April 30, 2024

NEED TO KNOW

Start Contacting the Governor – Support H. 766

As emailed to members last Friday, the Senate has now passed H. 766, which reduces prior authorization and other insurance paperwork burdens. The bill takes a significant step forward to reduce administrative burdens on patients, clinicians and the health care system and to help deliver the right care in a timely way in a more cost effective location. The changes made by the Senate will be reviewed by the House this week and then the bill will move to the Governor for his consideration. It is not too soon to start contacting the Governor’s office to communicate how the bill will help:

• Support Vermont’s health care workforce – helping retain and recruit not only clinicians but also nurses and office staff
• Reduce use of inappropriate and expensive care – for example, reducing use of the ED to obtain imaging, preventing hospitalization of kids with asthma, or destabilizing patients on chronic medications

Contact the Governor’s office at: 802-828-3345 or via an email form - https://vermontce.my.vermont.gov/s/governor-office-ce

The bill as passed the Senate (see House version here and Senate amendment here) will apply to state regulated commercial insurance plans in Vermont (MVP, BCBSVT and Cigna plans sold on the exchange) and:  

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. Prohibit insurers from applying any prior authorization to primary care clinicians (excepting prescriptions and out of network care) – note this change from the House bill, which would have required health plans to limit prior authorization for procedures and imaging to the instances when Vermont Medicaid uses prior authorization;
5. Require insurers to cover, without requiring prior authorization, at least one readily available asthma controller medication from each class of medication and mode of administration – new Senate language;
6. Reduce the time frames for health plans to respond to prior authorization requests to 24 hours for urgent requests;
7. Limit the occasions for reauthorization of previously approved treatments and medications – and require authorizations for ongoing treatments to last 5 years.

FY25 Budget Goes Into Conference Committee and Biennium Races to the End

Last week, the Senate passed their version of the FY25 Budget, which includes a requirement for the Department of Vermont Health Access (DVHA) to study and provide recommendations on how to ensure that the Medicaid professional services RBRVS fee schedule does not decrease with Medicare decreases. The FY25 Budget now goes into a conference committee made up of three House and three Senate members who will work over the next 2 weeks to come to agreements on the current differences in the budget. This work signals to the rest of the Legislature that they need to act fast to complete their work on necessary legislation, so things could advance or change very quickly over the next couple of weeks. Here is some of the action happening on VMS bills this week:

• H.861 – the telehealth bill that will provide permanent payment parity for both telehealth and audio-only visits, was agreed to by the House and now heads to the Governor's desk. 
• H.612 - the miscellaneous cannabis bill is up for debate in both the Senate Health and Welfare Committee and the Senate Economic Development Committee this week. The Vermont Medical Society is weighing in with both Committees this week, providing suggestions to put guardrails around a proposed endorsement to allow any adult use dispensary to sell medical products and with testimony on maintaining advertising restrictions.
• H.121- the data privacy bill, is scheduled for debate on the Senate floor, but the Senate Health and Welfare Committee has not provided their recommendations yet. The VMS continues to advocate for an entity-level exemption for all HIPAA regulated entities.
• H.72 - an overdose prevention center bill, that will pilot one overdose prevention site, has passed the Senate Health and Welfare, Senate Appropriations and Senate Finance Committees, has been reviewed by the Senate Judiciary Committee, and is on the calendar for debate on the Senate floor tomorrow. Language that VMS recommended regarding immunity for those working for an overdose prevention center has largely been adopted. 
• H.621- expanding health insurance coverage for diagnostic breast imaging, and H.741, removing an age from the statute requiring insurance coverage for colorectal cancer screening, have both been signed by Governor Scott.

CDC HAN Health Advisory Alert - Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to alert clinicians about risks of counterfeit or mishandled botulinum toxin injections. CDC, the U.S. Food and Drug Administration (FDA), and state and local partners are investigating clusters of 22 people in 11 U.S. states reporting adverse effects after receiving injections with counterfeit botulinum toxin or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas. Eleven patients were hospitalized and none have died. 

Learn more here.

FTC Non-Compete Ban Impact for Clinicians  

Resolve is also hosting an educational webinar this Thursday:

Date: May 2nd

Time: 7pm CST

Topic: FTC bans non-compete – What does this mean for physicians?

