Governor Bryan Announces ‘Healthier Horizons’ Initiative, Sweeping Healthcare Reform for U.S. Virgin Islands

US Virgin Islands Healthier Horizons Initiative – Slide Presentation

The Healthier Horizons Initiative is a sweeping reform of healthcare in the U.S. Virgin Islands, built on a foundation of three tenets: Increasing access to care, modernizing delivery of health services to residents, and hardening healthcare infrastructure.

Under the “Healthier Horizons” umbrella, there are 11 primary elements designed to upgrade and modernize healthcare in the Territory, making it easier and more efficient for residents to receive health services:

Behavioral Health & Developmental Disabilities

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Health Information Exchange

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Telehealth

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Medical Compacts

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V.I. Fire Service & EMS Merger

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EMS Regulation

Healthy Housing Initiative

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Associated Health Plans

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Hospital & Health Facilities Improvements

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Territorial Health Plan

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Medicinal Cannabis

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#1 – U.S. Virgin Islands Behavioral Health & Developmental Disabilities Act

The Behavioral Health and Developmental Disability (BHD) Act of the United States Virgin Islands (USVI) expands and updates mental and behavioral health services and consolidates every existing provision in the VI Code relevant to mental or behavioral health in one place. It addresses the coordination of services by public and private agencies that support individuals throughout the USVI who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, or drug dependency. 

The BHD Act also establishes the first comprehensive public facility to treat persons who require behavioral and mental health services, persons with developmental disabilities and those suffering from substance use disorders.   

The Act aligns with the Virgin Islands Behavioral Health Strategic Plan, which calls for the creation of a comprehensive, integrated behavioral healthcare system.  The BHD Act addresses long standing issues and weaknesses in the system to treat and care for persons suffering with behavioral health issues. It is important to note that the BHD addresses the needs of children and adults.

Specifically, the BHD Act establishes Community Behavioral Health Services to include the following: Crisis Intervention Programs to include Crisis Intervention Teams, Behavioral Health Training and Community Service Networks.

The BHD Act clearly defines the role of the Department of Health, Virgin Islands Police Department, the Bureau of Corrections, Department of Human Services and other agencies in their work with persons with behavioral health issues and those who have developmental disabilities.  The BHD Act also provides guidance on how the Territory addresses:

  • Determination of mental competency
  • Protective custody
  • Involuntary treatment
  • Transfer of patients to other facilities
  • Patient’s rights
  • Rules and regulation
  • Hospitalization of patients
  • Telepsychology or Telehealth
  • Intellectual and Developmental Disabilities

Governor Albert Bryan Jr. partnered with public and private organizations to create the first Behavioral Health and Developmental Disability (BHD) Act of the Virgin Islands and has solicited comments from key stakeholders and the general public.  

Partners included but were not limited to: Westcare, the VI Law Enforcement Planning Commission, the Judicial Branch, hospitals and health centers, the VI Department of Health, Viequicare, the VI Bureau of Corrections, VI Developmental Disabilities Council, Lutheran Social Services, Catholic Charities, the VI Department of Human Services, the VI Police Department, the VI Department of Labor, Community Foundation of the Virgin Islands and the St. Croix Foundation.

The link to the full bill is available here: 2020-01.13 Behavioral Health and Development Disability Act 2020

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#2 – U.S. Virgin Islands Health Information Exchange

A Health Information Exchange (HIE) allows healthcare providers and patients to securely access and share a patient’s vital medical information via an electronic transmission – improving the speed, quality, safety, and cost of patient care.

In January 2020, the US Department of Health and Human Services’ Center for Medicare and Medicaid Services (HHS-CMS) awarded the US Virgin Islands $14.9 million in federal funding to implement a HIE for approximately 29,000 Medicaid recipients living in the Territory.

The funding is also to be used for the continued administration of the Promoting Interoperability Program in the Territory, which incentivizes eligible professionals and hospitals to adopt, implement, upgrade and successfully demonstrate the use of certified electronic health record technology.

The VI Department of Human Services will administer the funds and is tasked with establishing the HIE.

A real-time interoperable HIE is critical to eliminating redundant tests and procedures, increasing patient engagement by allowing patients to view their health information in real time, and to increasing the quality of care since longitudinal information may exist. Overall, the HIE will improve health outcomes.

The effort to build a HIE infrastructure will require strategic partnerships between the public and private sectors and non-governmental organizations. These partners must work collaboratively to develop and sustain the HIE.

 The Health IT Collaborative for the Underserved, former VI Delegate to Congress Donna Christensen, MD, the VI departments of Health and Human Services and local hospital and health center officials are currently among the partners working closely with the Office of the Governor on the HIE initiative.

