December 14th, 2021


VMS COVID Convos with Commissioner of Health, Mark Levine

Join us every 1st and 3rd Thursday of the month from 12:30pm to 1pm as Commissioner of Health, Mark Levine provides us with the most pressing COVID-19 information affecting the state and nation. You will have the opportunity to submit questions to Dr. Levine who will answer them, time-permitting.

To join the last December 16th COVID Clinical Conversation from 12:30pm to 1pm, click here. 

You can join the zoom meetings beginning in January here or add to your calendar by following this link and clicking download (you will then need to open the downloaded file and click save to add to your calendar).

Administration Previews Push for Employer Vaccine or Test Requirements

At Tuesday’s press conference, Governor Phil Scott emphasized that unvaccinated adults are 5% of the adult population in Vermont but 75% of those hospitalized and at times up to 90% of those in the ICU.  Governor Scott stated that he will not institute more widespread mitigation requirements that will punish all Vermonters including those who are vaccinated but that he will be meeting with employer groups to encourage vaccine or test requirements like that in place for Vermont state employees.  He stated that this could be effective among the 18-29 year old population, with a lower vaccination rate, as well as address locations like restaurants, bars and clubs where a vaccine mandate may not be effective.  Administration officials also pushed all Vermonters to receive a booster shot before the holidays, will be rolling out an expanded booster shot messaging campaign, and Commissioner of Health Mark Levine, MD, stated that we are now receiving preliminary data that a 3rd shot/booster is much more effective against the Omicron variant.   Notes from the press conference are available here and the Department of Financial Regulation weekly modeling report here.  

In other COVID-19 updates:

  • FDA Expands Eligibility for Pfizer-BioNTech COVID-19 booster dose to 16- and 17-year-olds and CDC recommends boosters to this age group. 
  • FDA Authorizes AstraZeneca’s Evusheld (long-acting monoclonal antibodies) for pre-exposure prevention of COVID-19 in certain individuals ages 12 and older who have a moderate to severely compromised immune systems or a history of severe adverse reactions to a COVID-19 vaccine and/or component
  • All last week, VPR aired stories from frontline healthcare workers at Northeastern Vermont Regional Hospital in St. Johnsbury.  See stories from Monday, Tuesday, Wednesday, Thursday and Friday.
  • The Supreme Court declines to block enforcement of New York State’s vaccine mandate for health care workers; follow updates on the federal CMS and OSHA vaccine mandates and litigation here

“No Surprises Act” Requirements Becoming Effective January 1 – Posting Notice of Balanced Billing Prohibitions

Last week in the Rounds, VMS highlighted that effective January 1, 2022, health care providers and facilities must begin provide to patients who are not enrolled in a health plan or federal health care program or plan to self-pay a good faith estimate of expected charges, expected service and diagnostic codes of scheduled services. The Rounds article can be found here and VMS’ full summary of requirements of the No Surprises Act going into effect Jan. 1 can be found here.

This week, VMS is highlighting another Jan. 1 requirement: The rules also require certain health care providers and facilities make publicly available, post on a public website, and provide a one-page notice to individuals regarding: (1) The requirements and prohibitions on balanced billing applicable to the provider or facility; (2) any applicable state balance billing requirements; and (3) how to contact appropriate state and federal agencies if the individual believes the provider or facility has violated the requirements described in the notice. The notice must be must be provided in-person or through mail or email, as selected by the participant; posted on any provider website; and displayed in the practice location. More details, including exceptions to the requirement to give notice (for example, independent physician offices may be except) and timelines for providing notice are found on VMS’ summary here. The Summary also includes links to a CMS template notice. For more questions, contact  

Health Reform Committee Says Stay the Course on ACO

Last Friday, Dec. 10th, the Vermont Legislature's Health Reform Oversight Committee (HROC) met for the first time since August, 2021 to hear a presentation on "Opportunities for Evolution of Vermont's Health Care Regulatory System." Please click here for the report/presentation. The HROC Committee analysis focused on the central questions of whether Vermont's All Payer Model is the right system to move Vermont towards the overarching goal of "managing overall health care costs and improving the delivery system" and whether the Green Mountain Care Board provides the appropriate health care regulatory structure. The report indicates that Vermont should continue to implement the All Payer Model and that the Green Mountain Care Board provides exceptional value with suggested improvements to streamline the regulatory process and to optimize data models to drive care delivery transformation and cost containment. The report offered both and long and short-term strategies for the legislature to consider and specifically provided eight recommendations focused on advancing more towards predictable fixed global payment options and moving away from fee-for-service.  The HROC Committee is currently considering which recommendations could be tackled in the 2022 legislative session, which is scheduled to start Tuesday, January 4th, and which recommendations are long-term initiatives. Senator Jane Kitchel indicated that funding to initiate some of the recommendations could be included in the FY22 Budget Adjustment process. 

