January 6, 2026

NEED TO KNOW

Vermont Clinicians Respond to Federal Changes to Childhood Immunization Schedule

The American Academy of Pediatrics Vermont Chapter, Vermont Academy of Family Physicians, and Vermont Medical Society released a joint statement today in response to changes to the U.S. childhood immunization schedule reaffirming the unwavering commitment to evidence-based preventive care for children and adolescents in response to recent changes to the national childhood immunization schedule.

Read full statement here.

Vermont Legislature Convenes – Jumps into Federal Impacts, Vaccine Policy

The Vermont legislature convened today for the 2026 session.   The House Human Services Committee wasted no time in jumping into current topics, holding a hearing this afternoon on H. 545, which would allow the Vermont Commissioner of Health to adopt Vermont-specific vaccine recommendations.   Representatives from the Department of Health, as well as Vermont Medical Society Deputy Director Stephanie Winters, and pediatrician Tracy Tyson, MD, testified in favor of the bill.   The House Health Care Committee heard about impacts of federal Medicaid and health insurance changes in HR 1, and will be hearing an update about the Rural Health Transformation fund tomorrow.  Tomorrow at 2pm the full legislature will hear the Governor’s State of the State address, which also kicks off when administrative legislative proposals are released. 

A number of bills related to health care policy have already been introduced (see the list of introduced bills here), while bills introduced in 2025 are still under consideration.   For VMS’s 2026 legislative priorities click here and don’t forget you can still sign up for legislative breakfasts, which begin January 21^st!

Vermont to Receive Over $195 million in Rural Health Transformation Funds in 2026

The Centers for Medicare & Medicaid Services (CMS) announced last week that Vermont will receive over $195 million in Rural Health Transformation Funds in 2026, which is among the highest award per capita in the nation.  All 50 states will receive awards under the Rural Health Transformation Program, a $50 billion initiative established by Congress in HR 1. In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million. The federal investment is aimed at helping states expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home. 

Vermont is still finalizing the details of the budget and scope of work for 2026.  The State’s original application narrative, summary and spreadsheet of activities can be found here.   

As shared in the Rounds in November, projects proposed for funding include:

• Sharing Technology and Services to Lower Costs – including funding for those organizations interested in a shared EHR; infrastructure for e-consults; grants to purchase AI scribe technology; funding for Vermont’s Child Psychiatry Access Program, consulting services for primary care practices; funding purchase and implementation of systems that can rack referrals and coordinate patient care across organizations; development of a shared subscription to a real-time digital tool that tracks bed capacity and service availability across Vermont’s hospitals and health care facilities.
• Strengthening Vermont’s Rural Health Workforce – including start up funds for a new rural family medicine residency program (Maple Mountain Consortium); workforce housing renovation grants; onsite training programs and tuition assistance for nurses and other allied health care roles; also incudes supporting a pilot for expanding “test to treat” services by pharmacists in more scenarios, such as strep throat.
• Support for Primary Care – primarily through expanding and strengthening the Blueprint for Health, including a prospective PMPM amount to support community health team staff, a PMPM capacity payment for expanding access for services such as through expanded hours or offering telehealth, performance payments that will be shared between specialty and primary care providers to incentivize consultation, funds to assist with hiring collocated mental health and community support services; this also includes funding to an FQHC to adapt existing clinical sites through minor infrastructure renovations/refurbishments and equipment upgrades.
• Regionalization and Innovative Care Models -  expanding programs like community paramedics who can treat patients at home, mobile health and dental clinics, mental health/substance use focused urgent care, and recovery housing for individuals with substance use needs; providing grants to support health care providers in adopting tactical regional care strategies that will shift appropriate services from hospitals to nonhospital settings and create regional hospital services or centers of excellence.

The Vermont Medical Society and other health care associations submitted a joint letter of support for the application, which can be found at the end of the application here.

AHEC Loan Repayment Programs 2026 Application Period now OPEN!

