January 5, 2021


Happy New Year! The 2021-22 Legislative Biennium Kicks Off Wednesday 

The 2021-22 Legislative biennium will begin this Wednesday, January 6th, 2021, almost entirely remotely. After deciding that the risk of COVID-19 transmission would be too high for the newly-elected legislature to meet in the small, historic Statehouse in Montpelier, legislative leaders in the House and Senate worked to determine how lawmakers would be sworn in and given their seat and committee assignments virtually. Traditionally, this act is full of pomp and circumstances and a time when state leaders come together in the House chamber for a festive and crowded beginning of the session. This upcoming Wednesday, the Secretary of State will join the 150 House members on Zoom to provide their official Oath. House members will then be given their Committee assignments. On Thursday, the new Lt. Governor Molly Gray will be sworn in in-person and will facilitate the Senate's transition. After virtual joint assemblies, the Governor will join the legislature briefly, but will not provide his inaugural address in the afternoon, as he typically does. Instead the address will be streamed at 7pm this Thursday, with the FY22 Governor's Recommended Budget address coming in the next few weeks. Lawmakers have stated that COVID-19 recovery, broadband implementation and determining how Vermonters will vote during Town Meeting will be the first issues they tackle this January. Click to read the 2021 VMS Policy Priorities. 

______________________________________________________________COVID-19 Vaccine Distribution Updates

On today’s press conference, Commissioner of Health Mark Levine reported on Vermont’s progress in vaccinating health care workers in Vermont’s COVID-19 Phase 1A vaccination group. So far, 17,653 doses of the COVID-19 vaccine have been administered, which represents ¼ of healthcare workers in the State. At 2,557 doses administered per 100,000 residents, the CDC ranked Vermont first in the Northeast for vaccination rates and second in the travel region only behind West Virginia. This will be the first week that some health care workers begin to receive a second dose of the vaccine. Both Dr. Levine and Governor Phil Scott emphasized that Vermont is at the mercy of the federal government in terms of the distribution of the vaccine and therefore they need to prioritize the most vulnerable with the very limited number of vaccine doses. As stated in the latest Department of Health Advisory, all 14 Vermont hospitals have been asked to provide vaccination to health care workers in their hospital-service area identified in this initial phase. To ensure equitable vaccine access for eligible health care personnel, hospitals are directed to balance distribution between hospital-based and non-hospital-based personnel. Please note that those personnel who are exclusively seeing patients virtually do not meet the “direct patient contact” requirement to be eligible to receive vaccine in Phase 1A.  Individual hospitals will be reaching out to staff and health care workers in their area to schedule appointments. Health care providers and staff who have not heard from their local hospital by January 11, 2021 should reach out to the hospital. Vermont’s vaccine dashboard can be found here and this week’s press conference slides can be found here.

Dr. Levine reported that Phase 1B will begin with age-banding: first individuals 75 and over, then 64-74, followed by people in younger age groups with chronic conditions. Vermont’s Vaccine Advisory Group is still working to determine which conditions will be included in the high-risk category. VMS is also meeting regularly with the Department of Health to refine the role of primary care in vaccine administration.  


Congress' New COVID Relief Bill/Omnibus Budget Lessens the Impact of Scheduled Medicare Payment Reductions

The new COVID relief/omnibus budget bill passed by Congress on December 21, 2020 lessens a proposed 10.2% across-the-board reduction that was included in the Medicare physician payment final rule for CY (Calendar Year) 2021. VMS has been reporting on the upcoming E/M changes and Medicare physician payment adjustments scheduled to go into effect January 1, 2021, including this reduction that is required due to federal budget neutrality requirements. The AMA reported that the new legislation represents a significant win in two ways: 

  1. There will be an increase in the payment schedule of 3.75 percent. (This is applied across the board to all payments under the Medicare physician payment schedule).
  2. Payments for HCPCS code G2211 are suspended for 3 years (through the end of December 2023). This code was finalized as an add-on code by CMS to account for visit complexity in E/M visits. Implementing the G2211 code would have resulted in approximately $3 billion, or 3 percent of the reduction in the fee schedule. The delay in implementing the code will further reduce the budget neutrality adjustment for 2021.

Taken together, these provisions mean the budget neutrality adjustment is significantly reduced. Based on the specialty impact table in the final rule, the AMA estimates that most specialties will now see either a neutral or positive change in total Medicare payments in 2021. Impacts for particular medical practices will depend on both physician specialty. 


Recent COVID-19 Guidance and Resources:

VMS Weekly Zoom with Commissioner of Health, Thursdays at 12:30 pm


VMS Names February 2021 VMS Member Advocacy Month 

Are you passionate about a current health policy issue? This February, VMS will host four weeks of virtual advocacy actions on each Thursday of the month. Now more than ever, VMS member voices are critical to improving care for Vermonters, Vermont’s health care system and the practice environment. Advocacy actions include:

  • Feb. 4th- Join the Vermont House and Senate in recognizing the dedication of Vermont’s health care workers during the COVID-19 pandemic.
  • Feb.11th- Participate in an Advocacy training with legislative leaders and physician advocacy experts.
  • Feb. 18th- Register for our Race and Health Equity webinar for screening tools that promote anti-racism.
  • Feb. 25th-  Engage in our Town Hall discussion with our invited Congressional delegation. 

COVID-19 presents unique opportunities where testimony can be provided remotely and lawmakers are actively seeking your experiences from the front lines in order to help strengthen Vermont’s health care infrastructure and pandemic response. For more information and resources for VMS Advocacy Month click here.

