March 21, 2023

NEED TO KNOW

After Legislature's Crossover Week, the Focus Turns to the House FY2024 Budget 

Last week, the Legislature's policy Committees worked in earnest to meet the crossover deadline, by which they must complete work on the bills they want to advance this session.  Many of these bills will now go to the House or Senate floors for full debate this week. The House Appropriations Committee aims to vote out their version of the FY2024 Budget by this Friday and has zeroed in on the final topics they need to vote on.  They have yet to give final approval to an increase in Medicaid rates in the FY24 RBRVS fee schedule as recommended by the House Health Care Committee -  to 110% of Medicare for primary care providers and a 3.8% inflation increase to specialty care providers. The VMS continues to advocate for this increase, as well as the Governor's proposed 2-year pilot for an infusion of dollars to go to the Blueprint for Health Community Health Teams for expanded mental health and substance use services.

Here are some of the bills the legislature took action on last week: 

• Opioid Overdose Prevention: H.222, an opioid overdose prevention bill, including limits on prior authorization for MOUD and ensuring step therapy practices are not used for MOUD, passed unanimously out of the House Human Services Committee and will be on the House floor this week. The bill as passed now includes a study from the Department of Vermont Health Access (DVHA) on the feasibility of developing a gold card program for any prescriber who has 90% or more of their Medicaid prior authorizations (PAs) for MOUD approved to be waived from needing to perform PAs for MOUD.  
• Suicide Prevention through Firearm Safety: H.230 includes a safe storage requirement for firearms and a 72-hr waiting period to purchase a handgun.  The bill passed the House Judiciary Committee last week and will be debated on the House floor this week. Please email your Representatives and urge them to vote yes on this important public health initiative. Click here to find your Representatives.  
• Misc. Cannabis bill, H.270: Last week, after VMS advocacy and testimony, the House Government Operations Committee agreed with the House Human Services Committee to remove  a long list of new proposed medical conditions that would have qualified for the medical cannabis registry.  The bill was then voted out of the House Government Operations Committee and will still expand the package serving size for commercial cannabis products from 50 mg to 100 mg. Click here for our testimony.  The bill will be heard on the full House floor this week. 
• Covid Flexibilities: H.411, this year's bill to extend COVID flexibilities for one calendar year needs to pass out of the Senate this week in order to avoid a gap in continued regulatory flexibility such as flexible staffing arrangements; streamlined licensing; and allowing telehealth for MOUD renewals.  VMS will be testifying tomorrow.
• Flavored Tobacco Product Ban, S.18: Please urge the Senate Finance Committee and your Senator to pass this bill and prohibit the sale of flavored tobacco products including menthol. On Wednesday, the Finance Committee is only scheduled to hear testimony from those opposed to the bill, who say that the cost from lost revenue will be too high. With your help, it could still pass the Committee and be on the Senate floor this week. Please tell the Senate that preventing youth from starting a dangerous nicotine habit is worth the investment as flavored tobacco products, including menthol cigarettes, are easier to smoke, harder to quit and more likely to addict youth. Click here for the Committee email addresses and click here to find your Senator. 
• Violence Against Healthcare Workers: S.36 will be debated on the Senate floor this week. Please email your Senator and urge them to vote yes on this bill that would allow warrantless arrests for anyone who assaults or commits acts of violence against health care workers in health care facilities. The bill would also make threatening a health care worker a felony. Click here to find your Senator. 
• Shield Health Care Law: S.37, the "shield law" protecting clinicians who provide reproductive health care services and gender-affirming care passed the full Senate last week by a voice vote. Senator Ginny Lyons, D-Chittenden, Chair of the Senate Health and Welfare Committee and the lead sponsor of the bill provided an inspiring floor report. Click here and forward to the 11:00 time stamp to hear her statement.  
• Forensic Facility and Competency Restoration: S.89, the bill to create a forensic mental health care facility, was voted out of the Senate Judiciary Committee last week. The Committee also intends to pass S.91, the bill to establish competency restoration practices in Vermont, early this week and heard testimony from VMS’ Immediate Past President, Dr. Simi Ravven today. The two bills will be taken up simultaneously in the Senate Health and Welfare Committee this week.
• Adult Protective Services: H. 171 is a bill that overhauls Vermont’s Adult Protective Services statute, including the circumstances when a mandated reporter needs to make a report about abuse involving a vulnerable adult. VMS opposes a change in the bill that would define negligent medical acts as “abuse” that needs to be reported to APS.  The bill is on the House Floor this week and VMS will continue advocacy in the Senate.   

The VMS Policy Team will continue to keep you updated and will be publishing the 2023 VMS Mid-Session Legislative Bulletin with comprehensive coverage of the actions taken on health care related legislation.

