April 16, 2024

NEED TO KNOW

Keep Up the Momentum!  Contact Senate Finance Committee about Prior Authorization! 

The Senate Health and Welfare Committee plans to begin “mark up” (discussion and editing) of H. 766 this week.   H. 766 will reduce prior authorizations, allow exemptions to step therapy and simplify billing and other administrative burdens in health care.  Please start to contact members of the Senate Finance Committee this week to express support for the bill!  If you have previously contacted other committees, it is critical that the Finance Committee also hear your message – please send your comments to them.  If you are a constituent of a Finance Committee member (see list here), please consider calling.  Payers are stating this bill will increase insurance premiums.  Please share stories about how reducing PAs can actually reduce health care costs by getting patients the right care earlier, reducing extra costs like referring patients to the ED and reducing staffing costs. 

Please 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; ZBuckminster@leg.state.vt.us.

Thank you to Drs. Julie Lin, Ryan Clouser and Kristen Connolly, PA Rick Dooley and patient advocate Mary Nadon Scott for participating in press conference last week to support H. 766.  You can view the press conference here, press release, and media coverage here and here. 

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

1. 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;
2. Mandate adherence to coding standards and guidelines for processing healthcare claims and prohibit prepayment claims edits (ending a burdensome Blue Cross Blue Shield of Vermont policy that requires prepayment review of certain claims, including those used with Modifier -25 and -59);
3. Limit claims edits for services other than pharmacy to those instances when Medicare uses claim edits;
4. Require health plans to limit prior authorization for procedures and imaging to the instances when Vermont Medicaid uses prior authorization;
5. Reduce the time frames for health plans to respond to prior authorization requests to 24 hours for urgent requests;
6. Limit the occasions for reauthorization of previously approved treatments and medications.

Senate Begins to Finalize FY25 Budget and End of Session Comes into View – Telehealth Bill Passes Committee

All attention has turned to the Senate Appropriations Committee, as they have warned that a vote on their version of the FY25 Budget, H.883, could come as early as Tuesday of this week. This has sent the Chairs of Committees in both the House and Senate into hyperdrive, as this is about two weeks earlier than expected. With a significant number of bills still in mid-committee process, many are questioning what bills will make it over the finish line and will have money to be implemented. The House is wondering if the Senate will fund social determinant priorities they have passed including support for the general assistance housing program, childcare workforce, and expanding the Medicare Savings Program. The Senate Health and Welfare continues their work on several bills, including: H.233, a bill to strengthen regulation of pharmacy benefit managers (PBMs), H.721, the bill that expands Medicaid eligibility and the Medicare Savings Program, which Jessa Barnard testified on today, H. 766, the bill that will reduce prior authorizations (please see the action alert below), and H.72, the bill to authorize an overdose prevention site pilot program. The Senate Economic Development Committee is still finalizing their version of H.121, a data privacy bill, and will take up H.612, a cannabis regulation bill, at the end of this week and early next week. H. 861, which will provide permanent payment parity for telehealth and audio-only visits, passed the Senate Finance Committee last week and goes to the full Senate for debate this week.  Thank you to all of our members who testified and sent emails of support for H. 861 – payment parity for telehealth services has been a priority of VMS since the early days of the COVID-19 pandemic and this bill would be a big success for patient access to care.

In the House, S.192, the forensic mental health bill, is in both the House Human Services and Health Care Committees, and S.98, a bill providing authority over prescription drug costs, is advancing in the House Health Care Committee. The Speaker Jill Krowinski and the Senate Appropriations Chair Jane Kitchel are both saying on the record that May 10^th is this year's projected session adjournment date. 

Act 88 Updates VT Advance Directive Statute

During the 2024 legislative session, Vermont lawmakers and Governor Scott passed Act 88 to make the following updates to the advance directive statute:

• Makes permissible the use of digital signature for signing, witnessing and explaining advance directives
• Makes permanent remote witnessing and explaining of advance directives documents through live, interactive, audio-visual connection or by telephone
• Clarifies the process for completing a Ulysses Clause provision in an advance directive

Act 88 took effect on April 1, 2024. The Vermont Ethics Network will be offering an informational seminar on the details of Act 88 in May 2024 - more details to come on the VEN Events page. Read the full text of Act 88.

Vermont Releases AHEAD Model Application

Vermont’s Agency of Human Services last week released the application it submitted to CMS to participate in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, a new federal program that would allow Medicare to join Vermont’s health care reform efforts.  The Model would begin in 2026 and replace Vermont’s All-Payer Model.  The primary components of the model are:

• Hospital Global Budgets, where hospitals will be paid a fixed amount of revenue, or a “global budget,” to provide services to Medicare fee-for-service beneficiaries.
• Primary Care AHEAD, which is a voluntary program for primary care practices to receive an additional payment from Medicare to provide coordinated care to Vermonters with Medicare coverage.