Registration link: Register Here

Key topics we'll cover include:

• Understanding the FTC's rationale behind the non-compete ban
• Analyzing the potential effects on physician employment contracts and negotiations
• Next steps on how to navigate this with an in depth Q&A.

New Gun Injury Prevention Resource for Vermonters

Check out www.GunSafeVT.org   VMS has been a partner in the statewide effort led by the U.S. Attorney’s Office to provide free cable locks at Vermont libraries and resources for health care professionals and the public on the new Safe Storage Law, expanded Extreme Risk Protection Order, and Relief From Abuse orders. The website also includes a map of voluntary firearm storage sites throughout the state.  Please spread the word about this resource through your networks in Vermont.

MISC.

Federal Rule Updates: Conscience Rights Rule; HIPAA Abortion Protections; EEOC Discrimination Protections

The Department of Health and Human Services (HHS) issued a Final Rule this winter regarding the rights of conscience as protected by federal statutes.  The final rule clarifies the Office of Civil Rights conscience authorities and the tools OCR has for enforcing these laws.  The Rule also encourages entities to post a notice of rights.

Section 88.3 of the final rule states that entities may post a notice. This notice provision encourages covered entities to post notices, including by stating in regulatory text that OCR will consider an entity’s posting of the notice as a factor in any investigation under the rule. The notice informs providers and patients of their rights under the Federal health care conscience protection statutes and informs patients of alternative ways to obtain treatment. The rule provides model text for the notice in an Appendix, which includes:

• The full list of Federal health care conscience protection statutes that may be applicable to an entity;
• Direction to OCR’s website for additional information to help entities determine which statutes are applicable to them; and
• Notice that a person may base their claim of conscience on either religious beliefs or moral convictions and where to file a complaint.

The effective date of this Final Rule was March 11, 2024. The Final Rule text may be viewed here with a link directly to the model notice text here. A summary is available here.  For more information on conscience protection laws, click here.

In other regulatory news, HHS finalized rules last week updating HIPAA to prohibit the use or disclosure of protected health information related to reproductive health care data to conduct a criminal, civil or administrative investigation based on the mere act of seeking or obtaining reproductive health care services, similar to state law protections adopted in Vermont last year. Covered health care entities will need to update their Notice of Privacy Practices and implement an attestation process to confirm the use of reproductive health care data is not for a prohibited purpose.  Entities do not need to comply until the end of 2024 or update Privacy Notices until 2026 so VMS will share more information as the compliance date approaches.

This week, the EEOC also released updated workplace guidance to prevent harassment that clarifies protections for workers against discrimination on the basis of sexual orientation or gender identity. Along with the final guidance, the EEOC issued several educational resources, including a “Summary of Key Provisions” document, document for employees, and a fact sheet for small businesses.

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. 

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. 

EVENTS

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.

May 21, 2024

In-Person Lake Morey Resort in Fairlee, VT

Now is the time to Reinvent Normal. As everyone talks about getting back to normal, this talk asks the big question: Why? Was your old normal everything you wanted it to be. At work and at home, it’s time to break old habits and routines? It’s time to make things better. Reinventing Normal helps you learn how to stay positive, build resilience, live with uncertainty, and find and use your skills to make you a better leader -- and a better follower. Don’t miss the opportunity to build new. You will learn and laugh a lot while he takes us on the adventure of making your new normal not just productive, but also fun, positive, and hopeful.

Registration Information and full agenda  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.

Birth Certificate Quality Improvement Initiative Learning Series

June, July, September, October, 2024

Virtual

In collaboration with the Vermont Department of Health Division of Family and Child Health and the Division of Health Statistics and Informatics, the Perinatal Quality Collaborative - Vermont (PQC-VT) is embarking on a vital statistics birth certificate quality improvement initiative (BCQII).

The project aim is to improve the accuracy of key birth certificate variables to support public health and quality improvement efforts. The objective is to increase birth certificate data quality in Vermont by providing education opportunities, technical assistance, and shared learning to Vermont hospital teams involved in birth certificate data collection.

Register here for the learning series.

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.

Vermont ACP Chapter Annual Scientific Meeting

October 18, 2024

Trapp Family Lodge, Stowe, VT

The Vermont ACP Chapter's Annual Scientific Meeting will occur on

Friday, October 18, 2024.

This will be an in person meeting. We will

again host a poster competition for resident and student members.

Update your medical knowledge, engage with colleagues.

Meeting details and agenda forthcoming.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

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