April 2, 2024

NEED TO KNOW

FY25 Budget Advances to the Senate and Prior Auth Bill Has Hearing

Last week the FY25 Budget passed the House and, as passed, their version only differs from the Governor's Recommended Budget by .2%, which results in $3.3 million more in appropriations. The Senate Appropriations will now start their work on the FY25 Budget with the same message that there is zero money for new programs.  This week, there is only 24 hours before the Governor has to take action on S. 18, the bill to end the sale of flavored tobacco.  Please Take Action:  Please email Governor Scott and urge him to support kid's health over profit! Click here for his email.

The Senate Health and Welfare will take up a number of VMS priority bills this bill, including holding a full hearing on H.766, the bill to reduce prior authorizations, please see the action alert below. The Committee also took up H.621 and the VMS testified in support of the value of including coverage for diagnostic mammograms with zero-cost screening.  The Committee also took up H.741 and the VMS testified in favor 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. These bills are likely to pass the Committee, as there is no increase in insurance costs due to the expansion of preventive screenings. The Senate Finance Committee will be holding a brief hearing on H.861, the telehealth insurance coverage bill.  Please see the action below to urge the Committee to support the bill. The Senate Economic Development Committee will begin working on H.121, the comprehensive data privacy bill, which currently exempts data that health care entities process in compliance with HIPAA.

Take Action to Reduce Prior Authorizations and Insurance Burdens!

H. 766 is receiving hearings in the Senate Health and Welfare Committee this week. Please reach urge the Committee to support this bill, allowing clinicians and office staff to spend more time with patients rather than on paperwork. 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. 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 and turnover. 

Earlier in the session the House unanimously passed H.766, which will reduce prior authorization, step therapy & insurer billing requirements. The bill would also end a burdensome Blue Cross Blue Shield of Vermont policy that requires prepayment review of certain claims, including those used with Modifier -25 and -59.  The bill has now been referred to the Senate Health and Welfare Committee. 

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;
  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.

Take Action TODAY to Strengthen Telehealth Access! 

The Senate Finance Committee still considering H. 861 and is taking further testimony 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.  Please contact the Senate Finance Committee THIS WEEK to express support for this important patient access protection. See testimony submitted to the Committee on behalf of VMS, VTAFP and AAPVT here.  Please consider addressing:

  1. When and under what circumstances you use telehealth (especially audio-only services) to provide patients with access to care;
  2. Why reimbursing the same as in-person services is fair and helps preserve access to care; and/or
  3. Any stories about how telehealth helps patients. 

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.

AHEAD Model Application Submitted by AHS

Last week, the Agency of Human Services applied on behalf of the State of Vermont for the Center for Medicare and Medicaid Innovation’s States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The application outlines how Vermont would collaborate with the federal government to impact how Medicare, the health insurer for 21% of Vermonters, pays hospitals and supports primary care.  The application is not yet public, but a press release stated that it included letters of support from the Legislature, and letters of interest from the UVM Health Network, Rutland Regional Medical Center, and BlueCross BlueShield of Vermont. If Vermont is selected by CMMI to move forward with AHEAD, negotiations will commence in June or July of 2024. If CMMI and the State agree on terms, a final agreement would have to be in place by July 2025, in advance of the start of the first performance year on January 1, 2026. AHEAD would be in place for up to nine performance years, through 2034. See coverage from VT Digger here.  An AHS presentation to the Green Mountain Care Board includes detailed slides describing the Model.  The recording of the meeting can also be found here (part 1 of 2; starting at minute 19:16) and here (part 2 of 2). For more background information on AHEAD contact Jessa Barnard at jbarnard@vtmd.org and see the February 6th Rounds.

MISC.


Financial Education Series for March: Presented by Baystate Financials PLANWell


Each session will be held via zoom at 5:00 p.m.– Note: the start of these sessions have been moved a week later

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 This Thursday, April 4, 2024

The Commissioner of Health, Mark Levine, MD, will hold his next Public Health Update with VMS Members this Thursday, April 4th at 12:30 pm. You can join the zoom meetings here.

He 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.
 

EVENTS
2024 Annual NNESAM Conference

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.

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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