'Rooming house' bylaws draw discussion from citizens

After nearly two hours of heated discussion and comments from the public, the Springfield Selectboard voted 5-0 to adopt proposed amendments to zoning regulations for rooming houses. ...

Several voiced frustration at what they described as unregulated, unsupervised, crowded rooming houses. Others spoke up to advocate for residents who were low-income, elderly, transitional and in recovery and who may need a room to rent as opposed to a full apartment. Some said they wanted the people living in rooming houses or living transitionally, just out of prison, to “go home.” ...

Mairead O’Reilly and Springfield resident Jacob Speidel, who both work for Vermont Legal Aid, offered advice and cautioned the selectboard to seek further legal opinions on the wording of the amendments before making a final decision. O’Reilly said she had concerns related to federal law, and that enacting the ordinance as written could potentially expose town to liability. She also offered to share some of her writing in the field of opioid recovery to be included in the board’s consideration of issues.

Speidel, who represents low-income senior citizens, shared a concern that renting a single room is less expensive than a full apartment, and often, a room is what they can afford. He also said he was concerned the new rules would allow fewer rooms for rent.

Upon a suggestion from Speidel that the board send the document to the town’s lawyer for review before coming to a decision, to avoid any possible legal consequences in the future, McNaughton said the town’s attorney is “very aware” of the language in the amendment.

Grant Funds More Legal Services for Vermonters Facing Eviction, Debt Collection

Vermont Legal Aid’s partner organization, Legal Services Law Line of Vermont (Law Line) has received a two-year $246,034 Pro Bono Innovation Fund grant from the Legal Services Corporation to organize and manage clinics that focus on housing and debt collection cases in several counties. The grant provides an important opportunity for Vermonters who usually have to represent themselves in court against opponents who are represented by attorneys.

“The whole state of Vermont benefits when more Vermonters live in safe, healthy, and stable housing,” said Sam Abel-Palmer, Law Line’s interim executive director. “Children perform better in school, and families require fewer emergency health services. We look forward to being able to expand the successful housing clinic we’ve developed in Chittenden County to strengthen individuals and their communities in other counties. And we’re excited to have the opportunity to develop a new clinic focused on those whose lives and, in some cases, ability to earn a living are being impacted by unscrupulous debt collection practices.”

New all-payer health model under scrutiny

Several risks and concerns have been raised at recent meetings and hearings about the health care payment reform plan sought by Gov. Peter Shumlin, according to the Legislature’s Joint Fiscal Office.

Shumlin, who will leave office in early January, is seeking to transform the state’s health care payment system from the current fee-for-service, in which providers are paid for each service or procedure they perform, to one in which providers are paid based on their patients’ health outcomes. ...

[Shumlin's chief of health care reform Lawrence] Miller said a number of groups and stakeholders have provided letters of support for the all-payer model, including Blue Cross Blue Shield of Vermont, the Vermont Medical Society, Vermont Legal Aid, the Lake Champlain Regional Chamber of Commerce and many Vermont hospitals, among others.

'All-Payer' Health Care On The Way: What Is It?

Bob Kinzel hosted a discussion on Vermont Edition about the Green Mountain Care Board's expected vote on the all-payer model for health care funding, which would bring about a dramatic change in the way that health care providers are reimbursed, a change that purports to reward quality of care and not the quantity of services that are provided.

Guests included Green Mountain  Care Board chairman Al Gobeille; Paul Harrington, executive vice president of theVermont Medical Society; Julia Shaw, health care policy analyst at Vermont Legal Aid's Office of the Health Care Advocate; and Dr. Paul Reiss; chief medical officer at HealthFirst, Vermont's independent practice association to discuss what the all-payer model means and what the implications of the switch could be.

Listen to the 43-minute program

Bourgoin case raises questions about mental health screening

In the aftermath of a deadly crash Oct. 8 involving a wrong-way driver, questions have been raised about how health care providers screen people seeking treatment. ...

Jack McCullough, director of Vermont Legal Aid’s Mental Health Law Project, is often involved with involuntary hospitalization cases.

One of the biggest issues facing Vermont’s mental health treatment system, McCullough says, is a lack of resources at the community level.

A shortage of services in communities means that some people grappling with mental health issues cannot find support until their cases reach a serious level — at which point they are hospitalized, he said.

Room for Improvement & Room for None: Jimmo Ruling Directs Medicare Agency to Improve Its Educational Campaign Regarding the “Maintenance Coverage Standard”

As reported by the Center for Medicare Advocacy, “in an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, who oversees the ‘Improvement Standard’ case (Jimmo v. Burwell, No. 11-cv-17 (D.Vt.)), ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she had approved in January 2013.” ...

