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Appropriations committee questions elder‑care and primary care requests, flags limits of transformation funds
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Summary
Members pressed staff and presenters on elder‑care clinician services, VNA skilled‑nursing codes and a primary‑care inflationary adjustment, and heard that rural health transformation funds likely cannot be used to backfill existing provider payments.
The House Appropriations Committee scrutinized several health‑sector funding requests March 18, focusing on elder‑care clinician services, targeted VNA (visiting nurse association) skilled‑nursing increases, and a primary‑care inflationary adjustment listed in the materials.
A committee member explained that elder‑care clinician services had been partially funded by multiple sources and that the Department of Mental Health had reduced its share with the rationale "people can go to Medicaid counselors who can bill Medicaid to get their services in lieu of the elder care clinician," raising concerns about whether access and continuity would be maintained for older Vermonters if services shifted without additional pay or staffing.
Members asked whether the VNA skilled‑nursing increase was the same as other DA/SSA or home‑and community‑based services increases; an agency presenter clarified that VNAs are coded separately (different budget codes) and therefore are separate line items. Committee members requested a breakout of codes and dollar amounts so the committee does not inadvertently omit providers from funding decisions.
On primary care, the committee discussed an "inflationary adjustment" figure noted in materials as 1.299 (committee materials). The Vermont Medical Society representative warned that the rural health transformation program "cannot use it to backfill any current budget items," and said CMS rules remain in flux about what blueprint programs can include. Staff and members noted that transformation funds generally cannot replace ongoing provider payments or pay for infrastructure absent explicit CMS approval.
Committee members directed staff to provide clearer numeric breakdowns (global commitment vs. general fund), to confirm what can be covered by rural health transformation funding, and to supply the source documents behind the noted figures before the committee advances final appropriation recommendations.