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#3 – U.S. Virgin Islands Telehealth

In January 2020, Governor Albert Bryan Jr. convened the first meeting of the Virgin Islands Telehealth Workgroup to begin the planning and implementation of telehealth services in the U.S. Virgin Islands.

One of healthcare’s fastest-growing initiatives, telehealth is the use of mobile technology to extend the reach of physicians and healthcare providers beyond traditional clinical settings. It includes options such as video doctor visits and remote patient monitoring. Telehealth is changing the future of healthcare and is critical to expanding access to medical services for people living in the Territory.

The purpose of the VI Telehealth Workgroup is to develop a telehealth strategy, to coordinate telehealth activities, to address issues and challenges around telecommunications and interoperability, and to enhance the use of telehealth in the USVI. The workgroup established three subgroups that is already progressing toward its goals and objectives: 

  • The Policy subgroup is tasked with focusing on policy and regulation, has drafted proposed legislation called the Virgin Islands Telehealth Act. The purpose of the VI Telehealth Act is:
    • to authorize health care providers to use telehealth in their practice to increase access to care.
    • to provide a more expansive definition of telehealth, which does not exist in the current telemedicine legislation.
    • and to provide a framework for the use of telehealth services in the Virgin Islands.

The Policy subgroup is also developing Medicaid telehealth policies and providing guidance to the Health Insurance Board on recommended telehealth-related coverage.

  • The Infrastructure subgroup is assessing telecommunications requirements, broadband mapping and coverage, and 5G, the next generation of cellular technology. This subgroup is working on the framework for a common clearinghouse for health information. They are also working with the Medicaid Program to implement a health information exchange platform used in declared disasters to provide care to displaced patients.
  • The Application and Inventory subgroup developed a Provider and Patient Readiness Survey to assess the readiness of VI providers and patients to use telehealth. The health centers and hospitals will be among the providers who will receive these assessments.

The VI Telehealth Workgroup comprises members of the public and private sectors, including the VI Department of Health; VI Department of Human Services; LAN Communications; Broadband VI; Viya; The Plessen Group; TADAH; Continuum Care; VI Territorial Emergency Management Agency; Witt O’Brien; the VI Public Services Commission, VI Next Generation Network; Inner Circle Logistics; Island Analytics; and the Federal Emergency Management Agency.

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#4 – U.S. Virgin Islands Interstate Medical Compacts

To increase access health care in the US Virgin Islands, Governor Albert Bryan Jr. is exploring the use of Interstate Medical Compacts for certain medical professions, including for physical therapy, psychology, nurse licensure and EMS personnel.

Physical Therapy Licensure Compact

The Federation of State Boards of Physical Therapy has launched a project to develop an interstate licensure compact for physical therapy. The purpose of the compact is to increase consumer access to physical therapy services by increasing mobility of eligible physical therapy providers to work in multiple states.   To date, 26 states have enacted Physical Therapy Compacts. Read more about the PTC: http://ptcompact.org/  

Psychology Interjurisdictional Compact

The Psychology Interjurisdictional Compact (PSYPACT) is an interstate compact designed to facilitate the practice of telepsychology, the use of telemedicine within the practice of psychotherapy, and the temporary in-person, face-to-face practice of psychology across state boundaries. PSYPACT is limited to facilitating telepsychology and temporary in-person services. Through PSYPACT psychologists can reach underserved and geographically isolated populations. Read more about the PSYPACT https://www.asppb.net/page/PSYPACT 

Nurse Licensure Compact

The Nurse Licensure Compact (NLC) increases access to care while maintaining public protection at the state level. The compact allows mutual recognition of a nursing license between member states. Under the NLC, nurses can practice in other NLC states without having to obtain additional licenses.  Read more about the NLC: www.ncsbn.org/nurse-licensure-compact.htm 

EMS Personnel Licensure Interstate Compact

The Recognition of EMS Personnel Licensure Interstate Comp Act (REPLICA) is the only national multi-state compact for the Emergency Medical Services profession. As part of the compact, qualified EMS professionals licensed in a home-state would be extended a privilege to practice in remote states for qualified circumstances. Learn more about the EMS Compact at www.EMSCompact.gov

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#5 – U.S. Virgin Islands V.I. Fire Service & EMS Merger

In October 2019, Governor Albert Bryan Jr. submitted to the 33rd Legislature far-reaching proposed legislation that integrates the Virgin Islands Fire Services and the Department of Health’s Emergency Medical Services.

