February 6, 2024


House Health and Human Services Committees Begin Work on FY25 Budget 

This week, House Committees are beginning to take testimony on budget requests that are not included in the Governor's Recommended FY25 Budget. The Health Care and Human Services Committees are doing the difficult work of balancing requests from Vermont organizations responsible for the care of Vermonters, while being told there is no surplus and that the purse strings will be pulled tight. The VMS is keenly interested in ensuring that Medicaid payments for primary care and specialty care receive a 4.6% inflationary adjustment to match the Medicare Economic Index (MEI). Committee work on the FY25 Budget means that the House Health Care Committee will pause its work on the larger health reform bills, but the Senate Health and Welfare Committee continues to advance several bills including: 

  • S.197, this bill aims to ban the procurement of certain products containing PFAS by school districts and municipal and State government and would create a PFAS registry in the Department of Health. This week, Jessa Barnard, Executive Director of VMS, will testify on this bill regarding concerns that a registry is premature given that it is difficult to link any one health condition to PFAS exposure. 
  • H.151, a VMS priority bill from last session will be combined with S.211, another health reform initiative, before advancing out of Committee. This week, VMS member Erica Gibson, M.D., will urge the Committee to allow minors to consent to prevention services for sexually transmitted. 
  • S.192, the bill to authorize nine forensic beds at the Vermont State Psychiatric Hospital, continues to be debated by the Senate Health and Welfare Committee. It is likely to pass out of Committee this week without a competency restoration program because of concerns from the intellectual disability community. 
  • S.18, the bill to end the sale of all flavored tobacco products in Vermont, is stuck in the House Ways and Means Committee over concerns of the revenue loss to the state if retailers cannot sell flavored products. Click here to find your Representatives to email them to urge them to put Vermont kid's health over profit. Click here for Dr. L.E. Faricy's testimony.
  • H.612, a bill to reform the medical cannabis registry program, was debated last week in the House Government Operations Committee. After members expressed tepid support for removing the THC potency caps, the Chair has indicated the Committee will instead work on language to create a medical endorsement for some retail adult-use cannabis establishments. Patients on the medical cannabis registry would be able to access the products they have been using (including high potency products) tax-free from the retail establishments.

VMS members were in the news last week supporting S. 164, regarding insurance coverage for obesity treatments (Ashley Miller, MD and Kimberly Sampson, MD) and supporting Narcan distribution to schools (Becca Bell, MD, VMS President).

For an updated VMS priority bill tracker, that includes most of the bills we are following, click here

Contact the Senate Health & Welfare Today in Support of STI Prevention!

We have been working for several years to change minor consent language to allow minors to consent to prevention of sexually transmitted infections (STIs).  Current law allows minors to consent to treatment of STI’s (or lovingly called venereal disease in VT law), but not preventive modalities such as HPV, Hep B vaccination and PrEP.

There is language in S.151 (section 7, starting on page 16) that would put all of the minor consent language related to treatment and prevention of sexually transmitted infections in one place (now scattered throughout statutes) and expand what minors may consent to, to include prevention of STIs.

Legislators need to hear from YOU on why this important to adolescents and makes public health sense.  Parental Rights groups are currently inundating legislators’ inboxes with opposition to this change and clearly misunderstanding that minors are already able to consent to treatment to STIs.

Please reach out to Senate Health and Welfare Committee Members today to express your strong support for this change and what difference this will make to your patients!

Senator Virginia Lyons – vlyons@leg.state.vt.us 

Senator David Weeks – dweeks@leg.state.vt.us

Senator Ruth Hardy – rhardy@leg.state.vt.us

Senator Martine Gulick – mgulick@leg.state.vt.us

Senator Terry Williams – tkwilliams@leg.state.vt.us

Kiki Carasi-Schwartz, Committee Assistant - kcarasi-schwartz@leg.state.vt.us

Send a group email: vlyons@leg.state.vt.us; dweeks@leg.state.vt.us; rhardy@leg.state.vt.us; mgulick@leg.state.vt.us; tkwilliams@leg.state.vt.us; kcarasi-schwartz@leg.state.vt.us


Second VPMS Compliance Notice Mailed

The Vermont Prescription Monitoring System (VPMS) mailed a second notice for VPMS registration this week.

A couple points to keep in mind:

  • These providers were identified as having prescribed controlled substances at least 5 times in the prior quarter and did not have an active account.
  • Some of them may have had active accounts in the past but through lack of use, they may have been locked or deactivated. They may not have been required to query the account, but they still are required to have an active one.
  • Due to changes of address or mail issues, some of these prescriber may not have received the first mailing.
  • Reactivation is simple, if necessary.
  • If prescribers do not respond to this letter by registering by the next compliance check, we will generate a list of non-registered prescribers for the licensing boards to review.

