March 8th, 2022


Vermont Legislature Returns to Crossover Week Prepared to Pass Priority Bills

After a week off for their respective Town Meetings, Vermont lawmakers are preparing for a hectic week, in which they will be focused on getting priority bills across the "crossover" finish line of March 11th, when bills must have passed out of the first chamber's policy committees.

These bills being tracked by VMS are scheduled for action this week:

  • FY22 Budget Adjustment: The House is expected to give approval to the Conference Committee report for FY22 Budget Adjustment which: 
    • Maintains an increase to Medicaid’s RBRVS reimbursement rates through its alignment with the Medicare fee schedule
    • Includes the legislature’s support to pursue federal approval of Medicaid coverage for 12-months of post-partum care. The application process begins in April of 2022; 
    • Provides $60 million to the Agency of Human Services in healthcare workforce recruitment and retention funding. The first round of $45 million going to the Agency of Human Services will provide $2,000 per FTE for long-term care facilities, home health agencies, designated agencies, adult day providers and substance use treatment providers. The second round of $15 million will be for other health care providers with a "demonstrated need" and could provide funding for hospitals, independent medical practices, hospital-owned medical practices, designated and specialized services agencies, FQHCs and other health care providers
    • Provides $25M in financial support to healthcare providers to prevent disruptions or business closures due to COVID-19
    • Includes $500,000 to the Green Mountain Care Board for a consultant to perform  benchmarking analyses and analysis of avoidable utilization and low value care.
  • S.30: Prohibits Firearms in Hospitals: the Governor vetoed the bill, but offered a compromise on the “Charleston loophole,” allowing firearm sales to be approved if background checks take longer than 7 days to complete, rather than the 30-day requirement passed in the bill. The legislature will now decide whether to modify the bill.
  • H.548, the Misc. Cannabis bill: the bill, which seeks to remove the THC potency limits in solid concentrates, is scheduled for a vote this week in House Gov. Ops Committee. VMS testified against this proposal. 
  • Mental Health legislation aimed at coordinating mental health responses across the care continuum: S.195, and S.197 are scheduled for mark-up and potential vote in the Senate Health and Welfare Committee.
  • S.158a bill that would expand the scope of procedures optometrist may perform to include injections, lasers and surgeries to the eye and adjacent structures is scheduled for mark-up and possible vote in the Senate Government Operations Committee Tuesday afternoon; if passed, VMS is advocating for it to be referred to the Senate Health and Welfare Committee.
  • H.654, COVID-19 Flexibilities: The bill that aims to extend regulatory COVID-19 flexibilities until March 31, 2023, passed third reading and heads to the Governor's desk.
  • H. 655, a bill to establish a telehealth licensure and registration system has passed the House Ways and Means Committee and has advanced to the House Appropriations Committee. 
  • S.285, a bill that includes increased funding for the Blueprint for Health program is scheduled to be voted out of the Senate Health and Welfare Committee this week. The amount of the Blueprint investment has not been determined in the bill, but the intention is to increase the per member per month payments for community health teams and quality improvement staff. The bill currently also directs $5 million to the Green Mountain Care Board to hire consultants to developing a process for implementing hospital global budgets. The Vermont Medical Society is working to incorporate some of the provisions in S.244, a bill aimed at strengthening primary care, into S.285.
  • The Senate Health and Welfare Committee is also considering passing bills this week to license free-standing birth centers (S. 204) and to create a registry for patients diagnosed with ALS (S.90). 

Administration Emphasizes Changes to COVID-19 Guidance Coming March 14th

Given continued improvements in Vermont’s COVID-19 cases and hospitalization rates, the Administration focused at their weekly press conference today on upcoming changes to statewide COVID-19 guidance.  Starting on March 14th, statewide guidance will include:

  • Masking will be up to each individual based on a personal risk assessment for themselves or people they live with
  • School masking guidance will match the general public and will be up to each student
  • Isolation and quarantine guidance will be simplified
    • if you test positive, stay home for 5 days
    • If you are a close contact and not up to date on vaccination, you will not need to quarantine but should get tested
Schools will also be moving from a response mode to academic and social-emotional recovery.  Full notes from the March 8th press conference can be found here and call notes from the administration conference on March 3rd can be found here.  The DFR Modeling report for the week can be found here.  Hospitalization data has made significant improvement over the past few weeks, with a 36% decrease in the new hospital admission 7-day average over the past week or a 78% decrease from peak. There was also a 42% decrease in the 7-day ICU average over the past week, an 88% decrease from Omicron peak. The modeling continues to predict declines in cases and fatalities in the coming weeks. 

Other COVID-19 Updates from the week:

  • Click here for the February 2022 Vermont Vaccine Program Update covering topics including COVID-19 vaccines for children under 5 and vaccine ordering updates effective March 14th.
  • Find the CDC COVID-19 Community Levels here: the new CDC tool to help individuals and communities decide what prevention steps to take based on hospital beds being used, hospital admissions, and the total number of new COVID-19 cases in an area. Vermont will be taking a statewide approach to mitigation guidance.
  • The White House released last Wednesday its National COVID-19 Preparedness Plan, including creating “One-Stop Test to Treat” locations; Vermont currently does not have any planned Test to Treat locations. 
  • Households can now order additional free COVID-19 antigen tests through the federal partnership with the USPS.