 Annual awards up to $50,000 and $300,000 over 6 years are available to recruit and retain medical practitioners.   The deadline for applying is January 19, 2026.  The recipient must be a Vermont resident and a primary care nurse practitioner, physician assistant, psychiatric nurse practitioner, certified nurse midwife, or physician (MD, DO, ND). Specialties include family medicine, general internal medicine/adult primary care, pediatrics, obstetrics/gynecology, geriatrics, and psychiatry. Must practice a minimum average of 20 (clinical) hours per week and 45 weeks per year in Vermont.  For program overview, eligibility requirements and application, visit  The Vermont Educational Loan Repayment Program for Healthcare Professionals | AHEC | The University of Vermont . 

Telehealth Policies for 2026 –  Controlled Substances Prescribing Extended; Medicare Coverage On the Line

On December 31, 2025, the U.S. Drug Enforcement Administration, in partnership with the Department of Health and Human Services (HHS), extended current telemedicine flexibilities for prescribing controlled substances through December 31, 2026.  This is the fourth Extension of the COVID-19 Telemedicine Flexibilities for the Prescription of Controlled Medications.   Under these telemedicine flexibilities, DEA-registered practitioners are permitted to remotely prescribe Schedule II-V controlled medications via audio-video telemedicine encounters, including Schedule III-V narcotic controlled medications approved by the Food and Drug Administration (FDA) for maintenance and withdrawal management treatment of opioid use disorder via audio-only telemedicine encounters, without having ever conducted an in-person medical evaluation, provided that such prescriptions otherwise comply with the requirements outlined in DEA guidance documents, DEA regulations, and applicable federal and state law.  Read the full announcement from the DEA here.

At the same time, Medicare coverage for telehealth services is once again facing a cut off on January 30^th, when the current federal budget continuing resolution is scheduled to expire.  The AMA issued a statement yesterday urging Congress to enact permanent authorization of Medicare telehealth services and end the repeated cycle of temporary extensions that have undermined reliable access to virtual care.  A new AMA issue brief reveals that the expiration of Medicare telehealth flexibilities during the recent government shutdown sharply reduced access to care. According to a Brown University review of electronic medical record data, fee-for-service telemedicine visits dropped 24% nationally during the first 17 days of the shutdown. Several states saw declines approaching or exceeding 40%, highlighting the sensitivity of access to policy disruptions.

CMS Releases Proposed Rules Barring Use of Medicaid Funds & Hospitals Performing Transgender Services for Youth

Two widely anticipated rules that could impact access to care for transgender youth have now been released by the Federal government and are open for public comment through February.  One would limit the use of federal Medicaid funds for “sex-rejecting procedures for children.”  The preamble to the rule indicates that states could continue to cover treatment using state-only funds, however this is not further addressed in the rule text.  The second proposed rule would amend federal Conditions of Participation to prohibit Medicare and Medicaid-participating hospitals from “performing sex-rejecting procedures (SRPs) on any child.”  The rule would define SRPs as “any pharmaceutical or surgical intervention that attempts to align an individual's physical appearance or body with a stated identity that differs from the individual's sex.”   The rules are only proposed (not in effect) and CMS is accepting public comment on both rules through February 17, 2026.  It is widely anticipated that if and when finalized, the rules will be challenged in court.   

For more information or to submit public comment, see:

• Federal Medicaid funding: rule text and link to comment; analysis by Health Affairs
• Conditions of Participation:  rule text and link to comment; analysis by Health Affairs

Separately, on December 18^th, Robert F. Kennedy released a declaration stating that “Sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors, and therefore, fail to meet professional recognized standards of health care.”   A lawsuit challenging the declaration has been filed by a coalition of states, including Vermont. 

Vermont Medicaid Releases Proposed Professional Fee Schedule, Hospital Global Budget Model

Vermont Medicaid has released details on two programs that began January 1, although they are open for comment through January 30^th.   Vermont Medicaid has proposed that the Resource-Based Relative Value Scale (RBRVS) professional fee schedule be updated effective January 1 in a budget neutral way.  This means that because Medicaid is aligning with current Medicare Relative Value Units (RVUs) for codes based upon Medicare's 2026 Physician Fee Schedule, the “Conversion Factors” that translate codes into payment levels are decreasing.  The primary care CF is reduced from $37.28 to $36.81, changing reimbursement from 115.2% to 110% of Medicare and the standard conversion factor is reduced from $28.96 to $28.60, changing reimbursement from 89.5% to 85.6 % of the Medicare.  See the full description and information on submitting public comment here.  VMS will be submitting comments advocating for an inflationary increase in the Medicaid fee schedule. 

