Meetings
Transcript: Select text below to play or share a clip
[Alyssa Black (Chair)]: The sound of your voice. Hi. Welcome back. Sorry for the little break. Okay. So we're flipping to we've made some changes to six eleven. We're gonna walk through that. Have any committee discussions?
[Jennifer Carbee (Office of Legislative Counsel)]: Have a speaker hearing from some other witnesses.
[Alyssa Black (Chair)]: Yeah. Then we have some
[Jennifer Carbee (Office of Legislative Counsel)]: other witnesses. So it's a work in progress. Yeah. Alright. Again, Jen Harvey, Office of Legislative Counsel. So this is it's currently drafted as a strike all amendment, although the changes so far are fairly minimal. There is a new section two page starting on page six that amends a statute that was enacted based on work in this committee last year. So people who were on the committee may remember that you did a lot of work, and we talked about this a little bit when we walked through the acts from last year. This is from Act 55 around 340B entities, entities that are allowed under federal law to use the 340B drug discount program pricing for prescription drugs. And there are several things that were in there that prohibited 340B or drug manufacturers from discriminating against 340B covered entities and the contract pharmacists that they worked on. Oh, I don't have it on the screen.
[Alyssa Black (Chair)]: Doesn't know what's wrong on
[Jennifer Carbee (Office of Legislative Counsel)]: this page. Thank you. Nope. That was great. Alright. Here's the language. So on page six, section two. And this would strike the there were four subsections. This would strike the last subsection, which says a manufacturer or its agent shall offer or otherwise make available 340B drug pricing to a 340B covered entity or its contract pharmacy in the form of a discount at the time of purchase and shall not offer or otherwise make available 340B drug pricing in the form of a rebate. So some of you may know there is litigation ongoing on actually all of the 340B provisions that you enacted last year. This is the for the most part, the rest of the sections seem to have been upheld by courts. So only two courts have actually looked at this issue of whether states can prohibit rebates and only allowed discounts. Those two courts have found or have ruled that that is the exclusive jurisdiction of the federal government and that the states cannot do that. And so to be on the safe side, this would remove that language from our law as well. This language from our law is actually already subject to a preliminary injunction from the US District Court in Vermont as well. So this is would just remove this language so that it does not get dropped down.
[Alyssa Black (Chair)]: I asked Jen to to add this language. Not add the language. Write this language.
[Jennifer Carbee (Office of Legislative Counsel)]: Put the section in well. The only other, so I renumbered the sections. The only other change other than the section numbers at this point is I think there had been some committee discussion maybe this is around the state plan amendment for doula coverage under the Medicaid program. And under existing laws, DIVA has to seek the state plan amendment from the Centers for Medicare and Medicaid Services to allow Medicaid to cover doula services. If not, they have to seek that state plan amendment by July 1. Diva had asked in this bill to push that date out two years. This would move it back one year. So this would change instead of 2026 or 2028, it would have 2027 and give an additional year for him to do that. So it comes in in two places. First one is around when they seek the state plan amendment. The second is around when coverage would begin. And it is the later of those two dates, the date or the approval of the State Plan Amendment. So it would not start before 07/01/2027, even if they sought the State Plan Amendment tomorrow. So you could, if you wanted, leave that second date alone, and it would just be the later of the two, but that may create some false expectations around when coverage would start.
[Alyssa Black (Chair)]: We originally made it '26 last year. They asked for '28, and we put in '27, and we're going to hear from Ashley Berliner at DEETH regarding this. Unless there's any other questions from Jen or Jen. Okay. Thank you. Ashley, thanks for joining us, especially at the last minute. We really appreciate you flexing.
[Ashley Berliner (Director of Medicaid Policy, Agency of Human Services)]: Happy to. For the record, I'm Ashley Berliner, Director of Medicaid Policy for the Agency of Human Services. Can Can you hear me all right?