House Health Care Committee Takes Up Mental Health Boarding in Emergency Departments

Vermont’s House Health Care Committee met last week to discuss solutions to Vermont's mental health boarding crisis in Emergency Departments (EDs). House Speaker Jill Krowinski has identified this issue as a top priority for the 2022 legislative session and the Committee met for most of the day and heard testimony from: emergency medicine specialist and VMS Vice-President, Ryan Sexton, M.D., UVMMC pediatrician, Christian Pulcini, M.D., and Emily Hawes, Commissioner of the Department of Mental Health. Committee members also heard from family physicians, hospital representatives, the Designated Agencies, peer-based recovery programs, law enforcement, parents and others. Committee Chair Bill Lippert said the committee will be continuing this discussion in the 2022 session and is seeking concrete solutions to help alleviate the suffering for patients and their families, along with their clinicians and caregivers. Dr. Pulcini said, "watching children wait in the ED day after day, confined to their room due to necessary COVID-19 protocols, is extraordinarily disheartening to all individuals who bear witness to this unfortunate circumstance. Children should be in school, learning. Children should be at home, developing. And when needed, children should receive appropriate mental health services in the right setting at the right time." He said the biggest problem is bandwidth and staffing and that the State desperately needs workforce incentives and alternatives to emergency departments, along with peer certification and respite, increased telepsychiatry, and flexibility in CON process. Click here for testimony presented to the House Health Care Committee. Click here to read the VMS 2022 Pediatric Mental Health Policy Priorities. 


AMA, Hospitals File Lawsuit over Arbitration Method in No Surprises Act

Last Thursday, the American Medical Association and American Hospital Association filed a complaint and motion to stay against the federal government over implementation of the federal surprise billing law. The associations are joined in the suit by plaintiffs including Renown Health, UMass Memorial Health and two physicians based in North Carolina. The lawsuit challenges a narrow provision of a rule issued on Sept. 30, 2021 and set to take effect Jan. 1, 2022: the independent dispute resolution process that is required when providers and insurers are unable to reach agreement on payment for out-of-network services from providers who are not under contract with the insurer. Read the full press release here.

    U.S. Senate Passes Legislation to Halt Medicare Physician Payment Cuts

    Last Thursday evening, the U.S. Senate passed legislation to halt Medicare physician payment cuts that were scheduled to take effect on January 1. President Biden is expected to sign the bill into law.

    Highlights of the physician payment provisions include:

    • A delay in resuming the 2% Medicare sequester for three months (January 1- March 31, 2022), followed by a reduction to 1% for three months (April 1-June 30, 2022).
    • A one-year increase in the Medicare Physician Fee Schedule of 3% (0.75% less than the conversion factor boost provided for 2021).
    • A one-year delay in the cuts to the clinical lab fee schedule.
    • A one year delay in the Medicare radiation oncology demonstration.

    Additionally, the bill will erase the 4% Medicare PAY-GO cut and prevent any additional PAY-GO cuts through 2022. The AMA released a statement on Thursday’s vote to avert looming Medicare cuts to providers.

    Medicaid Coordination of Benefit Changes – Open for Comment

    Vermont Medicaid is proposing changes to the coordination of benefits practices in cases of third-party liability for payment in accordance with federal regulations. Medicaid is generally the payer of last resort where all other sources of coverage must pay for services before Medicaid and practices must bill third parties prior to billing Medicaid.  In the proposed changes, Medicaid will no longer pay and chase for the following services:

    • Prenatal care, including labor and delivery
    • When a child support enforcement order is in place
    • Pediatric preventive services

    Practices would be able to bill Medicaid if payment is not received from the third party after a specified period of time or when cooperation may result in physical or emotional harm to the individual or other person, or is deemed to be in the best interest of a child.  The full proposal can be seen here and is currently open for public comment. Please contact 

    with feedback or questions by December 28, 2021. 

