Final Reading: Service providers are wary of looming changes to Vermont’s case management structure

For years, the state of Vermont has been out of compliance with federal rules around home and community-based services.

The state’s system for caring for older Vermonters, Vermonters with physical and developmental disabilities, and Vermonters with traumatic brain injuries is operating in violation of federal regulations governing conflicts of interest.

Currently, those services — such as therapy, medication and home care, among others — are overseen by state programs such as Choices for Care, the Developmental Disabilities Services Division and the Traumatic Brain Injury Program.

The problem is that some entities, such as designated agencies and home health agencies, not only offer actual services to clients — they’re also in charge of their case management.

Therein lies the violation. The concern is that, because of their position filling both roles, agencies might improperly steer clients toward their own services.

For years , Vermont has been negotiating with the Centers for Medicare & Medicaid Services over how to solve this problem. Now, the state is homing in on a solution.

Per the state’s plan , Vermont will put out RFPs for case management services for Vermonters with developmental disabilities and brain injuries. The state’s five Area Agencies on Aging will provide case management for Choices for Care clients.

“The objective here is really to protect the rights of the participants in the home and community-based services programs,” Monica Ogelby, the Medicaid director at the Agency of Human Services, told lawmakers in the House Committee on Human Services last week.

The changes are necessary to adhere to federal regulations. But some in the industry are raising concerns about them.

“All of the things that are the reason that the feds didn’t want us to be able to do this, are what we think has some value,” Jill Olson, the executive director of the VNAs of Vermont, told the Human Services committee Thursday. “And so we view it as a loss.”

Housing direct services and case management under the same roof allows for closer coordination of services and communication between case managers and providers, advocates said.

In fact, Vermont’s system of care was designed specifically to offer wraparound services in clients’ communities, Delaina Norton, the director of long term services and supports at the Howard Center, told the committee Thursday.

“Our state early on had already understood the importance of continuity of care,” Norton said. And now, “one of the things that we’re really worried about being disrupted is this continuity of care.”

The move could also lead to turmoil in the field, witnesses said, as case manager jobs are lost at some agencies and added in others.

At the moment, lawmakers in the committee are not looking at legislation around the issue. But amid widespread staffing and housing shortages, it’s still a topic that bears scrutiny, said Rep. Theresa Wood, D-Waterbury, who chairs the House Human Services Committee.

“It’s something that we will need to be paying very close attention to,” Wood said Thursday. “Because it does have the very potential — and I’m gonna say likely — impact of further destabilizing a system that is already very fragile.”

— Peter D’Auria

In the know

Dueling press conferences from House Republicans and Democrats on Thursday afternoon sought to control the message on the education finance proposals working their way through the Statehouse.

Democrats, led by House Speaker Rep. Jill Krowinski, D-Burlington, were backed up by representatives from the associations representing Vermont’s teachers, principals, superintendents and school business officials.

Their message: The legislation under consideration has brought down estimated average education property tax increases, dropping them from 20% down to roughly 15%, and will lay the groundwork for structural reforms in the future.

House Republicans derided what they referred to as a lack of structural change present in the House’s annual yield bill.

Last week, the legislation included new ideas to limit school spending increases over the next two years and set the state in motion to pivot to a completely new funding formula in fiscal year 2027.

Both of those actions were tempered when the House Ways and Means committee voted out the bill Wednesday.

The Rs also offered their take on the big but vague idea coming out of Gov. Phil Scott’s administration to defer property tax increases over several years.

After Craig Bolio, the state tax commissioner, threw out the concept last week , State Treasurer Mike Pieciak opposed it due its potential negative impact on the state’s credit rating.

Republicans in the House similarly couldn’t support the idea.

“Right now, it’s not fleshed out enough for us to get behind it,” Rep. Scott Beck, R-St. Johnsbury, said at the party’s press conference.

— Ethan Weinstein

On the move

A key Senate committee has advanced a major bill that includes updates to Act 250 and a range of policies intended to encourage more housing development in Vermont. But hours before the vote, Gov. Phil Scott argued that the legislation does not go far enough to promote housing growth and signaled a potential veto.

Multiple bills aimed at modernizing Vermont’s half-century-old land use law have circulated around the Statehouse this year , drawing intense debate over how to protect Vermont’s natural resources in an era of climate change while also lowering barriers to more housing development.

Now, those bills have become one.

Read more here .

— Carly Berlin

A Senate panel advanced a bill Thursday morning that would allow the establishment of Vermont’s first overdose prevention site , a.k.a. safe injection site.

The bill, H.72 , initially envisioned a pilot program of two overdose prevention centers. But committee lawmakers amended the bill to allow for and fund only one site — specifically in Burlington.

Financial backing for the site — $1.1 million — will now come from the Opioid Abatement Special Fund, which is funded through settlements with drug companies.

The bill also directs $1.45 million in settlement money for syringe service programs, which provide clean syringes and paraphernalia, drug testing and naloxone.

The bill passed out of the Senate Health and Welfare committee in a party line 3-2 vote Thursday morning and will now head to Senate Appropriations.

— Peter D’Auria

The committee also advanced H.766 , a bill intended to limit how health insurance companies can handle claims and medical orders from clinicians. Providers say many insurer practices — such as prior authorization, step therapy and claims editing — are pushing clinicians out of the profession and have a negative impact on patient care.

The committee added an amendment intended to improve patient access to asthma medicine, which providers say is often subject to restrictions and regulations by insurers.

Insurers, however, say their tactics are necessary to curtail health care costs. If the bill passes, they say, Vermonters will end up on the hook for higher insurance premiums.

— Peter D’Auria

On the floor, the House advanced H.626 , a bill designed to address the state’s disorganized approach to animal welfare . After final approval, it will head to the Senate for consideration.

The issue, according to Rep. Chea Waters Evans, D-Charlotte, is that enforcement of animal welfare laws is fragmented between too many agencies, with no one to coordinate between them.

When concerned citizens call to report neglected horses , or starving baby goats , there’s a lot of finger pointing between departments as to who is responsible. And when the government finally intervenes, it is often too late.

“If everyone is responsible, then nobody is,” said Waters Evans, in her remarks on the House floor.

To address this, the bill would establish a division of animal welfare within the Department of Public Safety. It would be headed by a director of animal welfare, who would investigate reports of animal abuse and serve as a primary point of contact for concerned citizens.

To fund the expenses of the new department, the bill would create an Animal Welfare Fund. Money would come from appropriations made by the General Assembly, and from new license fees for registering dog or wolf-hybrids.

Lawmakers amended the bill to delay its implementation from the previous date of July 1, 2024, to Jan. 1, 2025.

“We believe the six month delay will allow a little bit more time to get off on the right foot with the right hire,” said Rep. James Harrison, R-Chittenden.

— Juan Vega de Soto

Visit our 2024 Bill tracker for the latest updates on major legislation we are following.

Corrections section

A caption for a photo that ran in last night’s Final Reading misspelled the last name of Sen. Alison Clarkson.

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Abenaki people speak out at United Nations about indigenous identity fraud in Vermont , Vermont Public

Corrections: A quote by Rep. Chea Waters Evans was misrendered and Monica Ogelby’s last name was misspelled in an earlier version of this newsletter. Rep. Anne Donahue’s first name was also misspelled in a caption.

Read the story on VTDigger here: Final Reading: Service providers are wary of looming changes to Vermont’s case management structure .