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Act 60 (H.201) An Act Relating to Hospice and Ppalliative Care

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Summary Act 60 (H.201): General Overview

This bill is the result of ongoing annual work aimed at improving access to palliative care, pain management and end-of-life care services for all Vermonters. The bill accomplishes further improvements in access to care and coordinated systems of care by:

  1. Encouraging private insurance companies in Vermont to offer an "enhanced hospice benefit" modeled after the Aetna Pilot Project. This pilot project utilized trained nurse care managers to manage the comprehensive needs of patients living with terminal illness; it expanded the standard hospice benefit from 6 months to 12 months, and allowed for continuation of curative therapy while on hospice. Results of this pilot project showed an increase in patient and family satisfaction, a decrease in the utilization of acute care services and a net cost decrease of 22%.
  2. Requiring by no later than July 1, 2012 the agency of human services to include as part of its application to the Centers for Medicare and Medicaid Services (CMS) for dual eligible individuals a proposal for "enhanced hospice access" where by the definition of terminal illness is expanded from six month life expectance to 12 months and individuals may access hospice without being required to first discontinue curative therapy. Also, by no later than July 1, 2013 the agency of human services shall submit a Global Commitment Medicaid waiver amendment to provide funding for the same enhanced hospice access benefit.
  3. Revising the current Department of Disabilities, Aging and Independent Living (DAIL) policy regarding Choices for Care (CFC) and Hospice Services. The current policy allows for participants already enrolled in CFC, who receive a terminal diagnosis, to then enroll in hospice. However, patients who enroll in hospice first, under the current policy, are not permitted to apply for and enroll in CFC. This bill creates a one-year trial period that will remove CFC as a barrier to hospice by allowing individuals admitted to hospice first, to then simultaneously apply for CFC.
  4. Including palliative care, hospice, end-of-life care and pain management into the definitions of chronic care and chronic care management in the state's Blueprint for Health.
  5. Requiring, the Board of Medical Practice to establish by rule, a minimum of 10 hours of continuing medical education (CME) as a condition for renewal of an active license to practice medicine. Additionally, the board will require evidence of current professional competence in recognizing the need for timely appropriate consultations and referrals to assure fully informed patient choice of treatment options, including treatments such as those offered by hospice, palliative care and pain management services.
  6. Improving seamless transitions between setting related to patient preferences regarding limitations of treatment by requiring that the DNR/COLST form be the required form for documenting out-of-hospital do-not-resuscitate (DNR) orders and clinician orders for life sustaining treatment (COLST). In addition, creating uniform requirements for DNR identification for patients seeking to wear a DNR identifier—such as a bracelet, necklace, or anklet.
  7. Requiring the Department of Health to convene a study committee to examine the criteria to be used for rules concerning individuals who are giving informed consent for a DNR/COLST order but who are not the patient, agent or guardian. The study committee will report to the Health Access Oversight Committee by December 1, 2011 with recommendations and by March 1, 2012 shall promulgate rules regarding these criteria.