriations process. The Hospitals and Nursing homes pushed to exclude language related to this important issue and ultimately the Committee felt it should be contained in a stand alone bill. COVE and other partners have committed to working on this issue over the summer and coming back next session with recommendations for enacting legislation.
Update: This issue is one of basic protection for elders, to ensure that when a fatality occurs, we understand the circumstances of that fatality so that information can be used to keep elders safe and healthy. We will work to ensure that the Administration joins COVE, Vermont Legal Aid and others to work out legislative language that is acceptable to all the parties, and most importantly, protects elders.
- H.25 Natural Burial Grounds: COVE lobbied in support of H.25 (now Act 24 of 2015), a bill that would expand access to natural burial grounds in Vermont and allow a lower cost option for people who want to be buried in a natural setting. The bill passed both bodies and was signed by the Governor on May 18th. This is a bill that COVE has long supported and one that takes a ground-breaking approach to how individuals choose to be buried and the ecological impacts of those choices. Act 24 may be found at: http://legislature.vermont.gov/assets/Documents/2016/Docs/ACTS/ACT024/ACT024%20As%20Enacted.pdf.
For a summary, you may go to: http://legislature.vermont.gov/assets/Documents/2016/Docs/ACTS/ACT024/ACT024%20Act%20Summary.pdf.
- Earned Time Off: Recap: The House passed a bill providing for 3 days of earned time off, which increases to 5 days in the second year. While this legislation was not taken up by the Senate before adjournment, it has tremendous momentum, including the backing of the White House, who directly engaged on the issue, and will likely see action next year. COVE will continue to monitor the bill and participate as a coalition partner, with a focus on the continued inclusion of elders and kinship care.
EXPLANATION OF LEGISLATIVE JARGONESE: “Crossover” is a date by which all bills have to be voted out of committee in order to have a reasonable chance of being acted on by the other body. The 2015 crossover date was March 13. Bills that miss crossover may be taken up by the other body if a prior agreement was made and/or with approval of the governing rules committee. (Crossover for bills in money committees was a week later – March 20 in 2015.)
If you go to the bill links noted in this report and view a bill that has been amended, the crossed-off language has been deleted from the bill as introduced, and the underlined language has been added.