The Virgin Islands Fire and Emergency Medical Services Act (VIFEMS) recognizes the need for firefighters throughout the territory to provide prompt fire prevention services as well as emergency medical services. VIFEMS, as a combined service provider, decreases the response times to emergencies and enhances the capability and capacity of providing emergency and basic and advanced life support services to all individuals in the U.S. Virgin Islands.

The optimal system for EMS service delivery is a Fire-based system comprised of cross-trained, multi-role fire fighters trained at the minimum to the Emergency Medical Responder level, and EMS providers (Emergency Medical Technician, Advanced Emergency Medical Technician and Paramedic), who are not cross-trained as fire suppression personnel.

Similar structures exist across the U.S. as communities address the increasing need for out-of-hospital emergency medical services. According to the US National Highway Safety Administration, fire services are the largest providers of EMS in the United States. 

The Bryan/Roach Administration has been working for several months to ensure a seamless transformation of EMS and VI Fire Services into an integrated and regulated emergency medical services system.

In 2019, Governor Bryan created a Fire-EMS Task Force comprised of representatives from the VI Department of Health, VI Fire Services, Office of the Governor, Division of Personnel, and the Office of Collective Bargaining.

Through the integration of the EMS and VI Fire Services, the Virgin Islands also has an opportunity to move toward an accountable system through fundamental, systemic changes.  Currently, there is no legal authority that establishes an Emergency Medical System in the Virgin Islands. The existing Virgin Islands EMS delivery system lacks effective coordination and accountability which stands in the way of progress and improved quality of care.

Consistent with this initiative to effect positive change in emergency response, Governor Bryan also submitted the Virgin Islands Emergency Medical Services System Act to create the first-ever Emergency Medical Services System in the US Virgin Islands.  The legislation, which was also submitted in October 2019, gives the VI Department of Health regulatory authority over all out-of-hospital emergency medical service providers in the Territory.

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#6 – U.S. Virgin Islands EMS Regulation

Governor Albert Bryan Jr. submitted the Virgin Islands Emergency Medical Services System Act (VIEMSS Act) in October 2019, to create the first-ever Emergency Medical Services System in the US Virgin Islands. The legislation also gives the VI Department of Health regulatory authority over all out-of-hospital emergency medical service providers operating in the Territory.

The VIEMSS Act establishes an Emergency Medical Services System in the VI Code, and allows for the Department of Health to regulate out-of-hospital emergency medical services in order to advance the quality of care, and increase the amount of available care providers. This proposed legislation, for the first time, gives the VI Department of Health the legal foundation to regulate emergency medical services whether it is provided by the VI Fire Service, a rescue squad, a private entity or a non-profit organization.

Currently, emergency medical service providers in the VI operate without oversight.

The proposed legislation calls for the VI Department of Health to establish a board which will be responsible for regulating ambulatory services and emergency medical care, for setting educational requirements and permitted practices, for licensing persons and organizations providing this service, and for developing a system that encourages providers to deliver the highest degree of care.

The VIEMSS Act was submitted to the 33rd Legislature in October 2019, as an accompaniment to the proposed Virgin Islands Fire and Emergency Medical Services Act (VIFEMS), which seeks to integrate the Virgin Islands Fire Services and the Department of Health’s Emergency Medical Services to improve response times to medical out-of-hospital emergencies.

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#7 – U.S. Virgin Islands Healthy Housing Initiative

The Office of the Governor is partnering with local stakeholders and the Corporation for Supportive Housing to develop a comprehensive health and human services residential facilities plan that meets the current and future needs of vulnerable populations living in the Virgin Islands. To complete the immense and significant work toward the completion of a comprehensive plan, Governor Albert Bryan Jr. has established the VI Healthy Housing Task Force and charged its members with working collaboratively to create a seamless system of healthcare and housing for at-risk persons in our community by 2021.

In May, the VI Healthy Housing Task Force launched the VI Healthy Housing Initiative with plans to accomplish its objective in three phases:

  • Phase 1 – Complete a housing and services assessment by the end of 2020.
  • Phase 2 – Conduct a Charrette Action Planning Session with key stakeholders to review the Territory’s existing housing and healthcare services, identify gaps and develop a comprehensive service and housing action plan by the beginning of 2021.
  • Phase 3 – Implement recommendations for an overhauled housing and healthcare system beginning in the spring of 2021

The VI Healthy Housing Task Force has begun the Phase 1 of VI Healthy Housing Initiative which assesses housing and healthcare services provided in four areas: 

  • Behavioral Health (Mental Health and Substance Use)
  • Youth Rehabilitation Services
  • Supportive Housing (Homeless and Persons with Disabilities)
  • Elder care services (Skilled Nursing Homes and Senior Living)

The Virgin Islands government provides residential housing for more than 300 persons territorywide. These services include supportive housing for persons who are disabled or homeless, mentally challenged or suffering with substance use disorders, youth who require rehabilitation and the elderly. The VI Department of Health and Human Services oversees four facilities locally and outsources off-island residential behavioral health services for children and adults.