Medicaid is also proposing to implement a voluntary hospital global budget (HGB) payment model in CY2026, which would allow participating hospitals to be paid prospectively for services covered under the HGB.  Eligible hospitals include short-term acute inpatient hospitals and Critical Access Hospitals (CAHs) in Vermont. Services covered under the HGB payment model include hospital inpatient, outpatient, and professional services (i.e., services provided by hospital-owned primary and specialty care practices). This is roughly equivalent to Medicare Parts A and B-like services. Services excluded from the HGB model include dental services, retail pharmacy, nursing home, home health, hospice, and certain high-cost drugs (e.g., CAR-T therapy drugs), and supplemental hospital payments, such as DSH and GME payments. Services excluded from the model will continue to be reimbursed through existing methodologies and arrangements. Hospitals will be paid a prospective, lump-sum amount on a monthly basis, equivalent to one twelfth of their annual hospital global budget amount.  See the full description and information on submitting public comment here.

CMS Shares Additional Details on AHEAD Model Changes

On December 18^th, CMS offered a webinar update on AHEAD Model changes for Vermont.  Slides and additional written materials will be available later in January.  In the meantime, highlights of changes to the model shared during the webinar include the following:

• AHEAD is renamed the Achieving Healthcare Efficiency through Accountable Design
• As a cohort 2 state, Vermont would begin the model on January 1, 2028 (rather than 2027) and the end date for all cohorts is now December 31, 2035
• At least two risk-bearing “Geographic Entities” will be present in all AHEAD-participating states.  CMS will issue competitive Requests for Application and eligible Geo Entities will bid to participate.  All eligible Original Medicare beneficiaries who are not currently attributed to a Medicare Savings Program or ACO will be attributed to a Geo Entity.   Geo Entities can be provider-led groups, technology and digital health companies, health plans, hospitals or other risk-bearing entities that agree to be accountable for the total cost of care for a Medicare population, are responsible for improvement in eight quality measures and are eligible for shared savings if quality standards are met.
• Rather than one primary care payment program, there will now be five primary care AHEAD payment choices:
• Basic (a prospective, quarterly per Medicare Beneficiary Per Month payment of $17-21 + continued fee for service Medicare payments)
• Advanced fee for service (same as Basic with opportunity for larger pay for performance payment)
• Advanced hybrid (PMPM of $17-21 plus 50% FFS payments plus 50% capitated payments)
• Advanced capitated (PMPM of $17-21 plus 100% capitated payments)
• Advanced Geo (same as advanced capitated with opportunity for shared savings with regional Geo Entity)

A brief description of some of these changes can be found on the CMS announcement here.  Reach out to Jessa Barnard at jbarnard@vtmd.org with additional questions.

MISC.

A Message from Pinnacle Wealth to VMS Members

Pinnacle Wealth has been a longstanding sponsor of the Vermont Medical Society Annual Meeting, and PFA joined Pinnacle Wealth as a sponsoring partner at the November meeting. As part of their ongoing partnership with VMS, they will be offering a series of educational webinars for members in 2026.

Advisor Capabilities Webinar – January 20, 2026  

Pinnacle Wealth and PFA will host a live Advisor Capabilities webinar on Monday, January 20, with sessions offered at 12:00 PM and 7:00 PM. Grounded in two influential works by Dr. Wade Pfau—How Much Can I Spend in Retirement? and Safety-First Retirement Planning—the session will highlight a coordinated approach to wealth accumulation, retirement planning, cash flow, tax mitigation, estate planning, and related planning considerations for physicians.

Registration:  

• Noon session  
• 7:00 PM session

Additional 2026 Educational Programming  

Pinnacle Wealth and PFA also plan to host three additional webinars in February, May, and October. Topics for these sessions are currently being developed and will be informed by member feedback.

VMS members are invited to complete a brief survey to share topics of interest:  

Further details on future webinars will be shared in upcoming VMS communications.

This programming is offered as part of VMS’s ongoing educational partnership with Pinnacle Wealth and PFA.