Comments Due March 31: DEA Proposed Rules for Permanent Telemedicine Flexibilities for Controlled Substances, Buprenorphine

The Drug Enforcement Administration (FDA) has announced proposed permanent rules for the prescribing of controlled substances via telemedicine beyond the scheduled end of the COVID-19 public health emergency. The public can comment until March 31st. The full text of the proposals with links to submit comments may be found here (non-buprenorphine) and here (buprenorphine induction).  The rules have drawn criticism from specialty societies like the American Psychiatric Association and American Society of Addiction Medicine and telehealth advocates for containing overly restrictive in-person requirements.

The proposed rules do not affect (would continue to allow):

• Telemedicine consultations that do not involve the prescribing of controlled medications.
• Telemedicine consultations by a medical practitioner who has previously conducted an in-person medical examination of a patient.

The proposed rules would address a subset of telemedicine consultations—those telemedicine consultations by a medical practitioner who has: never conducted an in-person evaluation of a patient; AND that result in the prescribing of a controlled medication. For these types of consultations, the proposed telemedicine rules would allow medical practitioners to prescribe:

• a 30-day supply of Schedule III-V non-narcotic controlled medications; or
• a 30-day supply of buprenorphine for the treatment of opioid use disorder
• To issue more than a 30-day supply, you would first have to conduct an in-person medical evaluation of the patient

Additional resources for practitioners can be found here:

• Press Release with Summary
• Proposed Rules Summary Telemedicine Rules Summary.pdf (dea.gov)
• Proposed Rules Highlights for Medical Practitioners Telehealth Highlights Medical Practitioners.pdf (dea.gov)

In parallel efforts, a new proposed rule from the Substance Abuse and Mental Health Services Administration (SAMHSA) proposes to make permanent telehealth flexibilities for hubs (or Opioid Treatment Programs/OTPs).  The rule proposes to allow initiation of buprenorphine via audio-only or audio-visual telehealth technology, and methadone via audio-visual telehealth, if an OTP physician, primary care physician, or an authorized healthcare professional under the supervision of a program physician, determines that an adequate evaluation of the patient can be accomplished via telehealth.

For more information contact jbarnard@vtmd.org. The Vermont Medical Society is working with the legislature and Department of Health to try to ensure that Vermont rules and statutes align with federal changes. 

Climate and Health Legislative Advocacy Day – April 7^th – Please RSVP

As you know too well, the climate crisis is a huge public health issue. There are solutions to combat it – and we need your help to make them happen.

Please join a few fellow Vermont Climate and Health Alliance and Vermont Medical Society members for a day at the Vermont State House to elevate the public health consequences and benefits of climate action: Friday, April 7th from 8am-12 pm in Montpelier. 

Can you join us – if even for an hour or two – to call on legislators to take bold action to reduce health-harming, planet-warming pollution?  Opportunities include a press event, meetings with legislative leadership, 1-on-1 connections with lawmakers and more. In advance of the day, with support from Vermont Natural Resources Council, we will share information on the big climate policies under consideration and provide talking points, informational materials, and a policy briefing to support you in knowing what bills are on the table for climate and health this session. 

Please let us know by Friday, March 31st if you’re available and interested in joining by completing this Google form

In the meantime, check out the Vermont Conservation Voters 2023 Environmental Common Agenda, supported by 19 groups, which outlines key climate and environmental priorities for the session.

2023 VT Educational Loan Repayment Open For Applications - Up to $50,000 

The 2023 Vermont Educational Loan Repayment (Recruitment/Retention) Program for Physicians, Nurse Practitioners, & Physician Assistants application is now available.

Application and corresponding documents can be found here. This year employer matching funds are encouraged but not required.

The 2023 application deadline is Friday, March 31^st, 2023.

View the full flyer here.

MISC.

VMS Policy Resolutions Open for Member Feedback

The VMS Board is seeking member feedback on two policy resolutions related to:

• The Medicare Advantage Program;
• Eliminating Medicare’s Direct Contracting Entity (DCE)/ACO-Reach Programs

All VMS members should have received an email with a link to submit survey feedback on these proposed resolutions between March 14th and April 12, 2023. If you had issues opening up the full resolutions, please try again because the links have since been updated. To read the full resolutions, click here. If you did not receive your survey links or have any questions or concerns with completing the survey please contact bpauley@vtmd.org. The resolutions will then be discussed together with the feedback received from members by the VMS Board at its April 19th Board Meeting.

