October 21, 2025

NEED TO KNOW

Vermont Fiscal Committee: Federal Program Uncertainty and Loss of Premium Tax Credit Could Contribute to Hospital Instability

Last Thursday, the Vermont Joint Fiscal Committee heard an update from members of the federal delegation, from Vermont agency leaders, and from the Green Mountain Care Board on the impacts of the current government shutdown and the potential impacts to health care coverage if HB 1 goes into effect. Congressional representatives underscored the primary issue underlying the shutdown being the fight for the reauthorization of Biden-era Premium Tax Credits (PTC). Without them, thousands of Vermonters are at risk of dropping their healthcare coverage due to increased premium costs. With open-enrollment only weeks away, Nov. 1 – Dec. 15, the Department of Vermont Health Access is currently preparing for premiums on the Vermont Health Exchange to increase by up to 300%. Blue Cross estimates 12.6% of their members will leave the market, while MVP estimates 17% of members will leave the market. Owen Foster, from the Green Mountain Care Board, told the Committee over half of Vermont’s hospitals are operating at a loss right now, and the loss of the PTC could push these hospitals towards insolvency. He warned that this coverage loss could spike already increasing uncompensated care. The impact to small and rural hospitals could hit the hardest and could increase cost-shifting to commercial payers.

For more Vermont Jt. Fiscal Committee documents from October 16, 2025:

Federal Shutdown – Sarah Clark, Agency of Administration

AHS Impacts – Jenney Samuelson, Agency of Human Services

Solvency Risks – Owen Foster, Green Mountain Care Board

Premium Tax Credits - Mike Fisher, Health Care Advocate

Registration Closes Next Wednesday, October 29th for the 2025 Collaborative Meeting 

Registration for the 2025 Collaborative Meeting, hosted by the Vermont Medical Society, American Academy of Pediatrics Vermont Chapter, Vermont Academy of Family Physicians, and the Vermont Psychiatric Association, will close next Wednesday, October 29th at midnight!

Join us in-person at Topnotch Resort in Stowe, VT on November 7–8 for two days of education, collaboration, and connection. (Please note: There is no virtual option for the educational sessions this year. The only virtual component offered will be the Awards Banquet on Friday, November 7th.)

Topics include:

Register here for the 2025 Collaborative Meeting by October 29th!

New Medicare Claims Guidance from CMS In Light of Shutdown

Today, the Centers for Medicare & Medicaid Services (CMS) updated its Medicare claims hold guidance to Medicare Administrative Contractors, which is copied below. The AMA had been communicating with CMS behind the scenes and urging the agency to clarify its guidance in light of significant confusion about which claims are being paid during the ongoing federal government shutdown.

“CMS instructed all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service of October 1, 2025, and later for certain services impacted by select expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025 (Pub. L. 119-4, Mar. 15, 2025).  This includes claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims.  This includes telehealth claims that CMS can confirm are definitively for behavioral and mental health services.  CMS has directed all MACs to continue to temporarily hold claims for other telehealth services (i.e. those that CMS cannot confirm are definitively for behavioral and mental health services) and for acute Hospital Care at Home claims. 

Beginning October 1, 2025, for services that are not behavioral health services, many of the statutory limitations on payment for Medicare telehealth services that were, in response to the COVID-19 Public Health Emergency, lifted, and subsequently extended, through legislation again took effect. These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas, and hospice recertifications that require a face-to-face encounter. In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage (ABN). Further information on use of the ABN, including ABN forms and form instructions can be found here: https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn. Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are currently not payable by Medicare in the absence of Congressional action. For further information: https://www.cms.gov/medicare/coverage/telehealth.

CMS notes that the Bipartisan Budget Act of 2018 (Pub. L. 115-123, Feb. 9, 2018), which added section 1899(l) to the Social Security Act, allows clinicians in applicable Medicare Shared Savings Program Accountable Care Organizations (ACOs) to provide and receive payment for covered telehealth services to certain Medicare beneficiaries without geographic restrictions and in the beneficiary’s home. Separate from requirements to participate in the Medicare Shared Savings Program, there is no special application or approval process for applicable ACOs or their ACO participants or ACO providers/suppliers to offer these covered telehealth services. Clinicians in applicable ACOs can furnish and receive payment for covered telehealth services under these special telehealth flexibilities. For clinicians in applicable ACOs, telehealth claims that CMS can confirm are definitively for behavioral and mental health services will be paid. At this time, claims for some telehealth services will continue to be held.  For more information, including information on to which ACOs these flexibilities apply: https://www.cms.gov/files/document/shared-savings-program-telehealth-fact-sheet.pdf (PDF).”

