March 19, 2024

NEED TO KNOW

Crossover Week Results in Some Winners and Losers

Last week was an action-packed week as it was crossover week, when all bills need to pass out of policy committees in order to advance this year. The bills have this week to make it through the "money committees," which include Appropriations, Ways and Means and Finance. VMS is thrilled that H.766, the prior authorization bill passed the House 137-0 and has advanced to the Senate Health and Welfare Committee, please see the action alert below. Some of the larger health reform bills, like S.151, which contained legislative intent language for the AHEAD model, failed to advance, due in part to a lack of support on the Committee. Thank you to all that reached out on the primary care provisions of this legislation, the VMS is working to determine if parts of this proposal can move forward as part of other legislation. In celebration, S.18 passed the House by a vote of 83-53 and goes back to the Senate Health and Welfare Committee tomorrow and then the full Senate for concurrence Thursday. Please see the action alert below. Here is the latest action on other bills that are in various stages of advancement:

  • Please Take Action: S.18, the bill to end the sale of flavored tobacco was passed by the House last week by a vote of 137-0. The bill now goes to the Senate floor for a final vote. Please tell your Senators to vote YES! Here is a link to recent testimonyfrom L.E. Faricy, M.D. and here is a link to find your Senator. 
  • Take Action to Strengthen Telehealth Access!  H. 861 is being taken up by the Senate Finance Committee this week.  The Department of Financial Regulation has said the bill will have no noticeable impact on insurance premiums while it will: (1) Require commercial payers to reimburse at parity with in-person visits for audio-only visits (vs the current requirement of 75%); and (2) Eliminate a 2026 sunset on payment parity for audio-visual telehealth visits.  Contact the Senate Finance Committee to express support for this important patient access protection and let them know how telehealth helps you care for your patients.  Email the Committee at: acummings@leg.state.vt.us; mmacdonald@leg.state.vt.us; cbray@leg.state.vt.us; rmccormack@leg.state.vt.us; rbrock@leg.state.vt.us; kramhinsdale@leg.state.vt.us; tchittenden@leg.state.vt.us  
  • Vermont Data Privacy Act: H.121: The House Commerce Committee passed this data privacy bill, which exempts data that health care entities process in compliance with HIPAA, by a vote of 11-0 and it goes before the full House this week. 
  • Medicaid Expansion: H.721, the House Health Care Committee voted out the bill that requires the Agency of Human Services to prepare a feasibility study on expanding Medicaid eligibility by 2030. It also currently includes expanding Medicaid coverage to 19 and 20 yr olds and pregnant women in Dr. Dynasaur coverage, though the legislature will have to approve appropriations to move forward with this cost. This bill also includes a provision to expand the Medicare Savings Program. The House Appropriations Committee has received the fiscal note which cites a potential $22m impact to the General Fund in 2026. 
  • Colorectal Coverage: H.741, was passed by the House Health Care and the VMS testified on the value of removing the age of 50 from Vermont's statute and following USPSTF recommendations for private payers to provider colorectal cancer screenings at no cost to patients. This bill advances to the full House floor.
  • Diagnostic Mammography: H.621, was passed by the House Health Care and the VMS testified on the value of including coverage for diagnostic mammograms with zero-cost screening. The bill advances to the full House.

Urge Senate to Reduce Prior Authorizations! 

Earlier in the session the House unanimously passed H.766, which will reduce prior authorization, step therapy & insurer billing requirements. The bill has now been referred to the Senate Health and Welfare Committee.  Please reach out to the Committee to urge them to take up this bill, allowing clinicians and office staff to spend more time with patients rather than on paperwork.  If you already sent letters of support to the House Health Care Committee, please resend to the Senate Committee. You can email them at:  VLyons@leg.state.vt.us; rhardy@leg.state.vt.us; mgulick@leg.state.vt.us; dweeks@leg.state.vt.us; tkwilliams@leg.state.vt.us; KCarasi-Schwartz@leg.state.vt.us.

See also this opinion video from the New York Times, painting a powerful picture of the impact of prior authorization on clinicians and patients:  “…insurance companies often weaponize this mundane process in order to control doctors and inflate their profits.”  “This is medical injustice disguised as paperwork.”

In more detail, H. 766 as passed the House  would:

  • Require health plans to allow requests for exceptions to prescription drug step-therapy under specific conditions, like if a patient is stable on an existing therapy or if the drug is expected to be ineffective;
  • Mandate adherence to coding standards and guidelines for processing healthcare claims;
  • Limit “claims edits” for services other than pharmacy to those when Medicare uses claim edits;
  • Require health plans to limit prior authorization for procedures and imaging to the instances when Vermont Medicaid uses prior authorization;
  • Reduce the time frames for health plans to respond to prior authorization requests to 24 hours for urgent requests;
  • Limit the occasions for reauthorization of previously approved treatments and medications.

CMS Announces Reopening of 2023 MIPS EUC Application in Response to Change Healthcare Cyberattack

CMS has now reopened the 2023 MIPS Extreme and Uncontrollable Circumstances (EUC) hardship application due to the Change Healthcare cyberattack. The deadline to apply for an exemption is April 15, 2024. The 2023 MIPS EUC hardship exemption is not automatic and requires physicians to apply. If a physician or practice has already submitted data and would like to take advantage of this flexibility, it requires logging into the CMS portal and updating the submission.  If a physician or practice would like to still be scored on the 2023 MIPS Program, the extended deadline to submit data remains April 15, 2024.

For more ongoing updates and links to information from each payer regarding the Change Healthcare incident, see the March 12th VMS Rounds. Please note that Vermont Medicaid (DVHA) believes that there are a number of impacted practices that have not yet applied for advanced funding to address delays in receiving claims.  See more information here.    Please contact Jessa Barnard at jbarnard@vtmd.org with questions or need for further assistance for your practice. 