Resolutions are now considered by the VMS Board on a year-round basis and members can submit resolution topics for consideration at any time. For more information on the resolution adoption process see: https://vtmd.org/vms-resolutions/. Members wishing to listen to the VMS Board discussion or share feedback at the Board meeting can contact bpauley@vtmd.org for zoom log-in information.

COVID-19 Test Distribution Available to Practices from the VT Dept. of Health

The State of Vermont has free COVID-19 tests available (Lucira Check-It, expiring July 2023) for free distribution to community health partners. If you are interested in requesting tests for your population, please read the protocol and complete the online request form below.

State of Vermont COVID-19 Over the Counter Antigen & LAMP Test Request Form (office.com)

Public At-Home Test Distribution Protocol:

1. Assessing needed volume of tests
1. Estimate the monthly number of people you are serving, including staff.
2. Assess the number of tests needed for a 60-day period.
3. At-home tests should only be used by persons aged 2 years old or older.
2. Requesting:
1. If interested complete the online request form above (LINK)
2. If you are running low on inventory, please reorder at your convenience. Tests are available while supplies last.
3. Distribution:
1. Tests are for the purpose of detecting an active COVID-19 infection.
2. Tests should be made available upon request to all members of the public.
1. Up to 2 LAMP test per household member (2 tests)
2. Up to 4 antigen kits per person (8 tests)
4. Administrative: Maintain a limited access, cool, dry storage space.

Billing Medicare for Telehealth Post-Public Health Emergency

As a reminder, the end of the federal COVID-19 public health emergency (PHE) is expected to occur on May 11, 2023. Most major Medicare telehealth flexibilities will remain in place through December 2024 due to the bipartisan Consolidated Appropriations Act (CCA), 2023, including the ability to use telephone E/M services (CPT 99441-99443). For a helpful summary of Medicare telehealth billing and documentation requirements after the end of the PHE, click here.  

For a more complete Health Emergency Transition Roadmap, which outlines which regulatory flexibilities will and will not be changing with the end of the federal PHE, click here.  For example:

• Coverage for COVID-19 testing will change, with the timing and out of pocket expense depending on an individual’s health care coverage
• Many Americans will continue to pay nothing out-of-pocket for the COVID-19 vaccine
• Out-of-pocket expenses for certain treatments may change, depending on an individual’s health care coverage
• Major Medicare and Medicaid telehealth flexibilities will not be affected
• FDA’s EUAs for COVID-19 products (including tests, vaccines, and treatments) will not be affected

Contact jbarnard@vtmd.org with questions.

Medicare Payment Advisory Commission Calls for Inflation Adjustment for Medicare Fee Schedule

For the first time, the Medicare Payment Advisory Commission (MedPAC) last week called for a Medicare physician payment update tied to the Medicare Economic Index (MEI). The American Medical Association (AMA) has long championed this move and commends MedPAC’s recommendation and acknowledgement that the current Medicare physician payment system is inadequate – a critical first step toward the larger, necessary work of reforming Medicare to make it more rational and serve patients better.

In the face of inflation, the COVID pandemic, and growing costs of running a medical practice, physicians have struggled to keep open their doors, jeopardizing access to care, particularly in rural and underserved areas. Not only have Medicare payments failed to respond adequately, but physicians saw a 2% payment reduction for 2023, creating an additional challenge at a perilous moment.  As one of the only Medicare providers without an inflationary payment update, when adjusted for inflation, Medicare physician payment has effectively declined 26% from 2001 to 2023.

Also today, the AMA and 134 other health organizations, including the Vermont Medical Society – representing 900,000 physicians and tens of millions of Medicare patients – wrote congressional leaders, telling them that a full inflation-based update is “the principal legislative solution to the ongoing problems plaguing the Medicare Physician Fee Schedule.”  VMS is also advocating for the same inflationary index to be used in Vermont’s Medicaid fee schedule. 

Commissioner of Health Public Health Update on April 6th

The next Public Health Update call with Commissioner of Health Mark Levine, MD will be on Thursday, April 6th at 12:30 pm. Hear about the 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 view the notes from the March 2, 2023 call here.

You can join the zoom meetings here.

Commissioner of Health Mark Levine, MD, gave a public health update on March 10, 2023 to the Vermont Association of Hospitals and Health Systems. Notes from the call can be found here.

EVENTS

The UVM CORA Clinician Office Hours

Weekly on Thursdays from 12pm to 1pm ET

This program offers free and confidential consultation from addiction medicine-certified physicians focusing on substance use evaluation and management. Information shared will be general in nature and should not be considered as case-specific medical care.

The UVM CORA Clinician Office Hours program is intended only for healthcare providers or others directly serving people with substance use disorders in HRSA-designated rural areas.