Informational Materials

• Watch a video on Vermont’s Health Care Reform Efforts and the State’s application for the AHEAD Model.
• Watch the AHEAD Press Event recording (4/11/24).
• Read Vermont’s AHEAD Model application.
• Read a Press Release about Vermont’s AHEAD Model application.

Updated Information & Resources on Change Healthcare Cyberattack

The AMA is circulating the following updates after a Wednesday, April 10 conversation on the Change Healthcare cyberattack with Jon Blum, CMS’s Principal Deputy Administrator & Chief Operating Officer, and Roger Connor, Optum Insight’s Chief Executive Officer.

• The AMA Press Release on our most recent Change Healthcare Cyberattack informal survey results is available online. The results show the ongoing, devastating impact of the Change Healthcare cyberattack, which threatens the viability of physician practices across the country, and, according to respondents, has serious implications for patient care.
• According to UnitedHealth Group (UHG), it continues to emphasize the availability of advance/accelerated payments to providers in need. Optum’s CEO emphasized that the program has more flexibility than it did originally. For more information, please visit Temporary Funding Assistance for Providers. This program is designed to help bridge the gap in short-term cash flow needs for providers impacted by the disruption of Change Healthcare's services. In particular, UHG encourages practices that find the amount prepopulated in the Optum Pay system insufficient to meet their financial needs to please contact UHG—either submit a request through the Temporary Funding Assistance Program Form or call 1-877-702-3253.
• UHG also stressed that it has no plans or timetable yet to require repayment of these funds. Until all claims submission and payment systems are back up and running, UHG is not requesting repayment. UHG indicated that a practice-level, phased approach will be used to ensure that an individual organization’s functionality has been restored before repayment is requested.
• More information about the CMS Change Healthcare/Optum Payment Disruption (CHOPD) program is available online. Physicians and other Medicare providers experiencing disruption because of the Change Healthcare outage can apply for “amounts representative of up to 30 days of Medicare claims payments.” HHS also distributed these resources (PDF) to assist physicians, pharmacists and hospitals, in the aftermath of the Change Healthcare cybersecurity attacks.
• The AMA will continue to raise issues of concern to UHG, CMS, state regulators, and other payers. Additional information from the AMA is also available on our Change Healthcare cyber outage webpage and from the VMS Resources page.

MISC.

VMS Board Adopts Obesity Treatment Resolution

The VMS Board met last Wednesday and adopted a resolution calling on VMS to ensure that all patients have access to anti-obesity medication and treatment, including lifestyle interventions and surgery, in line with evidence-based medical guidelines.  The Board also voted to support a resolution New Hampshire is bringing to the American Medical Association meeting in June that opposes health systems requiring patients to switch to primary care physicians within a health system in order to access specialty care.  The Board is moving forward with a letter to the Agency of Human Services, legislative leaders and the Green Mountain Care Board regarding the AHEAD Model.  A new orthopedic representative was elected to the Board, Bryan Monier, MD, and four members were re-elected to their seats: Adam Kunin, MD, (member at large), Jessie Leyse, MD (Washington county), Aida Avdic, MD (Windham County) and Tamara Rimash, MD (otolaryngology).   Contact Jessa Barnard with any questions at jbarnard@vtmd.org.

Participation Interest Form - 41st Annual Vermont Corporate Cup Challenge & State Agency 5K Race with the VMS

The VMS is trying to gain insight on whether VMS members, Specialty Society Members, and their families would be interested in joining the VMS Staff as a team for the 41st Annual Vermont Corporate Cup Challenge & State Agency 5K on Thursday, May 16th, 2024.

Please note, the VMS has not committed to participating in the event, but just wants to gain insight on if we have enough interest to register.

Fill out the interest form here if you are interested in joining us. 

Commissioner Call Thursday, June 6, 2024

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members Thursday, June 6th at 12:30 pm. You can join the zoom meetings here.

He held his most recent VMS member call on April 4th. Notes from the call are here. 

EVENTS

April 26 and 27, 2024

Virtual and In-Person Wolfeboro, NH

Presenters will be:

1. Dr. David Smith- founder of the Haight Ashbury Free Medical Clinic- Psychedelics and the
2. Treatment of SUD: The Risks and Potential Rewards of using Psychedelics in Recovery.
3. Dr. Marc Potenza- Non-Substance or Behavioral Addictions in the DSM-5 and ICD-11:
4. Clinical and Practical Considerations.
5. Dr. Elisabeth Mock- Addiction, Pain and Prescription Drug Monitoring Programs (PDMPs)
6. Dr. Andrew Seefeld- Emotional Sobriety and the Science of Addiction.
7. Dr. David de Gijsel- Hep Free NNE- Hepatitis Elimination in Northern New England
8. Dr. Cornel Stanciu MD- Understanding Kratom- Consumption, Addiction: A Workshop for Clinicians

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

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.

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.

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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