After the 2013 agreement was established, Michael Benvenuto, one of the lead attorneys from Vermont Legal Aid, stated that “[t]his settlement should send the message that denying Medicare coverage for a chronic condition is wrong.”  Similarly, even as the original settlement was being proposed, the New York Times wrote an editorial extolling the humanity of the rule change.  Together, these notions epitomize an ideal of human dignity that skilled care should be provided to the elderly or disabled, even when their condition may not improve.

Health Care Providers Say They're 'Cautiously Optimistic' About All-Payer Plan

A number of health care providers say they are "cautiously optimistic" that the implementation of a new payment system known as “all-payer" will help reduce costs and allow them to provide a higher quality of service. ,,,

Julia Shaw is a policy analyst in [Vermont Legal Aid's] Office of the Vermont Health Care Advocate. She says things definitely need to change.

"The cost of our health care system is growing too rapidly,” says Shaw. “And I think this is a promising way to address that and really start to bend that curve." ...

And Julia Shaw of the Health Care Advocate's office wants the “all-payer” system to include consumer protections to ensure that patients get appropriate care.

"In this kind of model, where providers are paid basically for treating a population, there are some financial incentives to provide less care," Shaw explains. "So really what the model needs is checks and balances to ensure that patients get the care that they need."

Read our white paper: Consumer Principles for Vermont's All-Payer Model

Driver restoration is a road to opportunity

In this op-ed piece, Vermont Legal Aid attorney Christopher Curtis writes:

A year and a half ago, more than 1,000 Vermonters turned out on a chilly March day in Burlington to get square with the law, pay their traffic fines at reduced rates and get back on the road safely, legally, and affordably. A bright tapestry of Vermonters from all walks of life waited patiently for a second chance to reinstate their driver’s licenses. People came from five counties – one all the way from West Virginia – for a “Driver Restoration Day” project initiated by Chittenden County State Attorney T.J. Donovan. ...

The scope of the license suspension problem is staggering. According to the Department of Motor Vehicles, about 60,000 Vermonters have suspended licenses. More than half of those are simply for failure to pay a fine. Most of those are low-income Vermonters who simply cannot afford to pay and then find themselves in a downward spiral of new tickets and fines following the original infraction. ...

The new law is not a free pass. All drivers remain obligated to pay fines and are subject to a “points system” for infractions. So, repeat offenders are still subject to suspension for failure to comply with our traffic laws. But, flexibility in the system will put low-income drivers on more equal footing with others to be able to simply pay their fines and move on with their lives.

Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage

... Though never part of Medicare regulations, the improvement standard was written into the C.M.S. manuals that providers and claims administrators relied on. “It was a policy they followed for 30 years,” Mr. Deford said.

The lawsuit brought by the Center for Medicare Advocacy and Vermont Legal Aid in 2011 became known as the Jimmo case, after Glenda Jimmo, an elderly Vermont plaintiff. A settlement reached in 2013 required C.M.S. to rewrite its manuals and to begin an educational campaign to publicize the change. ...

By early this year, however, the Center for Medicare Advocacy was hearing from many sources that despite the settlement, providers and the contractors reviewing Medicare claims were still denying coverage when beneficiaries didn’t demonstrate improvement.

The Centers for Medicare and Medicaid Services showed no inclination to take further steps, so the plaintiffs’ lawyers went back to court, seeking enforcement of the agreement. The federal judge in Vermont who oversees the settlement ruled in August that C.M.S. didn’t have to further revise its manuals, but did have to mount a better educational campaign.

By early next month, it has to explain how it plans to do that. A C.M.S. spokeswoman said the agency had reviewed the court’s order, but would make no other comment.

40,000 Vermonters could pay old traffic fines at reduced rates

Thousands of Vermonters have the opportunity to pay off old traffic tickets at a reduced rate. The driver restoration program, which runs until Nov. 30, is part of an effort to help people whose licenses were suspended because of unpaid traffic fines to get back on the road.

Vermonters with outstanding traffic tickets from before July 1, 2012 will be able to pay them off for $30 per ticket by applying by mail or email to the Vermont Judicial Bureau. ...

Christopher Curtis, an attorney with Vermont Legal Aid, hailed the program as “a huge step in the right direction” that will allow thousands of people to get back on the roads.

“Vermonters with old tickets who were locked in a poverty trap of expensive tickets they couldn’t afford have an opportunity to start over, pay a fraction of the old tickets and move on with their lives,” Curtis said.

“That said, this is not a free pass,” Curtis said. “Going forward it’s critical that Vermonters know they do have to pay their traffic fines and maintain their insurance — for those who cannot afford the standard fine they can ask for a repayment plan over time, or they can ask the court to consider their income in setting the fine amount. Not paying is not an option.”