Webinar Jan. 29, 6:30 pm: Navigating the MultiPlan Litigation - What Physician Practices and Facilities Need to Know

A sweeping federal antitrust lawsuit is moving forward against MultiPlan, Inc. and several major insurers, including Aetna, Cigna, UnitedHealth and Blue Cross Blue Shield, alleging a price-fixing conspiracy that artificially suppressed out-of-network payment rates and cost providers billions of dollars. Following a key court ruling in June, the case is headed into discovery, with potential damages tripled under federal law for successful claims.

Join the Vermont Medical Society for a webinar January 29^th at 6:30pm on what this case means for practitioners and facilities nationwide. Matt Lavin, AGG Healthcare Litigation partner and member of the Executive Committee for direct-action plaintiffs, will walk through the litigation’s origins, key legal developments and strategies for affected providers to consider. He will also explain why now it is important to evaluate your potential participation in the case and to support industry reform.

The session will conclude with a Q&A - and open discussion is welcome and appreciated. All participant information will be kept private.

Preregister here. This webinar is only open to VMS members.  Once your VMS membership is confirmed we will email a Go To Webinar link to join the meeting.  Please do not share the link with others.

Vermont Medicaid Prior Authorization Decision Timeframe

Effective January 1, 2026, Vermont Medicaid is changing the decision timeframes for prior authorization requests (excluding drugs). This change is being made in accordance with the CMS Interoperability and Prior Authorization Final Rule.

For Expedited (Urgent) Requests: decisions will be sent within 72 hours.

For Standard Requests: decisions will be sent within 7 calendar days.

Urgent requests are when the requesting provider indicates with submission of clinical evidence, or Vermont Medicaid determines that the standard time frame could seriously jeopardize the beneficiary’s life or health or ability to attain, maintain, or regain maximum function.

New Clinician Well-Being Workshops for 2026

VMS is pleased to continue our partnership with Doug Wysockey-Johnson of WyJo Consulting to offer no-cost clinician wellbeing workshops over 2026.

These workshops are designed to support clinicians in meeting the demands of modern health care. Workshops are built around Doug’s daily experience working with physicians, nurses, APPs and clinical leaders across the country. These meetings are designed to be efficient, effective and interactive, with topics that directly address the biggest challenges clinicians face daily.   The workshops can be adjusted to fit a variety of formats and lasting anywhere from 45 minutes to 2 hours, tailored to your practice’s or medical staff’s needs.

New Topic for 2026:  Dealing with the Reverberations of Adverse Events, Medical Error and Bad Outcomes

Description:  According to the AMA, 31% of physicians will be sued at some point in their career.  (In certain specialties that percentage is much higher).  Over 50% will make a medical error with a bad outcome, and 100% will be involved in some kind of patient safety issue or ‘near miss.’  These experiences often lead to emotional distress, sometimes described as the “second victim” phenomenon. Feelings of guilt, shame, loss of confidence are common when this occurs.  Without requiring personal disclosure, this workshop will provide general ideas on how to cope and heal from these types of adverse events. 

For more information and all 2026 topics, click here or contact Jessa at jbarnard@vtmd.org or Doug at dougwyjo@gmail.com.

EVENTS

2026 Hospital Medicine Conference

February 4-6, 2026

Topnotch Resort, Stowe, VT

This conference will focus on key clinical advancements and guidelines to ensure optimal patient care. The target audience is comprised of physicians, physician assistants, nurse practitioners, pharmacists and nurses practicing in hospital medicine. We also encourage hospital medicine program administrators, resident physicians, and medical students with an interest in careers in hospital medicine.

Please visit the conference website the agenda and registration link here.

AlpTerra Wilderness Medicine Course

March 5–9, March 12–16, October 1–5, October 8–12, 2026

Franconia, New Hampshire

Join Alpterra for an immersive, hands-on wilderness medicine course designed to prepare you for real-life scenarios in the outdoors. Treat mock injuries, problem-solve in the elements, and walk away with practical skills that stick.

• Max 4:1 participant-to-instructor ratio for highly personalized, discussion-driven learning.
• Accredited for up to 16 AMA PRA Category 1 Credits™ — an excellent use of your CME allowance.
• Stay on-site in a luxury home-style setting. Enjoy locally sourced, family-style meals tailored to dietary needs.
• Add-on trips let you ski, climb, or explore the White Mountains with expert guides before or after your course.

Learn more about the agenda and registration here.

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

Vermont Medical Society

PO Box 153

Williamstown, VT 05679

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