Vermont Health Care Delivery Advisory Committee Holds First Meeting

Vermont’s Act 68 Health Care Delivery Advisory Committee held its first meeting last week.   Act 68 of 2025 established the Health Care Delivery Advisory Committee to enhance Vermont's health care system. Its primary responsibilities include: 

1. Setting Affordability Benchmarks: Establishing standards to ensure health care remains affordable for all residents.
2. Monitoring System Performance: Evaluating the effectiveness of Vermont’s health care system and its impact on public health outcomes.
3. Strategic Collaboration: Working with the Agency of Human Services and other stakeholders to develop and maintain a Statewide Health Care Delivery Strategic Plan.
4. Incorporating Recommendations: Considering input from the Vermont Steering Committee for Comprehensive Primary Health Care.
5. Advising on Evaluation Processes: Guiding the Green Mountain Care Board on creating a continuous evaluation process for the health care delivery system.
6. Providing Recommendations: Offering coordinated advice to the General Assembly on health care delivery issues, including primary care and population health.

The first meeting, held on October 15^th, was largely organizational, with members sharing their priorities for the work of the group.  VMS is currently represented by VMS Executive Director Jessa Barnard.  Several physicians, hospital representatives, and representatives from a range of health care organizations are also on the Committee. Please visit the Health Care Reform Delivery Advisory Committee page to view the membership, agenda for meetings and presentation materials:  Health Care Reform Delivery Advisory Committee | Health Care Reform.  

Updated Guidance on Providing Off Label COVID-19 Vaccines

VMS has worked with attorney John Wallace of Primmer Piper Eggleston & Cramer to create an FAQ intended to summarize some of the legal implications of the changes in federal COVID-19 vaccination policy and provide suggestions to respond to those changes.  The FAQs were recently updated to reflect the October 7^th CDC recommendations - see the updated FAQs here.

Important QPP Updates- CMS Releases 2024 MIPS Final Scores

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year. Physicians 2024 MIPS final score determines the MIPS payment adjustment physicians will receive in 2026. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026. The AMA encourages physicians to review their final score as soon as possible as the deadline to file a Targeted Review is only open until November 14, 2025.

The AMA has sought clarification from CMS and they are still accepting and reviewing Targeted Reviews during the government shutdown. However, some decisions may be delayed due to the need for broader CMS staff review, and some staff are furloughed. There are no plans currently to extend the targeted review period.

For more information, please see https://qpp.cms.gov/ under “MIPS Performance Feedback Updated: MIPS Payment Adjustments Are Available.”.

MISC.

Mildred Reardon Medical Student Scholarship Open for Applications for Class of 2027

Do you dream of becoming a Vermont doctor? 

The Vermont Medical Society’s Education and Research Foundation (VMSERF) is now accepting applications for the Mildred Reardon scholarship, which awards $10,000 to a University of Vermont Larner College of Medicine student committed to practicing medicine in Vermont.

The scholarship will be made to a Class of 2027 student interested in any specialty, with a preference for specialties in high need in Vermont.  The scholarship is tuition-linked and is paid directly to the College of Medicine towards tuition. Applications are due December 12, 2025.  Click here for more information and details on applying for the scholarship.

Red Wheelbarrow Deadline Extended to October 31st

UVM Larner College of Medicine’s literary and visual arts magazine, The Red Wheelbarrow, is extending its search for submissions in the literary, visual, and now performing arts! We particularly welcome work in the medical humanities, an interdisciplinary field that aims to make sense of medical practice, education, and human health and disease; non-medical work is also welcomed. The literary arts include prose, poetry, reporting, and personal essays. The visual arts include photography, painting, graphic design, drawing, and 3-D art (e.g., sculpture, ceramics, fiber). For 3-D submissions, please provide a picture of your work. For performing arts (music, dance, acting, etc.), you can send an audio or video file to showcase your work. Submissions can be submitted to the following link:  https://tinyurl.com/3pmd3y29 . The deadline for submissions is October 31st, 2025 at 11:59 PM. Please reach out to redwheelbarrowuvm@gmail.com if you have any questions!

Student Survey Request – Impact of Changes to Medicaid

Medical students at UVM Larner College of Medicine are working on a public health project collecting clinician perspectives and concerns around the 2025 Budget Reconciliation Act or the "One Big Beautiful Bill" Act and its changes to Medicaid.   They are seeking clinicians willing to complete a short survey at your convenience.  Responses will remain confidential and the project will only share anonymized data. The Qualtrics survey should take no more than 4-5 minutes:

https://qualtrics.uvm.edu/jfe/form/SV_8kpxyKnrYIRAIUm.  Please feel free to share this with colleagues, but please do not post the link online.  The students thank you for your time and consideration.  Please contact Patrick Parkinson at patrick.parkinson@med.uvm.edu with any questions.

