Vermont Legislature SmartTranscripts:

[Virginia "Ginny" Lyons (Chair)]: Rebecca. Alright. Good morning. Center Health and Home Fair, and it is May 20 Thank you. So, Jen, I we're we're sort of crunched for time. We've three or four minutes, so maybe help us understand if there are any significant differences between what we pass for 01/1997 and what the house is returned with us. Okay. Jen Carvey, I'm the legislative counsel. I have provided a markup version showing you for S197 and Act relating to payment reform, or is it the new title of the end of bill reform for primary care? And this is showing the markup front house proposal of amendment.

[Jennifer Carbee (Legislative Counsel)]: So, I would say, probably the biggest change from what you sent over is this is not focusing on necessarily on using the Blueprint for Health as the basis for doing primary care payment reform. It is, instead, it is expanding on Blueprint language the way you had, but it's not necessarily said that that is the mechanism for getting larger payments for routine care out to the primary care providers. So it says it is the intent of the General Assembly to invest in primary care and to establish a program of universal primary care that is accessible and affordable for all Vermonters and will promote the public good through improving patient experience of care, improving population health, reducing costs, and improving provider well-being. And it gives the purposes of the bill, obtaining information needed to develop a framework for implementing universal primary care, optimizing the blueprint, determining whether the blueprint is an appropriate mechanism through which to provide universal primary care, and exploring other approaches and whether they may be more suitable than Blueprint. Then it makes the same changes that you had made in the Blueprint language itself, except they strike out this new section that was being added, new statutory section that was being added on primary care spending targets. Although much of this concept gets added in a different section.

[Ann Cummings (Member)]: So the per person per month is somewhere else?

[Jennifer Carbee (Legislative Counsel)]: Well, idea of establishing a target for the amount of per person per month spending that should be on primary care and a transitional schedule to increase it over time, that goes somewhere else in the bill. Okay. But the increased spending directed to the per person per month payments in the blueprint does not that's the piece that's coming out. So it's not, yeah, it's not necessarily choosing the blueprint as the basis. You had a lot of reports that were due on January 1. They were changed from those part to January 15. And again, backing off a little bit more circumspect about changes that would be necessary, but not necessarily are necessary. We're not sure if we're transitioning the Blueprint payments. And then this is the report due from the Blueprint, so the director of the Blueprint by January of next year, and you send over a list of things to go in that report. The House has added, starting with establishing definitions of primary care services and primary care provider, which is often a big part of the work in getting started on primary care reform. When they've left the rest of your provisions, you made a couple of changes around the operational plan language you sent, have them providing a description of any additional legislation needed to implement the methodology not later than 01/01/2028. They've taken out that date certain and instead ask for a post timeline for implementation. And then they've added a new provision asking the Blueprint director to provide a description of the ways that Blueprint can optimize services it's already providing for its current initiatives, what it would cost with doing that kind of optimization, and what additional per member per month spending would be needed. And that requires the director of the Blueprint or designee to be available to the Health Forum Oversight Committee throughout the summer and fall for updates. Section 3A directs the agency of Human Services in consultation with the tax department to recommend to various committees, including this one, a process by which Blueprint funding could be transitioned away from the current process or using healthcare claims tax, which was a recommendation from a Blueprint report submitted in 2024 in accordance with Act 51 of 2023. So, that's due by January 15. What it would look like, what kinds of changes would there need to be to the tax rates, and what would be a potential timeline for implementation. Primary care spending report, just change the reference to the definitions to be the ones established in section three. Section five, this is where the primary care spending target language landed, directing AHS to establish a target for the amount of person. About spending should be on primary care in a transitional schedule, and the potential for payer specific differences. So, all of those concepts are still in here, just in a different format. Section six. Here's here's what I'm gonna suggest, Ann. We'll meet briefly fifteen minutes after the floor. We're probably gonna finish around twelve.

[Virginia "Ginny" Lyons (Chair)]: And I have a committee conference at twelve, so you all can vote. What time do you have at at twelve? Yeah. Okay. Have to get up there to get the logistics for health. Okay. Education bills around. Yeah. I will say, having looked at this with Jen on Friday and having reviewed it again over the weekend, I think that the changes are not significant. Okay. Oh, I get it. And really, I think. You can give me a high level version of what else is Section in or not six directs the Agency of Human Services Green Mountain Care Board and Department of Financial Regulation in collaboration with the healthcare advocate to look at their roles in healthcare regulation and healthcare reform, and make recommendations for where all of those functions should, get in their minds, be housed, and come back with a report, separate reports from each of them in January with their own recommendations of how to distribute those responsibilities to where there's agreement and disagreement, and any legislative change is needed, and again, they would need to be available to be held through phone numbers at United for the summer and fall. Section six, you had them update, the Green Man Care Board updating some reports. Gremant Care Board said they would need an appropriation to do that, and so the House took that language out. So that we don't have any money. No changes on seven or eight, section nine is a provision that is in the budget. This is removing the sunset on the primary care medical student scholarship program, so it's not gone, it's just in the budget instead of in this bill, and that's it. They've been entitled to emancipating to reform for memory. Okay. I get it. Anybody wanna meet again to discuss this?

[Ann Cummings (Member)]: Basically, isn't this moving out of covering a lot of it.

[Virginia "Ginny" Lyons (Chair)]: Right, it's taking a step back from deciding that blueprint should be the basis. Right. Makes it more generally primary care. Yeah, I don't I don't know have a stroke bone. Good. Thank you. You're on. Perfect. Nice. Majority of the committee. There

[Ann Cummings (Member)]: you go. That line down.

[Virginia "Ginny" Lyons (Chair)]: Got it. That's right. Thank you. Thank you, John. And no one. Oh, she So we won't meet. We won't meet.