The VI Healthy Housing Task Force consists of members from the departments of Health and Human Services, VI Housing Authority, VI Housing Finance Authority, VI Department of Labor, Workforce Development Board, St. Croix Foundation, Community Foundation of the Virgin Islands, Lutheran Social Services, Office of Disaster Recovery, Frederiksted Health Care, Inc. St. Thomas East End Medical Corporation, Juan F. Luis Hospital and Medical Center, and Schneider Regional Medical Center.

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#8 – U.S. Virgin Islands Associated Health Plans

On June 19, 2018, the U.S. Department of Labor expanded access to affordable health coverage options for America’s small businesses and their employees through Association Health Plans. 

Association Health Plans work by allowing small businesses, including self-employed workers, to band together by geography or industry to obtain healthcare coverage as if they were a single large employer.

The Association Health Plans will promote healthcare choice and competition in the Virgin Islands and strengthen the negotiating power with providers from larger risk pools allowing for greater economies of scale. Participation in Association Health Plans expands access to quality, affordable health coverage for U.S. Virgin Islands residents employed by small businesses.

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#9 – U.S. Virgin Islands Health Recovery Projects

The Office of Disaster Recovery is currently awaiting proposals to conduct the architectural and engineering design for the permanent repairs of the the Roy Lester Schneider Hospital, the Charlotte Kimmelman Cancer Institute, and the Myrah Keating Smith Community Health Clinic. They are also awaiting proposals for the architectural and engineering design of the permanent replacement to the Juan F. Luis Hospital. Proposals for these four facilities are all due on July 17th. The Request For Proposals for the architectural and engineering design of the Department of Health facilities at the Charles Harwood Complex, the Morris De Castro Clinic, and the John S. Moorehead Clinic, are currently being prepared.

The results of the planning efforts engaged through the  Community Health Improvement Plan and the Healthy Housing Initiative will greatly inform the decision-making and design process for these major health facilities. This includes the size of facilities needed and the type of services they need to be prepared to provide, not just now, but for the foreseeable future. It is the type of informed decision-making and strategic planning we don’t engage in nearly enough as a community. 

Governor Juan F Luis Hospital

Temporary Hardened Structure (THS)  

  • Currently Under Construction
    • Pending Obligation of additional items required to complete the THS buildout.
    • 100% Furnitures Fixtures and Equipment orders are being scheduled for delivery to the territory.
  • Tentative Opening Date:  September 30, 2020

Permanent Structure    

  • Currently in Procurement Phase for A&E Design
    • 2nd round of site visit scheduled for Thursday, June 18, 2020
    • Proposals are due Friday, July 17, 2020

Dialysis Center

  • Territory is pending decision from FEMA to relocate and lease building instead of relocating the modular 

 

Schneider Regional Medical Center

Roy L. Schneider Hospital Temporary Facility

  • Pending build out of Temporary Swing Space Facility adjacent to existing facility
    • Territory is awaiting FEMA RFI & Cost Reasonableness review to move forward with the next steps for funding the project

Roy L. Schneider Permanent Structure  

  • Currently in Procurement Phase for A&E Design
    • 2nd round site visit scheduled for Thursday, June 16, 2020
    • Proposals are due Friday, July 17, 2020

Charlotte Kimmelman Cancer Institute

  • Currently in Procurement Phase for A&E Design
    • 2nd round site visit scheduled for Thursday, June 16, 2020
    • Proposals are due Friday, July 17, 2020

Myrah Keating Smith Community Health Clinic

  • Currently in Procurement Phase for A&E Design
    • 2nd round site visit scheduled for Thursday, June 17, 2020
    • Proposals are due Friday, July 17, 2020

Department of Health

STT John S Moorehead Temporary Clinic

  • Currently Pending Costing Development with FEMA
    • Project sent to FEMA CRC and a Time Extension has been approved through November 2020
    • DOH has provided all Damages, descriptions, and dimensions (DDD’s) to FEMA to be inputted for review and approval

Charles Harwood Complex

  • Currently with FEMA CRC for Development, Pending BBA Review. Awaiting the Master Planning Obligation.  (Pending Large Project Review as of June 11, 2020)

STJ Morris De Castro Clinic

  • Currently with FEMA CRC for Applicant CEF Validation, Pending BBA Review
  • Permanent Roof and Interior/Exterior Damages

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#10 – U.S. Virgin Islands Territorial Health Plan

The VI Department of Health has embarked on a mission to create a Community Health Improvement Plan by the end of 2020, to address public health problems based on results of community health assessment activities and the community health improvement process. The Community Health Improvement Plan is a long-term, systematic effort and once complete, will serve as a guide for government officials, in collaboration with community partners, to prioritize, coordinate, and target resources that promote health.