Please direct questions regarding the notices or around reactivation or registration to ahs.vdhvpms@vermont.gov.


Fluoridation on the Ballot for Rutland in March

Fluoridation is going to be on the ballot in Rutland in March when voters will decide whether or not to continue fluoridating the Rutland public water system.  See this coverage by WCAX: https://www.wcax.com/2024/01/31/rutland-voters-weigh-fluoridation-again/  Here is a link to an AAP website about CWF. This is a great source of information for health care providers and patients.

The Health Department’s Office of Oral Health includes community water fluoridation (CWF) as a priority because it is an evidence-based strategy to promote oral health equity in populations. In fact, US Surgeon General Vivek Murthy co-authored a commentary in the March 2022 New England Journal of Medicine citing water fluoridation as one of the strategies with "the greatest potential" to reduce oral disease. The US Department of Health and Human Services led the development of Healthy People 2030, a list of health goals for our nation. Increasing the percentage of people who benefit from CWF is a Healthy People and Healthy Vermonter 2030 goal; it’s also a strategy to promote population health in Vermont’s  State Health Improvement Plan and State Oral Health Plan.  For more information about ways to get involved contact swinters@vtmd.org.

Details Emerging on AHEAD Model for Primary Care

As covered in prior issues of the Rounds, Vermont’s agreement with Medicare to participate in payment reform (the “All-Payer Model”) will be ending in 2025.  Vermont’s Agency of Human Services (AHS) is currently drafting an application to participate in Medicare’s new payment reform model, the AHEAD Model, starting in 2026.   The Model includes paying hospitals with a new “global budget” methodology and a Primary Care AHEAD component.  A Primary Care Workgroup has been meeting with AHS to both learn more about the model and provide feedback to the State.  Materials from the workgroup are now available on the AHS website here.  Primary care clinicians and practices are encouraged to review the materials and reach out with any questions, concerns or interest in joining the workgroup to jbarnard@vtmd.org.  Of note, slides from December 15th crosswalk between the approximately $17 per FFS Medicare beneficiary payment that Medicare will make available to practices participating in the Model with Vermont’s existing Blueprint and ACO payments (see slides 8-12).  While $17 PMPM is greater than most payments currently available to primary care, this will only be linked to FFS Medicare patients, so the impact on each practice will be different.  Slides from the same meeting also demonstrate how the AHEAD Model could potentially work concurrently with a Medicare-ACO program called MSSP.  AHEAD is not an ACO-based model and without an ACO primary care practices could potentially lose an exception from participating in the federal pay-for-performance programs MIPS, as well as lose OneCare Vermont’s capitated Comprehensive Payment Reform Program. In January (see slides 11 & 12), the work group also began discussing primary care quality measures required by AHEAD.  While the measures are largely familiar to Vermont practices (such as colorectal cancer screening and screening for depression), AHEAD does require reporting using the eCQM electronic reporting format. Practices should also reach out to jbarnard@vtmd.org with feedback on reporting via eCQM. 

The AHEAD Model also incudes global budgets for hospitals. Under global budgets, hospitals are paid a prospective, predetermined monthly amount for in-patient and out-patient hospital services, based on the hospitals’ historic spend with annual updates for population changes and inflation.  States can choose to use a CMS methodology (the details of which are expected to be released later this month) or develop a state methodology.  Medicare FFS and Medicaid are expected to participate from the beginning of the model, with at least one commercial payer required to participate by year 2 of the model.  See slides 20-26 of this presentation.  

The model will be voluntary for both hospitals and primary care practices. Vermont’s application for the AHEAD Model is due by Monday, March 18th

Submit a Resolution to VMS – Help Direct the Work of YOUR Society

VMS welcomes members to submit resolution ideas.  Resolutions set the policy positions of VMS and often drive VMS advocacy work at the state and federal levels.

Resolutions can be submitted on a year-round basis, any time by any VMS member or group of members, including student members. Resolutions are intended to express composite positions of the VMS and are to suggest a significant course of action to be taken by the Society. To see adopted VMS resolutions, click here.

Once a resolution idea is submitted by a member, the resolution will be reviewed by VMS staff, who may assist with further drafting or clarification.  Resolutions are then distributed for comment and non-binding survey to all membership. At a Board meeting after gathering member feedback, the VMS Board will review the resolution and feedback of membership.  All resolutions presented to the Board then require a majority vote of the Board for action, including adoption, amendment or referral.

To submit a resolution idea, please fill out the form, available here or contact jbarnard@vtmd.org for further assistance.

Next Commissioner of Health Call is March 7, 2024

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members on Thursday, March 7th at 12:30 pm. View notes from the February 1st 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.

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.

Click Here to Register


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. Learn more and register here.

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


Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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