Commissioner Call Update -  VMS weekly calls with Vermont Department of Health Commissioner, Mark Levine, M.D. are held each Thursday from 12:30-1:00 p.m. on ZOOM - click below for the virtual meeting address that will remain constant each week. 

Once a month, VMS will feature a guest speaker during this call time, as the Commissioner has a conflict. The speaker will discuss clinical protocols and best practices during the State of Emergency.

Join Zoom Meeting -https://us02web.zoom.us/j/86726253105?pwd=VkVuNTJ1ZFQ2R3diSVdqdlJ2ZG4yQT09

Meeting ID: 867 2625 3105 / Password: 540684

Dial In: 1 646 876 9923 / Meeting ID: 867 2625 3105 / Password: 540684


COVID-19 Vaccines - SL Modifier is Not Allowed

In the Vermont Medicaid Banner for January 8, 2021 they clarify that Vermont Medicaid does not allow the SL modifier for the COVID-19 vaccines. The nuance between the Vermont Child Vaccine Program (VCVP) & COVID-19 vaccines was key in the State of Vermont decision. In VCVP, the State purchases vaccines and provides them to providers and as such, the SL modifier is required. However, the COVID-19 vaccine is not purchased by the State at this point in time as the supply is provided to the State by the Federal government.


DVHA Seeks Comments on Proposed Medicaid Next Generation ACO Program Rule

The Department of Vermont Health Access (DVHA) recently released a call for comments on proposed Vermont Medicaid Next Generation (VMNG) ACO updates, including the PMPM rates for CY 2021. DVHA is entering the fifth year of the Next Generation ACO and the proposed rule includes these updates: 

  1. The value-based component of the program will be modified to include both a Value-Based Incentive Fund (as in previous years) and an additional Year-End Quality Adjustment to link ACO quality performance to financial accountability.
  2. The risk corridors will decrease for both the Traditional Attribution Cohort (from+4% to+2%) and the Expanded Attribution Cohort (from an asymmetrical risk corridor with 2% upside and 1% downside risk to a symmetrical risk corridor of+1%).
  3. Additional COVID-19 provisions will be made to the payment provisions of the contract to align with Medicare’s approaches for their 2021 ACO programs.

These rates and changes are effective January 1, 2021, but the comment period is open until February 1, 2021. Please send your comments to Jill Sudhoff-Guerin at jsudhoffguerin@vtmd.org by January 28, 2021.


DVHA Adopts Protocols for Ordering Home Health Services

Effective January 1, 2021 Vermont Medicaid is making changes to allow additional provider types to order Home Health Services. Although, these changes are a result of the Federal CARES Act in response to the COVID-19 Public Health Emergency they are permanent changes that are not limited to the duration of the public health emergency. Physician assistants, nurse practitioners, and clinical nurse specialists may now order home health services in addition to physicians. This applies to the following services provided by a home health agency:

  • Part time or intermittent nursing services,
  • Home health aide services,
  • Physical therapy, occupational therapy, or speech language pathology services.

Durable, medical equipment, and supplies may be ordered by a licensed medical provider acting within the scope of their practice as authorized under Vermont State law. Click here for the new rule


Reminder – E/M Office Visit Code Changes Coming Jan. 1

Effective Jan. 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is adopting updated Current Procedural Terminology (CPT®) Evaluation and Management (E/M) codes.

  • The revisions only apply to office visits
  • Code 99201 has been eliminated
  • Codes 99202, 99203, 99204, 99205, 99206, 99207, 99208, 99209, 99210, 99211, 99212, 99213, 99214 and 99215 descriptors and documentation standards have been revised

The AMA offers a wide variety of free tools and resources to keep you informed on critical updates such as the E/M office visit code changes. These resources include:


      VMS January 2021 Webinar: Emerging Information on COVID-19

      Please join us on Thursday, January 21, 2020 from 12:00 pm to 1:00 pm for our VMS January webinar, "Emerging Information on COVID-19." Patsy Tassler Kelso, PhD, the State Epidemiologist for Infectious Disease at the Vermont Department of Health (VDH) will discuss how COVID-19 has developed, spread, and led to necessary public health changes in Vermont. To register click here. To see the entire VMS Thursday Webinar series for 2020/2021 click here. 

      Center on Rural Addiction (CORA) Best Practices Scholarship Program

      Deadline: April 30, 2021

      UVM CORA leverages innovative technology and telehealth strategies to deliver support to providers in rural counties. Their patient-focused approaches are sensitive to the demographics and needs of rural populations, which have been disproportionately impacted by Substance Use Disorder (SUD). This scholarship program offers an opportunity for two days of in-person comprehensive training and consultation at the University of Vermont with Center on Rural Addiction (UVM CORA) faculty and staff experts. Click here to learn more. 

      Someone You Love: The HPV Epidemic Documentary

      Friday, January 8, 2020

      11:30 AM – 1:30 PM EST

      Earn 2.0 CME Credits for participating in this free virtual showing of the HPV Documentary, "Someone You Love." Following the film screening, participants can choose to attend two breakout session discussions focused on cancer prevention and the HPV vaccine. This event is sponsored by Bi-State Primary Care Association, the Norris Cotton Cancer Center, the American Cancer Society, Southern NH Area Health Education Center, and the Vermont Department of Health. Register here. 


      Vermont Medical Society

      134 Main Street

      Montpelier, VT 05602

      -- Unsubscribe --