[Alex [last name unknown] (Director of Communications and Legislative Affairs, Department of Vermont Health Access)]: Yes. Yep, we hear you great.
[Alyssa Black (Chair)]: So go ahead, we just wanted you sort of to speak about the section seven, kind of get your read on whether or not you think this is achievable and what needs to happen in the meantime while you're trying to figure this out. When I say your, I don't mean you personally, you know.
[Ashley Berliner (Director of Medicaid Policy, Agency of Human Services)]: Absolutely. So we think that July 2027 is achievable. We need time between now and then to get our state plan amendment drafted, submitted, and approved by the Centers for Medicare and Medicaid Services. We also need to do some not modest IT work to create doulas as a provider, get all the billing and rate setting done and set up in our Medicaid Management Information System or MMIS. We generally go out a year from whenever we're like turning on a new benefit or adding a new provider type. So July 2026 or 2027 feels like a realistic date for us.
[Jennifer Carbee (Office of Legislative Counsel)]: Okay.
[Alyssa Black (Chair)]: I think in previous testimony, there had been, maybe some concerns around certification or licensure. Is that something that you think that Vivo will be able to reconcile with and that'll make a strong pace for the state plan amendment.
[Ashley Berliner (Director of Medicaid Policy, Agency of Human Services)]: So my understanding is that there's been some movement in the past week around what the doula advocacy is really looking for and hoping for related to Medicaid benefit. I think previously, AHS and DIVA had been concerned about having doulas providing doula services without a touch point to clinicians. My understanding now is that they are comfortable having a referring provider make sure that that is something that is happening before doula services are provided. And if that's the case, then I feel a lot better about being able to get that in front of CMS and get it approved. It satisfies not all, but a lot of our concerns around just program integrity and making sure that we are ensuring high quality services for the Medicaid population. Thank
[Alyssa Black (Chair)]: you. That's so important. And I appreciate all the work that everyone has done on this. Any questions for Ashley? Any concerns from the date change from anyone? Just opening up for That was a nice compromise. Easy when got one year, another year, and then one right in between. It's like, here we go. Alright.
[Ashley Berliner (Director of Medicaid Policy, Agency of Human Services)]: We're gonna start proposing everything be two years out now.
[Alyssa Black (Chair)]: Don't wish your luck. Can make it like six months.
[Alex [last name unknown] (Director of Communications and Legislative Affairs, Department of Vermont Health Access)]: And there's also elections every two years, so.
[Alyssa Black (Chair)]: All right, thanks, Ashley. Thanks for joining us.
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: Thank so
[Ashley Berliner (Director of Medicaid Policy, Agency of Human Services)]: much, Ashley. Thanks so much, take care.
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: All
[Alyssa Black (Chair)]: right, is Emma with us on Zoom? Oh, okay.
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: Hi, I am here.
[Alyssa Black (Chair)]: Hi, Emma. How are you?
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: Good. I see Mike Fisher moving to the front of the table as well. Maybe
[Mike Fisher (Chief Health Care Advocate, Office of the Health Care Advocate)]: I'll just sit for a second and I'll let you share the screen. Does that work?
[Alyssa Black (Chair)]: Yeah, That sounds great. And
[Jennifer Carbee (Office of Legislative Counsel)]: let me just let me
[Mike Fisher (Chief Health Care Advocate, Office of the Health Care Advocate)]: just introduce it, and I'm gonna give it to Emma to do the details. We had put some energy into and some work to try and develop. We had a number of things we were contemplating offering on this bill. And after some discussion with Diva, decided that there was one narrow, very technical thing to offer and that the other things we were contemplating needed more work, and we will continue to work with Diva on those things. And so, Emma, I'm glad you can make it. Go ahead.