        Feedback Sought on Vermont CON Thresholds

        At the Green Mountain Care Board Meeting on Wednesday, March 2, 2022, the Board discussed the Certificate of Need (CON) dollar thresholds, the Board’s authority to adjust them, and whether the Board will adjust them for inflation. The presentation can be seen here on the GMCB website. The Board welcomes input from stakeholders and there is currently an open special public comment period. The Board will discuss this topic again at a public meeting within the next month. Feedback can be shared directly with the GMCB or sent to VMS at   

        Thank You for Attending the VMS Congressional Town Hall 

        Thank you to all of the VMS Members who attended last week's Congressional Town Hall with Vermont's federal delegation. It was a fabulous turnout and your participation made for an excellent discussion on federal health care policies that impact your practice. We were lucky to have time with Rep. Peter Welch, as well as Thiffeen Dean from his Vermont office, Pollaidh Major from Senator Patrick Leahy's office and Beth Stern from Senator Bernie Sanders' office. Representative Welch touched on the delegation's efforts throughout the pandemic to increase access and reimbursement for telehealth services, for increased funding for substance use disorder treatment, for expansion of loan repayment programs and increased Health Resources and Services Administration (HRSA) funding and other health care workforce initiatives. The conversation covered the impact of Medicare Advantage plans, federal pay-for-quality initiatives and workforce. Thanks again for all who participated in the VMS 2022 Advocacy Month!


        CMS to Apply MIPS Automatic Extreme and Uncontrollable Circumstances Policy for the 2021 Performance Year

        Due to ongoing discussions and advocacy the AMA has being having with CMS on the impact the COVID-19-PHE is having on physician practices, CMS will apply the Automatic Extreme and Uncontrollable Circumstances Exemption Policy (EUC) for the 2021 MIPS performance year. This 2021 policy change recognizes the continued challenges physicians face with providing care during the PHE and reduces administrative burden. Therefore, if a physician participates in MIPS as an individual, they don’t need to take any action to have the automatic EUC policy applied to them. CMS will automatically identify and re-weight all 4 MIPS performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless the physician 1) submit data in 2 or more performance categories, or 2) have a higher final score from group or APM Entity participation.

        Unfortunately, due to a systems issue if a physician or small practice participates in the 2021 MIPS program by submitting Part B quality measures through claims and has submitted quality data codes on their 2021 Medicare claims, they will need to still file a 2021 MIPS Hardship EUC to avoid a 2023 payment adjustment and be exempt from the 2021 MIPS program. If the physician or practice has not submitted any 2021 MIPS performance data, then the automatic EUC will apply to the physician.  For more detailed information on the automatic EUC policy and CMS announcement, please click here.

        UVM Health Network to Wind Down Yankee Medical Operations

        The University of Vermont Health Network announced last week its intention to end operations at Burlington-based medical equipment supplier, Yankee Medical, after the COVID-19 pandemic set back financial and operational progress toward sustainability. The supplier is set to close on June 2, 2022.  Over the last five years, the Network has made numerous investments and operational changes at Yankee to make it a more sustainable DME provider. However, staffing challenges created by the COVID-19 pandemic, combined with the increased availability of alternative DME suppliers in the region, led to the decision to close the business. From now through June 2, Yankee will not be accepting new patients and will be working with existing patients to transition them to alternative DME suppliers. Existing Yankee patients should expect a letter from Yankee outlining next steps within the next few days. For additional assistance, current patients may visit here.

        Lawsuit Invalidates Independent Dispute Resolution Process under No Surprises Act

        On February 23, 2022, the United States District Court for the Eastern District of Texas invalidated portions of a CMS interim final governing aspects of the federal independent dispute resolution (IDR) process under the No Surprises Act.  The IDR process established an arbitration process for resolving payment disputes between certain out-of-network providers and group health plans and the Court found that the rule was in conflict with underlying statute. The case was brought by the Texas Medical Association. The court order did not affect any of the Departments’ other rulemaking under the No Surprises Act. Thus, consumers continue to be protected from surprise bills for out-of-network emergency services, out-of-network air ambulance services, and certain out-of-network services received at in-network facilities. The patient-provider dispute resolution process for uninsured and self-pay consumers to dispute bills that exceed a provider’s or facility’s good faith estimate by $400 or more also remains available and unchanged by the court’s order.  The Departments are reviewing the court’s decision and are in the process of updating guidance documents.  To read more, visit: here.  Click here for VMS’s No Surprises Act materials, and here for CMS background materials.

