April 25, 2023

NEED TO KNOW

Thanks to Your Advocacy Budget Proposal Increases Medicaid Fee Schedule

Setting the stage for a countdown to legislative adjournment, the Senate Appropriations Committee finalized their work last Friday on the 2024 State Fiscal Year Budget. The Senate Appropriations Committee proposes to keep the House-passed increase in the Medicaid RBRVS (professional) fee schedule, making it very likely that these increases will be reflected in the final budget. Consistent with VMS advocacy and testimony, the Senate agreed to increase to 110% of Medicare the Medicaid rates for primary care services (a $1,755,041 increase) and provide a 3.8% increase for all other services in the Medicaid professional fee schedule (a $3,804,600 increase). Thank you to the many VMS members who reached out to legislators to urge support for this needed investment in medical services! Thank you also to House Health Care Committee member Alyssa Black and House Health Care Committee chair Lori Houghton, who first championed this increase, all members of the House Health Care Committee, House Appropriations Committee, Senate Health and Welfare Committee and Senate Appropriations Committee for your strong support and recognition that primary care and medical services need sustainable payments from Medicaid. The budget proposal also includes a 4% increase for FQHC rates, and the Senate Appropriations Committee has approved a full two-years of funding for a pilot expansion of the Blueprint for Health program, while the House only funded one year of the pilot. The budget next goes to the Senate Floor and will most likely require a conference committee with the House. 

Big Week for VMS Legislative Priorities

Along with the budget, described above, other VMS-priority bills are also close to the finish line in the legislature.  Bills moving this week include:

• The “shield laws,” protecting those who provide reproductive health care services and gender-affirming care. H.89 passed third reading in the Senate this week and needs to have final amendments reviewed by the House; S.37 passed the House Floor last week with a roll call vote of 114-26. In light of the federal lawsuits challenging their FDA-approval status, and due to advocacy by VMS and quick action by legislators, both bills now also include protections for medication used to terminate pregnancy. See VMS’s press release from yesterday recognizing legislators and the Scott Administration for their support of access to evidence-based abortion medications. 
• S. 36, which would permit an arrest without a warrant for violent or threatening behavior in hospitals. The bill is up for a final vote in the House this week. The Senate Judiciary Committee has reviewed the final changes proposed by the House, including limiting the bill to the hospital setting. 
• H.222, the overdose prevention bill that reduces prior authorization for medication for opioid use disorder (MOUD), passed the Senate on a preliminary vote today. The bill, as passed the Senate, would prohibit insurers from requiring step therapy before prescribing MOUD, requires a feasibility study of a gold card program for MOUD prescribers and allows for on-site community drug-checking services providers to test the composition of drugs to prevent overdose. 
• House Judiciary passed S.91, the competency restoration bill and it will go back to the Senate this week for final approval. S.89, the forensic facility bill has not passed the House yet and will be heard in the House Human Services Committee this week.
• H.270, the miscellaneous cannabis bill, will be heard in the Senate Economic Development Committee this week, where they are expected to add a study to look at the latest evidence regarding cannabis for symptom relief.  

VMS Board Adopts Position on Medicare Advantage Plans

The VMS Board met for two hours last Wednesday evening and, among other agenda items, discussed the member-introduced resolution concerning Medicare Advantage plans.  After lengthy discussion and input from several VMS members in attendance at the meeting, the Board adopted the policy, which states that:

• the Vermont Medical Society will advocate to the Center for Medicare and Medicaid Services to discontinue overpayments to Medicare Advantage plans and to use those funds to improve traditional Medicare and bolster the Medicare Trust Fund;
• VMS will advocate to Vermont’s Congressional delegation to improve the benefit package in traditional Medicare by reducing deductibles and copays, and capping annual out-of-pocket spending and by adding dental, hearing, and vision coverage; and
• VMS will advocate to the Center for Medicare and Medicaid Services to improve and stabilize physician payment, including an increase in reimbursement for mental health and primary care services within the traditional Medicare program.

The Board deferred discussion on the resolution regarding the Medicare Reach ACO program to a later meeting.  The Board also elected a new at-large member, Ryan Clouser, DO, the new CMO of Central Vermont Medical Center, and approved dropping membership by May 1 for those members who have not renewed their 2023 membership by that date (see how to renew here). For any questions or concerns, please contact jbarnard@vtmd.org.

Green Mountain Care Board Holds Primary Care Sustainability Panel

Last week, the Green Mountain Care Board held a two-hour panel on the sustainability of primary care in Vermont (agenda here).  A number of VMS members and other primary care clinicians and organizations spoke about the high administrative burden, workforce challenges and low reimbursement facing primary care practices in Vermont.  Members of the panel also shared suggestions to address these concerns, from creating a primary care “Czar” to reducing prior authorizations to continuing OneCare’s Comprehensive Payment Reform program. 

MISC.

VITL Launches the State’s First Two-Way Immunization Data Sharing Connection

Last week VITL (Vermont’s health information exchange), Northeastern Vermont Regional Hospital (NVRH), and the Vermont Department of Health (VDH) launched the State’s first bidirectional immunization data sharing connection. This connection enables NVRH clinicians and staff to query the Vermont Immunization Registry for their patients’ complete immunization histories from inside the NVRH EHR. VITL is looking forward to establishing these connections for more Vermont hospitals, Federally Qualified Health Centers, and primary care practices. Read more here.

VMS Partners to Provide Financial Education Series

Vermont Medical Society has partnered with Baystate Financial to offer The PlanWell™ Series. This is a financial education curriculum geared explicitly towards VMS members. The objective is to help you realize your financial goals, whether it's saving for a house, paying off student debt, or planning for retirement.

There will be multiple webinar offerings in May for early to early-career individuals (click here for details) and for late-career individuals (click here for details).

Learn more and register here.

Commissioner of Health Public Health Update on May 4th

The next Public Health Update call with Commissioner of Health Mark Levine, MD will be on Thursday, May 4th 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 April 6, 2023 call here.

You can join the zoom meetings here.

EVENTS

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

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

View the topics of the webinar series here.

Vermont Ethics Network Presents: Spring 2023 Palliative Care Virtual Series

May 4th, 9th, 17th from 12pm to 1:15pm

Virtual

Join the Vermont Ethics Network for their first session in their Spring 2023 Palliative Care Virtual Series!

May 4th - Uncertain End of Life Trajectory: Care implications for patients with severe psychiatric illness. This session will be presented by Steven Runyan, DO and Belle Matheson, NP. Register here

Other sessions include:

• May 9th - Clear as Mud: The nuances of hospice eligibility & financial issues at end of life
• May 17th - Use of Opioids in Serious Illness: Inpatient and outpatient considerations

Learn more about all sessions here.

Integrative Pain Management Conference

May 5, 2023

In-person

This conference will meet the needs of an interdisciplinary healthcare community in the following ways:

1. Learn about integrative therapies and share best practices, research, and innovations in integrative approaches for chronic pain management.
2. Understand national initiatives and innovative policies that increase access to high-quality, evidence-based, comprehensive pain 

Learn more and register 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.

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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