January 23, 2024

NEED TO KNOW

Contact House Health Care Committee: Reduce Prior Authorizations

The House Health Care Committee held a hearing last week on H. 766, a bill to reduce prior authorizations and other paperwork and billing hassles in medicine. Thank you to clinicians Trey Dobson, MD; Mark Peluso, MD; and Rick Dooley, PA, who testified at the hearing. The bill would:

• reduce the time frames within which health plans must respond to urgent prior authorization requests;
• limit the occasions on which reauthorization is necessary for a previously approved treatment, service, or course of medication;
• require health plans to grant exceptions to prescription drug step-therapy requirements under certain circumstances;
• direct the Department of Financial Regulation to prohibit prior authorization requirements for generic medications and for items and services with low variation and low denial rates across health care providers;
• limit payer claims edits to Medicare claims edits and prohibit any prepayment reviews where documentation is required before claim payment; and
• require health insurers, not health care providers, to collect cost-sharing amounts from patients.

Please contact members of the House Health Care committee to express support for H. 766 and for reducing administrative burdens in health care!  Please consider sharing (redacted) stories of your experience trying to get prior authorizations approved, patients having to go through step therapy, the impact of having to collect patient copays or other specific examples of burdens in practice.  Contact the committee at:

LHoughton@leg.state.vt.us; fmcfaun@leg.state.vt.us; ablack@leg.state.vt.us; berbeco@leg.state.vt.us; mcarpenter@leg.state.vt.us; bcina@leg.state.vt.us; mcordes@leg.state.vt.us; ademar@leg.state.vt.us; bfarlice-rubio@leg.state.vt.us; lgoldman@leg.state.vt.us; apeterson@leg.state.vt.us; CNeal@leg.state.vt.us

Also last week, CMS announced a final rule that makes important reforms in prior authorization programs for medical services in government-regulated health plans including Medicare Advantage and state Medicaid programs.  The rules will require more timely PA responses and better electronic communication regarding PAs.  A summary of the rule from the AMA can be found here.

Health Reform Bills Dominate Discussion in Legislature 

Both the House and Senate Health Care Committees are continuing work on legislation that would make significant changes to the way that health care is paid for, billed for and regulated. Jessa Barnard, Executive Director of the Vermont Medical Society, will be testifying on three of these bills that are up for hearings this week. These bills include:

• H.766 - A priority bill for the VMS, this bill includes improvements to insurance claims processing and also provides strategies to reduce and streamline prior authorization. The House Health Care Committee will be taking testimony on a provision that would require payers to direct bill patients and puts the onus on the payer to collect co-pays and coinsurance. See the related action alert, above. 
• H.721 - The House Health Care Committee will also be taking testimony on a bill to gradually expand the income eligibility for Medicaid to 312% of the Federal Poverty Level by 2030 and to increase the age of eligibility for Dr. Dynasaur up to age 26. The bill includes an increase in Medicaid reimbursement for primary care, with a floor of 125% of Medicare. The bill also includes an expansion of eligibility for the Medicare Savings Program (MSP), which helps low-income Vermonters afford Medicare premiums and out of pocket costs.  The VMS Board took a position last week to support the MSP expansion and to express interest in expanding Medicaid coverage as long as it is paired with increases in reimbursement rates for primary and specialty care that matches the coverage the individuals would be leaving. 
• S.211 - Chair of the Senate Health and Welfare, Ginny Lyons, D-Chittenden, is leading on this bill that would transfer some Green Mountain Care Board duties to Agency of Human Services Director of Health Reform. This bill would also require insurers to participate in multi-payer alternative payment models and aims to streamline credentialing practices.

Other top issues of discussion include:

• State Fiscal Year 2025 Budget: Governor Phil Scott is scheduled to deliver his SFY25 Recommended Budget Address on Tuesday, January 23^rd at 1pm. Click here to watch the Governor's speech and to get the transcript after the speech. The expectation is that he will recommend an austere budget, with a focus on removing barriers to housing development. One item that will be included in the SFY25 Budget is the recommendations released from the Opioid Settlement Advisory Committee last week. By the end of 2023, Vermont has received $13,099,962 in payments, of which $8,196,000 was previously appropriated last year. This leaves $4,903,962 available for appropriation in FY2025. The recommendations do not include funding for the two-pilot overdose prevention sites, a Democrat priority, as the Commissioner of Health points out there is other funding available. The recommendations do include funding for stabilization and recovery beds, for youth prevention with expanded Student Assistance Professionals (SAPs) and expanded contingency management funding for specialty Blueprint spokes.
• End the Sale of Flavored Tobacco Products in Vermont – We Still Need Your Help!
  The House Human Services Committee is likely to vote this week on S.18, a bill to end the sale of all flavored tobacco products in Vermont.  The message has been reaching the Committee from Big Tobacco that S.18 will hurt Vermont businesses and that adults should be able to choose to purchase flavors if they want to. But, it is actually kids age 12-17 who are the highest users of menthol cigarettes, and 54% of youth smokers start by using menthol (read more here).  See the recent commentary highlighting the need for this law by VMS Member, L.E. Faricy, MD. Please email members of the House Human Services Committee this week urging them to support S.18, including a ban on menthol: twood@leg.state.vt.us; jbrumsted@leg.state.vt.us; ADonahue@leg.state.vt.us; rgarofano@leg.state.vt.us; jgregoire@leg.state.vt.us; nhyman@leg.state.vt.us; jmcgill@leg.state.vt.us; DNoyes@leg.state.vt.us; kpajala@leg.state.vt.us; tsmall@leg.state.vt.us; DWhitman@leg.state.vt.us
• Mental Health Services:  Last week, the Department of Mental Health updated the House Health Care Committee on its latest initiatives including their statewide mobile crisis program, the 988 suicide prevention program, and other efforts.  Dr. Greta Spottswood also presented on the Child Psychiatry Access Program and the impacts of the program as outlined in the 2022-2023 Impact Report.  The committee was very interested in this program and how to help support in the future.