The Community Health Improvement Plan will define the vision for the health of the VI community through a collaborative process and will address the gamut of strengths, weaknesses, challenges, and opportunities that exist to improve the Territory’s health status.

In October 2019, the VI Department of Health initiated this effort with a stakeholders meeting that included representatives from the Territory’s hospitals and health centers, and the University of the Virgin Islands. The department also engaged ASTHO, the Association of State and Territorial Health Officials, a nonprofit organization dedicated to assisting states and territories with developing sound public health policy.

The first step to achieving the department’s goal is the completion of a Community Health Assessment to identify key health needs and issues through comprehensive data collection and analysis. This information will help develop a Community Health Improvement Plan by justifying how and where resources should be allocated to best meet the Territory’s needs. The VI Department of Health is in the final stages of completing the community health assessments.

In addition to the data analyzed and presented in the community health assessment, the development of the Community Health Improvement Plan will include extensive community engagement and participation, to ensure the voice of the community is captured and instrumental in the selection of key health indicators and objectives aimed at improving the overall health of the population. 

The entire process is being guided by an Advisory Group comprising of a wide cross-section of the community, to include consumers and providers in the private and public sectors.  The group is currently developing a framework for completion and implementation of the Community Health Improvement Plan. 

In addition, the VI Department of Health is simultaneously completing a strategic plan to strengthen the capacity of the department to ultimately achieve the goals and objectives of the Community Health Improvement Plan.

The VI Department of Health intends to align the Community Health Improvement Plan with Healthy People 2030, a US Department of Health and Human Services comprehensive, nationwide health promotion and disease prevention agenda. The local version of the initiative will be titled Healthy VI 2030.

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#11 – U.S. Virgin Islands Medicinal Cannabis

In December 2019, Governor Albert Bryan Jr. proposed a landmark amendment to the Virgin Islands Medicinal Cannabis Patient Care Act that has the potential to significantly address the looming financial crisis of the Government Employee Retirement System (GERS). 

The existing law, enacted by Governor Bryan in January 2019 shortly after taking office, establishes guidelines for regulated use and the licensing of dispensaries throughout the Territory, but would not generate enough tax revenues to establish or regulate the program.

The amendment, titled the Virgin Islands Cannabis Use Act, seeks to improve the existing law by providing more regulatory controls and enabling the generation of larger tax and fee revenues. Those revenues, estimated at between $14 million and $17 million annually, would be used to help stabilize the GERS which is underfunded to the tune of $2.82 billion by some estimates, and by $4.74 billion by other estimates.

The proposed amendment creates a regulated system under the Office of Cannabis Regulation (OCR), enables sales to tourists, and increases tax revenues to the Government of the Virgin Islands.

Seventy-five percent of the revenues generated as a result of this act will be dedicated to the GERS, five percent will be devoted to senior citizen services, and 20 percent fund the regulatory system around the legalization of medicinal cannabis.

The amendment also seeks to provide for controlled cultivation, manufacture, production and sale of cannabis products, and for a controlled environment for consumption of cannabis and cannabis products by persons over the age of 21. It recognizes the adult use of cannabis for cultural and sacramental uses and enables business ownership and financial opportunities for local Virgin Islanders.

As written, the amendment ensures a strong regulatory structure which includes requirements to prevent fraud and enhance transparency, for digital tracking of seed-to-sale, for testing for toxins by an independent agency, and for licensing. It also includes strict penalties for cannabis production outside of designated areas and requirements for an air filtration system. It sets up regulations for advertising and placement of facilities at certain distances from houses of worship, schools, and cruise ship docks.

Under the amendment, criminal records of individuals incarcerated for possession of less than a pound of cannabis will be automatically expunged. However, the amendment does not seek to legalize cannabis for general use and existing laws that speak to possession or sale of cannabis remain in effect.

In May 2020, Governor Bryan resubmitted to the 33rd Legislature an amended version of the proposed Virgin Islands Cannabis Use Act, which incorporates the product of collaboration and input from those multiple senators who came forward and comments received from the public in town hall meetings.

Governor Bryan urges the 33rd Legislature to act expeditiously on his proposed legislation. The bill will not solve the GERS financial status, but it will serve as a key revenue funding source to shore up the system.

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