    VMS Seeking Information Re: Virtual Visits and MOUD

    VMS is determining a position on continuing COVID-19 flexibilities allowing the telehealth prescribing of Medication for Opioid Use Disorder (MOUD). Vermont's 2021 COVID-19 flexibility law, Act 6, allows of virtual induction of MOUD, virtual maintenance visits and the ability for patients to be prescribed a 30-day supply of buprenorphine until March 31, 2022.  VMS’ understanding is that these State flexibilities are also dependent on the federal declaration of a public health emergency (PHE), during which the Department Enforcement Administration (DEA) has allowed the prescription of controlled substances and MOUD without having to see the patient in-person. Click here for the DEA guidance from March 2020.   VMS is seeking feedback on extending and/or making permanent the ability in Vermont to prescribe MOUD via telehealth visits – recognizing that this may also be dependent on continued federal flexibility. Please send your feedback to Jill at by January 4th, 2021. 


    Please join us for a conversation about COVID-19 vaccines for children. Find the forum dates here. To view recordings from previous forums, click here.

    University of Vermont Project ECHO 

    Adult Complex Mental Health

    January 19th to June 22nd, ET

    This program will highlight best practices and evidence-based care for treating patients with complex mental health issues and disorders. The program will identify strategies, best practices, and emerging topics in this field – and highlight resources for patient care. The intended audience is a cohort of individuals or practice teams throughout Vermont, including Family Medicine and Internal Medicine Adult Primary Care.

    This program is offered at no cost to participants through a grant from the Vermont Department of Health.

    Participants can receive CME credits for each learning session attended. 

    For more information, visit here.

      Register here.

      Hospital Medicine 2022 and Optional POCUS Workshop

      January 30-February 1, 2022, ET

      The course will provide practical approaches to common problems in hospital medicine, informed by experts and the latest evidence. All provider types practicing Hospital Medicine are welcome, including administrators, resident physicians and medical students.

      An optional Point-of-Care Ultrasound (POCUS) workshop will take place at the UVM SIM Lab in Burlington on Sunday morning, January 30.

      For registration information (in-person and virtual option), full agenda & accreditation details, click here. 

      Questions: Contact Michele Morin at: or 802-922-3594

      The 33rd Annual Eastern Winter Dermatology Conference

      February 5-7, 2022, ET

      Dr.. Glenn Goldman invites you to attend this year’s dermatology conference which is returning to Stowe for its 33rd year. The conference is divided into morning and late afternoon sessions, with a large mid-day break to allow for recreation. Although the course is designed for dermatologists, medical professionals with an interest in dermatology are welcome to attend.

      Topics: Locoregional and in-transit metastatic melanoma, skin reactions to immunotherapy, testing and imaging for SCC, MCC, and MM, cosmetic dermatology, challenging cases, medical pearls, Dermatology Jeopardy, and more!

      For registration information, full agenda & accreditation details, click here.

      Questions: Contact Michele Morin at: or 802-922-3594

      Institute of Cannabis Research (CSU-Pueblo) - Monthly Webinar

      Recordings of monthly webinar series from The Institute of Cannabis Research (ICR) at Colorado State University -  Pueblo can now be viewed here.

      ICR is the nation’s first multi-disciplinary cannabis research center at a regional, comprehensive institution. The primary function of the Institute is the generation of knowledge that contributes to science, medicine, and society through investigation of the benefits and risks associated with cannabis. Research findings are used to translate discoveries into innovative applications that improve lives. 

      New Free Course - Caring for Newly Arrived Afghans

      With the influx of Afghan families resettling to U.S. States under Operation Allies Welcome we know that many clinicians and health care systems will be seeing  these individuals. 

      We put together this free four-hour course, composed of recorded lectures and interactive lessons to help prepare providers to serve newly arrived Afghans. It covers topics ranging from Operation: Allies Welcome to Afghan cultural background, general and skin medical exams, and mental health care, to clinical observations from practitioners at welcome centers and in receiving states. 

      We hope you will find this resource helpful. Please share this message and link with anyone you think would find it useful. We have additional free resources available here.

      Register here! This course is free but does require registration. Once registered you will receive an email receipt with a link to the course.


      Vermont Medical Society

      134 Main Street

      Montpelier, VT 05602

      -- Unsubscribe --