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: Hi. Emma Zavez. I'm a health policy analyst at the office of the health care advocate, work with Mike. Yes, and I'm pleased to be with you all. I'm sorry it's not in person, but rather on Zoom, but glad that I was able to make it. So we are let's just move right off the slide. We're here to make a recommendation. I think it's a simple recommendation, really. We are suggesting that in H611 you consider deleting a reference to MAGI, which is the modified adjusted gross income methodology. That is cited as the financial methodology for calculating eligibility for the V Pharm program. V Pharm is a pharmacy assistance program that helps Vermonters with Medicare. A long time ago, this was put into statutes, and it was never it was never realized. So why are we suggesting it now? Well, first, this is a cleanup bill, and I think it's the first Diva miscellaneous bill we've seen in a couple of years. So it's a great place and a great time to do it. And since the MAGI methodology has never been utilized for V farm, it seems it seems about time that we clean that up to go back a little bit further. I will say that this committee received a report about the future of the V farm program. Believe that was last session from Diva, And this was one of the notes in the report was that the VFARM financial methodology and statute has been sort of off off base for what it actually evolved as a program. And fixing this is a good first step sort of in beginning to contemplate the future of the V farm program. As many of you know here, we've expanded the Medicare savings program that brings more pharmacy benefits to from a federal program to Vermonters and will have implications in future years for the V farm program. So. That's teeing up what's to come in future years thinking about the future of the V farm program, but this is just a little baby step in that direction. Just a little bit more background, I think I mostly covered this farm utilizes the old Vermont Health Access Plan rules, all of which have been repealed except for the income counting rules, and that was never inserted into statute.
[Mike Fisher (Chief Health Care Advocate, Office of the Health Care Advocate)]: Who remembers VHAP?
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: Sorry. Can you say that again?
[Mike Fisher (Chief Health Care Advocate, Office of the Health Care Advocate)]: I said, who remembers VHAT? Probably
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: not many.
[Mike Fisher (Chief Health Care Advocate, Office of the Health Care Advocate)]: VHAT was great.
[Emma Zavez (Health Policy Analyst, Office of the Health Care Advocate)]: Yep. Yes. And I will tease our position, which is that in future years, we hope that the DIVA staff will will be able to calculate the farm eligibility, utilizing sort of the Medicaid age blind and disabled and Medicare Savings Program eligibility rules. Right now they've got a lot of different systems running different rule sets for different programs, and we would love to, see some more efficiencies for them, with those being aligned. I think it would also be good for Vermonters too. That is not something that I think is on anybody's plate this year. There's so much coming at us, but we hope to to bring that back up in future years. Here is the language that's currently in statute with the section highlighted that I believe could just be deleted, but I will leave that to Jen Carvey, who will know best. Alright, short and sweet. Are there any questions?
[Alyssa Black (Chair)]: Not from me. Most, Mike, do you wanna?
[Mike Fisher (Chief Health Care Advocate, Office of the Health Care Advocate)]: Think I think that's that's it. It's truly technical, I think, we have coordinated our efforts with Debra here, so it might be good to hear.
[Alyssa Black (Chair)]: I was going to ask,
[Jennifer Carbee (Office of Legislative Counsel)]: can you speak in
[Alex [last name unknown] (Director of Communications and Legislative Affairs, Department of Vermont Health Access)]: I'm happy to. Yeah. Record, Alex, happen to What about? The Director of Communications and Legion Affairs for the Department of Remodeling Health Access. We have no problem with this change. We're the last part of this, and as Mike referenced, this was a finding contained in the VFR report from last session. So we're perfectly happy to see this included. Okay,
[Alyssa Black (Chair)]: Should we take a break?
[Jennifer Carbee (Office of Legislative Counsel)]: What at least she ate breakfast?
[Alex [last name unknown] (Director of Communications and Legislative Affairs, Department of Vermont Health Access)]: We were. Oh, we don't have to work at 03:30.
[Alyssa Black (Chair)]: Okay. I think we're going to take a break. We're going to take a ten minute break.
[Alex [last name unknown] (Director of Communications and Legislative Affairs, Department of Vermont Health Access)]: Perfect.