Preliminary Findings from Provider and Community Meetings Presented to GMCB

Over the fall, Green Mountain Care Board consultants held dozens of community meetings with over 1800 stakeholders to discuss health care system needs in communities and across the state.  Many VMS members attended these meetings to share strengths and weaknesses of their local health care systems.  The consultants presented preliminary findings to the Green Mountain Care Board last week, pulling themes that will sound familiar to Vermont clinicians, such as a shortage of primary and specialty physicians, a shortage of advance practice clinicians, administrative complexity and challenges recruiting.   Themes also hit on many patient barriers to care including a lack of mental health professionals and services, transportation and the cost of health care.  The consultants will next be drafting recommendations for ways individual hospitals, regulators and the legislature can begin tackling these problems.   The GMCB also received an extensive update from the Agency of Human Services regarding applying for the new AHEAD payment reform model.

The presentation slides can be found here and videos of the updates are found here regarding the AHEAD model and here regarding the stakeholder meeting findings.  Contact jbarnard@vtmd.org for more information or with questions. 

2024 Vermont Educational Loan Repayment Program for Physicians, Nurse Practitioners, & Physician Assistants - Application Deadline Friday, March 1st

The 2024 Vermont Educational Loan Repayment (Recruitment/Retention) Program for Physicians, Nurse Practitioners, & Physician Assistants application is now available.

Application and corresponding documents can be found here.

The 2024 application deadline is Friday, March 1st, 2024.

Next Commissioner of Health Call is February 1, 2024

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members on Thursday, February 1st at 12:30 pm. View notes from the January 4th call here.

Hear about the most pressing public health information affecting the state and nation and have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting. You can join the zoom meetings here.

MISC.

Salary Data & Contract Review Tips

Wednesday, January 24^th, 12-1pm

VMS has recently partnered with Resolve to help connect members to physician contract review services and access to compensation data. Join Resolve CEO Kyle Claussen to learn tips about physician employment contracts.  How do you know what you are worth? What's in a normal contract? How do you know if you have leverage?  Kyle will address key contract provisions including:

• Compensation
• Call Coverage
• Maternity Leave
• Non-competes
• Side Gigs
• Intellectual Property
• Private Equity Buy-outs

Bring your questions! Whether you are considering your first job after residency, thinking about a position change or just want to understand what is in your current contract, this webinar is for you.

Register in advance for this webinar here.

Kyle Claussen is the CEO of Resolve, an attorney and physician compensation and contract expert. He has spent the last decade advocating for physicians in their employment contracts. Kyle is married to an ophthalmologist, has 3 kids, and a dog.

Vermont Medicaid Implements 12 Months of Continuous Eligibility for Children

The Vermont Medicaid program implemented a 12 month continuous eligibility requirement for children effective January 1, 2024.  Continuous eligibility for children means that children will not lose Medicaid coverage between their annual eligibility reviews due to most changes in circumstances.  See the announcement from the Vermont Department of Health Access (Vermont Medicaid) here and more information about continuous eligibility here.

VMS Member Fundraising for Ukraine

VMS member Robert Tortolani, MD, is requesting member support in efforts to raise funds for 240 Individual First Aid Kits (IFAK) for Ukrainian soldiers. Since the massive increase in Russian attacks has exponentially increased the need for critical medical supplies for those who are wounded, there is a need for IFAKs which include tourniquets, compression bandages, hemostatic gauze, chest seals, decompression needles, airway tubes and more to help keep soldiers alive. The cost per IFAK is $50-$100 and they are not standard issue gear.

Make a charitable contribution today to Blue/Yellow USA.

Financial Education Series for March: Presented by Baystate Financials PLANWell
Each session will be held via zoom at 12:30 p.m. or 5:00 p.m.

SaveWell: Gaining Awareness and Setting Goals - March 12th
Will help you understand your financial goals and the factors that will impact these goals.

InvestWell: Understanding How to Put Savings to Work - March 19th
Gain a clearer picture of how to grow a nest egg by investing it.

LiveWell: Protecting a Fulfulled Life and Retirement - March 26th
Protect your ability to make and save money by looking at how to utilize your assets to prepare for the uncertainties of life after work.

EVENTS

35th Annual Eastern Winter Dermatology Conference

February 1-4, 2024

TopNotch Resort, Stowe, VT

Learn more and register here.

Hospital Medicine 2024

February 7-9, 2024

TopNotch Resort, Stowe, VT

The course will provide practical approaches to common problems in hospital medicine informed by experts and the latest evidence. The target audience is comprised of physicians, physician assistants, nurse practitioners, and nurses practicing Hospital Medicine. Some of the clinicians will also be engaged in education, research, quality improvement, and management. The audience may also include Hospital Medicine program administrators, resident physicians, and medical students with an interest in careers in Hospital Medicine. Topics include Congestive Heart Failure; Pain Management; Care of Transgender Patients in Hospital; and more.

Learn more and register here.

Future Health Best: Practices for Advancing Care

March 22, 2024

Virtual and In-Person Waltham, MA

This 2024 conference will focus on the nexus of climate change and its growing impact, AI and new technologies to diagnose and treat patients, and the evolving and expanding role of physicians in this rapidly changing health landscape.

View the event flyer here. Registration will open in January 2024.

For more information about offerings from UVM CMIE, visit here.

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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