        Grant Opportunity to Help Vulnerable Populations Understand Heath Insurance Options

        On February 25, the Department of Vermont Health Access (DVHA) posted a Notice of Application for $150,000 in grants for community organizations to use to engage and educate populations of Vermonters that have a higher-than-average risk of being uninsured. Vermont’s rich network of community organizations have a unique perspective and ability to communicate with young adults, BIPOC, LGBTQIA+ and other underserved Vermonters. Activities eligible for funding under the grant opportunity can include but are not limited to events, interpretation, translation, cultural brokerage, and technology. 

        Organizations will be able to submit applications until April 1, 2022 for activities taking place between May 1 and September 9, 2022. More information here.

        Feedback Sought on Access to Coverage and Care in Medicaid & CHIP

        As part of the Biden-Harris Administration’s work to advance health equity and reduce health disparities, the Centers for Medicare & Medicaid Services (CMS) is seeking feedback on topics related to access to coverage and care in the Medicaid and CHIP programs, such as enrolling in and maintaining coverage, accessing health care services and supports, and ensuring adequate provider payment rates to encourage provider availability and quality. Some of the specific information sought by CMS includes:

        • What actions could CMS take to encourage states to reduce unnecessary administrative burdens that discourage provider participation in Medicaid and CHIP?
        • What are the opportunities for CMS to align approaches and set minimum standards for payment regulation and compliance across Medicaid and CHIP delivery systems?
        • What are specific ways that CMS can support states to increase and diversify the pool of available providers for Medicaid and CHIP?

        See the full list of questions here.  Please send feedback regarding your participation in or experience with the Medicaid or CHIP programs to to inform VMS comments on this RFI by Friday, April 1st. 


        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.

        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).

        Project ECHO: Aging, Community, and Equity (PEACE)

        2nd Wednesday of Every Month from February to September

        12pm to 1:30pm, EST

        Project ECHO® (Extension for Community Healthcare Outcomes) is an evidence-based method developed by researchers at the University of New Mexico. During teleECHO™ sessions, expert mentors share their expertise across a virtual network via case-based learning.

        In this Older Adult ECHO program, we will explore:       

        • Pandemic-related social isolation
        • Methods to support formal & informal caregivers
        • Impacts of the pandemic on cognitive decline
        • Effects of isolation on physical & mental health
        • Solutions for rural communities

        Intended audience: Medical, mental health, and community social service individuals working to support older adults in rural settings of Maine, New Hampshire, Vermont, and Northern New York

        Register here.

        AMA STEPS ForwardTM Webinar: Racial and Health Equity: Concrete STEPS for Health Systems

        March 24, 2022, 12pm CST

        The new AMA STEPS Forward™ toolkit “Racial and Health Equity: Concrete STEPS for Health Systems,” developed in collaboration with HealthBegins, offers five steps to advancing health equity for clinicians, patients, and the communities served. The toolkit helps motivated leaders develop a shared understanding and commitment, set data-driven goals, and embark on a journey of continuous learning and improvement for racial justice and health equity. Join co-authors Denard Cummings, AMA Director of Equitable Health Systems Integration, and Rishi Manchanda, MD, MPH, President and CEO of HealthBegins as they provide actionable steps for advancing racial and health equity in your health care system.

        Register for the webinar.

        AMA STEPS ForwardTM Webinar: Setting Boundaries for Preventing Fatigue and Building Resilience

        March 30, 2022, 12pm CST

        How can physicians avoid heading down the road of fatigue, exhaustion, and ultimately burnout? During this AMA STEPS Forward™ live webinar held at noon CST March 30, participants will learn the value and necessity of setting limits and how doing so positively affects personal well-being. Together, we will identify strategies for developing, implementing, and maintaining healthy boundaries. Attendees will be asked to consider examples of personal boundaries and challenged to choose one to try. Additionally, we will explore tools and resources available from the AMA that can help. 

        Register for the webinar.

        Vermont Geriatrics Conference

         April 12, 2022

        The 16th Annual Vermont Geriatrics Conference will equip physicians and other healthcare professionals with practical and innovative approaches to the medical care of older adults. TOPICS: commonly-used medications for preventative care, Alzheimer’s disease, anxiety and depression, falls prevention, Medicare wellness visits, ethical issues in COVID, and more.

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

        The UVM Medical Center Cardiovascular/Vascular Forum

        May 2, 2022

        Course Director Dr. Matt Alef invites Primary Care, internal medicine, and urgent care providers to attend virtually or in-person to learn more 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.

        TOPICS: SAVR vs TAVR, vascular nurse wounds, aortic dissections, POCUS hands-on workshop, echocardiography and more.

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

        The 48th Annual Family Medicine Review Course

        June 7-10, 2022

        Course Director Dr. Anya Koutras invites you to this intensive four-day program for family physicians and other primary care professionals. The program will focus on current issues in the practice of Family Medicine, with special attention to new contributions. Attendees will have a choice between in-person and virtual participation. This conference coincides with the Discover Jazz Festival and makes it a great time to bring the family for a visit to Burlington.

        Sign-up to receive notification of the complete program and registration details as soon as they are available by visiting here.


        Vermont Medical Society

        134 Main Street

        Montpelier, VT 05602

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