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NEED TO KNOW
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Vermont Withdraws from AHEAD Payment Reform Model |
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After
major changes from federal government, the Agency of Human Services has had a
change of heart in the AHEAD model. |
The Agency of Human Services announced last week that the State is withdrawing from the federal AHEAD payment reform model. AHS staff said the decision was driven by changes the federal Centers for Medicare and Medicaid Services (CMS) made to the terms of Vermont’s participation since the State first applied under the Biden administration. The new terms significantly decrease the funding that would have been available to Vermont from up to $138 million to less than $10 million. “We continue to look at pursuing global budgets as designated in legislation, this is just not the right model for us,” Sec. Jenney Samuelson said at a legislative hearing today.
What does this mean for health care in Vermont?
- Participating in the AHEAD Model provided a way to secure Medicare’s participation in multi-payer payment reform efforts. Without AHEAD, Medicare may not participate in programs such as hospital global budgets or a primary care spending target, making it harder to have scale in payment reform efforts. Separately, earlier this month CMS informed Vermont that state agencies did not have the authority to operate Medicaid global hospital budget payments.
- Participation provided a pathway to secure flexible investment dollars to fund Medicare’s contribution to Vermont’s primary care payment program, the Blueprint for Health. While CMS had reduced the amount of funds that the State of Vermont could earn, it is now unclear if any federal dollars will be available to support the Blueprint for Health or Support and Services at Home (SASH).
- CMS agreed to waive certain regulatory requirements for the purposes of testing the AHEAD model, such as the requirement for a three-day hospital stay before skilled nursing admissions. Some of these requirements were also waived under Vermont’s All Payer Model. It is unclear if CMS will approve waivers without the AHEAD model.
- Primary care practices will not be eligible to participate in Primary Care AHEAD, which offered an Enhanced Primary Care Payment (EPCP) of $17 to $21 per Medicare beneficiary per month. The Blueprint for Health continues its work to design a new patient-centered medical home payment funded with Rural Health Transformation dollars. “We’ve got a runway,” Sec. Samuelson said.
VMS will share more information as we receive it. Our archived materials describing the AHEAD model are available here. |
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💰 Millions Awarded in RHT Grants The Agency of Human Services has agreed to fund over a dozen projects with the Rural Health Transformation dollars, according to a presentation from agency officials earlier today. Projects include the Maple Mountain family medicine residency program, expansion of substance use disorder and mental health urgent care facilities, and funding for mental health and community support staff in primary care offices. The agency is still reviewing applications for several projects and will list grantees on its website in the coming weeks.
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IN CASE YOU MISSED IT
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📌 Green Mountain Care Board Seat Open Last week, the governor announced that Owen Foster will step down as chair of the Green Mountain Care Board at the end of September. He’ll remain on the board, taking the seat of departing member Jessica Holmes. A new chair of the board will be chosen by a committee appointed by the governor and state lawmakers, including Sandy Rousse and Mike Smith. If you’re interested in learning more about the opening, reach out to VMS staff at jbarnard@vtmd.org. VMS will also share the job posting once it's live. |
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🗓️ Upcoming Changes to Medicaid Eligibility Based on Immigration Status Starting October 1, the federal government will restrict the definition of qualified immigrants for purposes of Medicaid or CHIP (Dr. Dynasaur) eligibility to legal permanent residents (“green card” holders), certain Cuban and Haitian immigrants, citizens of Micronesia, the Marshall Islands and Palau, and lawfully residing children and pregnant adults. These changes are outlined in last year’s Budget Reconciliation Law, or the “One Big Beautiful Bill Act.” State officials estimate that about 200 households in Vermont will no longer qualify for Medicaid because of their immigration status. Officials at the Department of Vermont Health Access (DVHA) said they've tried to contact these families and haven't been successful.
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⚖️VMS Litigation in the News
The Vermont Medical Society is a plaintiff in a federal antitrust lawsuit alleging that MultiPlan (now Claritev) and major health insurers worked together to suppress out-of-network reimbursement rates paid to providers. Healthcare Finance Management Association (HFMA) recently covered the growing momentum behind the case, highlighting two favorable rulings for providers in recent months, including the court's rejection of defenses aimed at limiting recovery and a decision allowing 17 additional insurers to be named as defendants. Members who believe they've been impacted by MultiPlan's practices can still file a case by reaching out to an attorney. |
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📣 Department of Vermont Health Access Seeks Input from Clinicians The head of the department is asking for feedback. Please reach out to lkrupp@vtmd.org to share your thoughts on the following questions: Where do you see opportunities for Medicaid to operate more efficiently without reducing the quality of care?
Are there administrative processes that we can streamline that currently create burden for members or providers without adding value and would reduce costs
Are there services or approaches that could be delivered differently while achieving the same or better outcomes?
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️🏆 Send Your Nominations for VMS' Leadership Awards
Nominations are open for the VMS' Leadership Awards. Recognize Vermont leaders who have made outstanding contributions to the medical profession, health organizations, and the welfare of the public. Submit your nominations by August 14. |
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EVENTS
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Webinar: Medicaid Timely Filing Overview
Thursday, July 30, 10 - 11 a.m.
Gainwell Technologies will be hosting a webinar to review the updated submission process for both Timely Filing Reconsideration requests and Reconsideration requests for Vermont Medicaid. They will review the reconsideration processes, and explain submission requirements and common errors. Register here. |
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Maternal Health Innovation Summit
Monday, Aug. 10, 9 a.m. - 3 p.m. | Montpelier
The Maternal Health Innovation Team at the Vermont Department of Health is excited to bring together clinical, community, and public health practitioners, and other maternal health champions for the second annual MHI Summit.
It will be an in-person event at the the Capital Plaza Hotel (100 State St., Montpelier) to advance strategic priorities for improving maternal health across Vermont. Click here for the registration link. |
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UVM Menopause Conference
Friday, Sept. 11, 7:30 a.m. - 4:30 p.m. | South Burlington
Join the Menopause Clinical Update, a comprehensive, evidence-based educational program designed for clinicians seeking to enhance their expertise in menopause care. This full-day session will explore the critical role of estrogen across the lifespan, with practical guidance on managing perimenopause, optimizing menopausal hormone therapy (MHT) prescribing, and addressing key long-term health considerations. See the full agenda here. |
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Clinician Leadership Development Course
Oct. 2026 - Mar. 2027 | Stowe, VT Offered with the Larner College of Medicine and Vermont Medical Society, this course empowers clinicians to become effective leaders. Through in-person learning, you’ll gain skills in team development, finance, communication, and healthcare systems to drive strategic, high-quality patient care and organizational success. Apply here. |
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American College of Physicians Vermont Chapter Annual Scientific Meeting
Friday, Oct. 9 | Stowe, VT The Vermont ACP Chapter's Annual Scientific Meeting is scheduled for Friday, October 9, 2026. We will again host a poster competition for resident and student members. Please visit the Meeting Hub for registration and agenda. Please contact Colleen Magne at cmagne@vtmd.org or call at 802-793-0493 with any questions. |
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2026 Collaborative Meeting
Nov. 13 - 14 | Stowe, VT
The 2026 Collaborative Meeting is taking place at Topnotch Resort in Stowe.
More information here. |
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For more information about offerings from UVM Continuing Medical and Interprofessional Education, visit here.
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Vermont Medical Society PO Box 153 Williamstown, VT 05679 -- Unsubscribe -- |
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