CDC HAN: Increase in Global and Domestic Measles Cases and Outbreaks - Ensure Children in the United States and Those Traveling Internationally 6 Months and Older are Current on MMR Vaccination

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and public health officials of an increase in global and U.S. measles cases and to provide guidance on measles prevention for all international travelers aged ≥6 months and all children aged ≥12 months who do not plan to travel internationally. To prevent measles infection and reduce the risk of community transmission from importation, all U.S. residents traveling internationally, regardless of destination, should be current on their MMR vaccinations. Healthcare providers should ensure children are current on routine immunizations, including MMR.  Read the Advisory here.

MISC.

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.– Note: the start of these sessions have been moved a week later

SaveWell: Gaining Awareness and Setting Goals - March 19th

Will help you understand your financial goals and the factors that will impact these goals.


InvestWell: Understanding How to Put Savings to Work - March 26th
Gain a clearer picture of how to grow a nest egg by investing it.

LiveWell: Protecting a Fulfulled Life and Retirement - April 2nd
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

Commissioner Call Held March 7th; Next Call is April 4, 2024

The Commissioner of Health, Mark Levine, MD, held his most recent VMS member call on March 7th.  Notes from the call are here. Commissioner Levine highlighted recent changes in COVID isolation policy as well as new booster recommendations for adults over 65.

He will hold his next Public Health Update with VMS Members on Thursday, April 4th at 12:30 pm. You can join the zoom meetings here.

VMS Board Seeking Resolution Feedback by March 27th

The VMS Board is seeking member feedback on a policy resolution related to:

  • Support for Expanded Coverage for Obesity Treatment

The full text of the Resolution is available here.

You should have received a survey link specific to you on Wednesday, February 28th. If you did not receive your survey link or have any questions or concerns with completing the survey, please contact bpauley@vtmd.org.

The survey will be open for member comment between February 28, 2024 and March 27, 2024. The resolutions will be discussed together with the feedback received from members by the VMS Board at its April 10th Board Meeting. If you would like to join this meeting via Zoom, please contact Birdie Pauley at BPauley@vtmd.org.

Survey: Integrating Gender-Affirming Care into Primary Care

Throughout Vermont, transgender and gender-diverse people look to primary care providers for inclusive, respectful, affirming healthcare. We’d like to learn more about the care that PCPs currently provide for transgender patients, barriers that they encounter, and what resources they would find helpful to meet these patients’ needs.

We would like to hear from all physicians, NPs, and PAs providing primary care for adults and/or youth in Vermont. If you currently see few or no transgender patients, we are especially interested in hearing from you!

Please click here to take the survey: https://redcap.link/vttranshealth

The survey is open until Friday, March 29, and takes about 10 minutes to complete. Respondents will be entered into a raffle for one of twenty $20 Amazon gift cards.

This project is based at The Fenway Institute and is led by Eli Goldberg, MD, a family physician raised and trained in Vermont who is currently doing a fellowship in LGBTQIA+ Health. Questions? Please email Eli Goldberg: egoldberg@fenwayhealth.org
 

EVENTS

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.

2024 Vascular and Cardiac Forum

April 1, 2024

In-Person South Burlington, VT

The vascular and cardiac forum this year will provide primary care, internal medicine, urgent care, and physical therapy providers with education about a variety of vascular and cardiac conditions. The objectives are to improve accuracy and timeliness of the diagnosis and treatment of these conditions, and efficiently use expert consultation in a value-based environment.

Registration Information, full agenda and accreditation details can be found here.

18th Annual Vermont Geriatrics Conference

April 16, 2024

In-Person South Burlington, VT

Please join us for the 18th Annual Vermont Geriatrics Conference. The conference is designed to equip nurses, nurse practitioners, pharmacists, physicians, physician assistants, social workers and other healthcare professionals with practical and innovative approaches to the medical care of older adults.

Registration Information, full agenda and accreditation details can be found here.

Diabetes 2024: Updates on Management and Treatment

May 3, 2024

In-Person South Burlington, VT

This conference is designed to equip primary care clinicians with updated knowledge on issues related to outpatient management of patients with diabetes. Specific topics to be addressed at this year’s conference include Lipid-Lowering Therapies to Reduce Cardiovascular Disease, Basal Insulin Use, Insulin Titration, MASLD (Liver Disease) and more.

Registration Information, full agenda and accreditation details can be found here.

The 50th Annual Family Medicine Course

June 4th-June 7th, 2024

In-Person South Burlington, VT

This intensive four-day program for family physicians, advance practice providers, nurses, and other primary care professionals will focus on current issues in the practice of Family Medicine, with special attention to new contributions. An optional, pre-conference full-day workshop on Mastering Early Goals of Care Conversations will also be offered. Conference emphasis is on practical, clinically applicable diagnostic and management issues in primary care. This conference will be presented in-person and virtually; participants may choose to join via a mixture of in-person and remote attendance. This conference is also anticipated to overlap with the Burlington Jazz Festival, taking place June 5-9, 2024.

Registration Information, full agenda and accreditation details can be found here.

Whole Person Care: Enhancing Substance Use Disorder and Mental Health Treatment

June 14, 2024

Lake Morey, VT

Please mark your calendars for Friday June 14 when we will be hosting "Whole Person Care: Enhancing Substance Use Disorder and Mental Health Treatment", an in-person conference at Lake Morey, VT.

This is a part of the Collaborative to Advance Mental Health Treatment and Substance Use Recovery for Everyone (or CARE Series).

Learn more here.

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

VTMD.ORG

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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