EVENTS

Medicare Advantage: The Good, The Bad, and The Future

October 21, 2025, 4pm to 5pm

In this session, three nationally recognized experts will discuss opportunities and challenges for Medicare Advantage, which now enrolls more than half of Medicare beneficiaries. The panelists will examine evidence of the program’s effects on quality and costs; weigh concerns about risk adjustment and coding practices; and consider the tradeoffs that policymakers face when deciding whether and how to reform the program.

View the flyer here and register here. 

Clinical Quality Symposium: Building & Expanding Collaborative Systems for Maternal Health

October 28, 2025

Join us for a one-day symposium focused on strengthening partnerships across maternity care, primary care, and public health. Designed for maternity providers, primary care clinicians, public health professionals, and community organizations, this event will explore collaborative models to improve maternal health outcomes—particularly in the face of growing maternity care deserts in Vermont and New Hampshire.

Sessions will include:

• Innovative approaches to integrating maternity and primary care
• Dedicated breakout tracks for maternity and primary care providers
• Strategies to support postpartum care and mental health
• Practical tools for building cross-sector collaboration

Register here.

2025 Obesity Medicine & Weight Management Conference

November 14, 2025

Delta Hotel, South Burlington, VT

This conference is designed to improve the skills of primary care healthcare teams as they navigate new treatments in obesity medicine and weight management. The target audience includes primary care physicians, nurses, physical therapists, and other health professionals who pertain to primary care.

Learn more and register here.

New England History of Medicine Society: Noah Webster: Proto Epidemiologist with Richard Kahn, MD

November 18, 2025

Virtual

Noah Webster (1758-1843), best known for the dictionary that bears his name (1828), was also an educator, newspaper editor, lawyer, and politician, and he advocated for universal education, social welfare, and public health. Less well known are his efforts to understand the causes and prevention of diseases such as yellow fever that plagued the young nation, Though not a physician, between 1796 and 1800 Webster published two books and many articles on disease, public health, yellow fever, and quarantine, and this work catalyzed the creation of the first U.S. medical journal, The Medical Repository (1797-1824).

Richard Kahn's research explores Webster’s medical writings, their publication challenges, and contemporary responses.

Learn more and register here.

Dartmouth Health: 2025 NNEPQIN Fall Conference

November 19 - 21, 2025

Omni Mount Washington Resort, Bretton Woods, NH

Registration is open for the NNEPQIN Fall 2025 Conference! The conference will be taking place November 19-21, 2025, at the Omni Mt. Washington Resort in Bretton Woods, NH. A pre-conference opportunity is available on Wednesday, November 19, 2025, with either the obstetric track or neonatal track options. The pre-conference is available for actively practicing inpatient providers (MD, DO, CNM, and RN). Registrants can attend just the pre-conference if desired, or join for the main conference as well!

We have presentations related to TeleOB, neonatal cooling, inclusive care for LGBTQIA+ patients, breastfeeding support, SUD and cannabis use in pregnancy, adoption and legal considerations, shared decision-making and its impact on moral injury, postpartum mental health, NICU transitions, and more. We have topics to inspire every member of your care team—covering prenatal, delivery, postpartum, and neonatal follow-up. We hope your interprofessional team will participate!

Learn more and register here.

Save the Dates - 2026 VMS Advocacy Breakfast Series

Please join us in the Vermont Statehouse cafeteria for informal conversation with legislators over coffee on specific Wednesday mornings from 8-9am throughout the legislative session. Starting this January, lawmakers will be tackling tricky policy issues like Medicaid coverage, health care workforce initiatives and next steps in both State and federal health care reform. Your expertise is incredibly valuable in educating them on the practice of medicine in Vermont and what you think can improve our current system. These advocacy breakfasts are hosted by the Vermont Medical Society, the Vermont Academy of Family Physicians, the American Academy of Pediatrics Vermont Chapter, the Vermont Ophthalmologic Society, and the Vermont Psychiatric Association. Each date will be hosted by your specific specialty society with everyone being welcome on the Vermont Medical Society dates. Look for the dates to be posted to our website shortly - but look below for a preview of the Wednesdays we will be hosting Legislative Coffee Hours in 2026:

• Jan. 21- Vermont Medical Society/Vermont Psychiatric Association
• Feb. 3 – UVM OB/GYN Residents
• Feb. 4 - Vermont Ophthalmologic Society
• Feb. 18 - Vermont Academy of Family Physicians
• Mar. 18 - American Academy of Pediatrics Vermont Chapter
• Apr. 1 - Vermont Academy of Family Physicians
• Apr. 15 - American Academy of Pediatrics Vermont Chapter
• Apr. 29 - Vermont Medical Society

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

134 Main Street

Montpelier, VT 05602

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