Please complete the form here to register for the Clinician Office Hours sessions held weekly on Thursdays, 12:00 -1:00 pm ET.

Registration will close weekly on Wednesdays at noon.

Good Faith Estimate (GFE) FAQs: Co-providers, Sliding Fee Discount Providers, and Providers Who Do Not Expect to Charge

March 22, 2023 from 3pm to 4pm ET

Virtual

The Centers for Medicare & Medicaid Services (CMS) will host a webinar on Good Faith Estimates (GFEs) for Uninsured (or self-pay) Individuals FAQs 3 and 4.

Beginning January 1, 2022, providers and facilities are required to provide GFEs to uninsured (or self-pay) individuals in connection with items or services scheduled, or upon the request of the uninsured (or self-pay) individual. In December 2022, CMS issued two FAQs on several topic areas, including enforcement discretion related to co-providers, and clarifications for sliding-fee discount providers and providers who do not expect to charge. CMS wants to provide an opportunity to review the content of both FAQs and allow time for stakeholder questions. 

Register here.

Future Health Best: Practices for Advancing Care

March 31, 2023

Virtual and In-person at Waltham, MA

Join physician leaders and health care experts from the Northeast for a signature event to share knowledge and research that advances equitable, sustainable, patient-centered, and best-in-class health care.

You can view the full flyer here.

For more information about the speakers, program, CME accreditation and to register please visit here.

Note: You can use the discount code of FHB23NE when registering for this event 

UVM Medical Center Cardiovascular / Vascular Forum

April 3, 2023

In-person

This course will provide primary care, internal medicine and urgent care providers education about cardiovascular and vascular disease, including additional POCUS skills for evaluation. The objective is to improve accuracy of appropriate and timely cardiovascular disease treatment, and efficiently use expert consultation in a value-based environment.

For more information about our speakers, sessions, accreditation and to register, visit here.

Save the Dates - Preparing for and Delivering Value-Based Care in Rural Communities

April 4th, May 2nd, June 6th, and June 27th, 2023

View the topics of the webinar series here.

Look for more information and registration details in February 2023 

Division Of Substance Use Programs

April 5, 2023, 11:30am-1:00pm and

April 6, 2023, 1:30-3:00pm

Virtual

In honor of Alcohol Awareness Month, the Division Of Substance Use Programs is hosting 2 webinars to discuss treatment access for alcohol use disorder (AUD). Each webinar will focus on a specific audience, one for emergency department providers and one for community-based practitioners. All are welcome to register for one or both webinars.

Please see the flyers in registration link here for more information.

Emergency Department Providers

April 5, 2023, 11:30am-1:00pm

Community-Based Practitioners

April 6, 2023, 1:30-3:00pm

Howard Center Annual Conference: Breaking Barriers: Finding Purpose & Possibilities Together

April 19, 2023

In-person and Virtual

The 6th Annual Howard Center Spring Conference is taking place on April 19th from 8:30am to 4:30pm with featured speakers including Dr. Nadine Burke Harris, Dr. Dacher Keltner, Dr. BJ Miller, Dr. Jeffrey Swanson, and Dr. Anna Malaika Tubbs.

For more information about the speakers, sponsors, and to register, visit here. 

Vermont Geriatrics Conference

April 20, 2023

In-person

The 17th Annual Vermont Geriatrics Conference is designed to equip physicians, advance practice providers, nurses, pharmacists, social workers and other healthcare professionals with practical and innovative approaches to the medical care of older adults.

For more information about our speakers, sessions, accreditation and to register, visit here. 

Diabetes 2023: Updates on Management and Treatment

May 12, 2023

In-person

This conference is designed to equip primary care clinicians and other professionals, including dietitians, with updated knowledge on issues related to outpatient management of patients with diabetes.

For more information about our speakers, sessions, accreditation and to register, visit here.

49th Annual Family Medicine Course

June 6-9, 2023

In-person and Virtual

This intensive four-day program (with optional pre-conference full-day workshop taking place June 5, 2023) 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. Emphasis is on practical, clinically-applicable diagnostic and management issues in primary care.

The conference dates will overlap with the Burlington Discover Jazz Festival, and all ages, live-music event on four stages in downtown Burlington that brings the community to life! 

The pre-conference workshop titled Mastering Early Goals of Care Conversations will take place on June 5, 2023

Empathic, honest conversations are cornerstones of patient- and family-centered care. Research shows that patients who speak with their clinicians about their goals and values are more likely to receive the care they want, have fewer non-beneficial medical treatments, spend fewer days in hospitals and intensive care units, and report a better quality of life. Take part in this safe, small group pre-conference workshop.

For more information about our speakers, sessions, accreditation and to register, visit here.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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