May 16, 2023

NEED TO KNOW

Call to Action: Contact the Governor TODAY to Support Suicide Prevention & Firearm Safety

H.230 is on its way to the Governor! The bill includes:

1. A 72-hour waiting period for the purchase of firearms;
2. Penalties if a firearm is not safely stored in homes with children or prohibited persons and is used in a crime or in a threatening manner; and
3. The ability for family members to petition for extreme risk protection orders.

This is the most sweeping legislation we've seen since 2018 to implement meaningful firearm safety measures and the Governor needs to hear from you to get it over the finish line!  The Governor has said he supports the storage provision but does not believe the waiting period is evidence-based.  Once the bill gets to the Governors desk he has 5 days to make a decision - he can sign the bill in to law, let the bill go in to law without his signature or he can veto it.

Now is the time to contact the Governor and ask for him to allow H.230 to go in to law.  You can contact the Governor by calling his office at 802-828-3333 or sending a message HERE. 

See talking points presented in testimony by Becca Bell, MD, here as well as the letter of support sent from VMS and partner specialty societies.

2023 Legislative Session Adjourns With Veto Session Looming

Despite divisive disagreements about how to increase funding to Vermont's childcare system and whether to extend funding for Vermont’s hotel program for the unhoused, the final gavel fell on the 2023 session right before midnight last Friday night. Lawmakers have gone back to their districts to breathe a momentary sigh of relief before they have to return to address vetoes by Governor Scott, scheduled for June 20th-22nd. After working closely with legislators all session on priority bills, the VMS Policy team has now turned our attention to the Governor to see what legislation he will sign into law, what will go into law without his signature and what he will veto. He has foreshadowed vetoes on bills addressing suicide prevention, housing, childcare and others, but the most likely veto target is the Legislature's agreement on the $8.5 billion state fiscal year 2024 budget. When lawmakers return in June the Democratic supermajority in both the House and Senate is hoping to override the Governor's vetoes, and maybe then we can all celebrate the good work accomplished by so many lawmakers and legislative staff members.

The VMS has already thanked the incredible lawmakers, who prioritized primary care by supporting a substantial increase in Medicaid rates in the final FY24 Budget. Consistent with VMS advocacy and testimony, the Senate has agreed with a House proposal to increase to 110% of Medicare the Medicaid rates for primary care services and to provide the MEI inflationary increase of 3.8% for all other services in the Medicaid professional fee schedule. Pending changes to the state budget in the veto session, these rate increases would go into effect July 1.

Other VMS priority legislation that advanced this session includes:

• Patient Centered Medical Home Pilot Expansion in FY24 Budget: The Senate has agreed to a pilot of increased investments in embedded staff co-located at primary care practices to support mental health and substance use disorder screening, referrals and treatment.  
• Suicide Prevention bill: H.230 as passed both the House and Senate includes a provision requiring safe-storage for firearms and also includes a 72-hour waiting period for the purchase of firearms. The Governor has said he supports the storage requirements but does not believe the waiting period is evidence-based and therefore it remains unclear if he will veto this bill. See the action alert, above.
• “Shield laws,” protecting those who receive or provide reproductive health care services and gender-affirming care: H.89 and S.37 have been signed into law by Governor Scott! These laws protect those who seek or provide legally protected health care activity from out of state judicial or disciplinary action. 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. “Today, we reaffirm once again that Vermont stands on the side of privacy, personal autonomy and reproductive liberty, and that providers are free to practice without fear,” Republican Gov. Phil Scott said in a statement.
• S.36, Addressing Violence Against Health Care Workers: the bill will permit an arrest without a warrant for violent or threatening behavior in hospitals. A number of VMS members have shared personal stories testifying in favor of this bill. The bill as passed the House and Senate now includes two required studies: one requires Vermont Program for Quality Health Care (VPQHC), along with stakeholders, to develop de-escalation practices and recommendations on best policies to minimize violence in health care settings and another report requires the Department of Public Safety to report back on data collection on the demographics and number of violent incidences. This bill if passed goes into effect upon immediately. 
• S. 222, Expanding Access to Opiate Treatment and Harm Reduction  Among other things, the bill prohibits step therapy for any prescription for substance use disorder; allows telehealth for MOUD to the extent allowed federally; and distributes Vermont’s opiate settlement fund dollars. The bill also removes many MOUD prior authorization requirements and allows on-site community drug-checking service providers to test substances that may contain a regulated drug to analyze their composition to mitigate risks and prevent overdose. If the Governor signs this bill, it will go into effect immediately except for the prior authorization section which takes effect January 1, 2024.
• Forensic Mental Health: S.89 would create a forensic mental health care facility and S.91 would establish competency restoration practices in Vermont. Both of these bills are a priority for the Vermont Psychiatric Association (VPA) and have passed both chambers and await the Governor's signature. 

VMS has also been engaged on the following issues:

• Cannabis Regulation: To date, VMS has fought off legislative proposals to eliminate a THC potency cap on cannabis, add additional conditions to Vermont’s cannabis for “symptom relief” program and expand advertising. H.270, this year's cannabis bill, includes a number of agricultural and license changes, and tasks the Cannabis Control Board to work with medical professionals to make recommendations to improve the medical cannabis registry. 
• Adult Protective Services: H.171 overhauls Vermont’s Adult Protective Services statute, including the circumstances when a mandated reporter needs to make a report about abuse involving a vulnerable adult. VMS successfully advocated for the removal of a change to current statute in the bill that would have defined negligent medical acts as “abuse” or “neglect” that are required to be reported to APS. This bill awaits being sent to the Governor's desk. 
• Cybersecurity: H.291 creates a new statewide Cybersecurity Advisory Council. The bill as passed the House would also have authorized the Council to “review and approve cybersecurity standards,” and tasked the Green Mountain Care Board with developing cybersecurity standards for health care entities, which VMS and other health care organizations were concerned would lead to duplicative regulatory standards. This portion of the bill was removed in the Senate and the House agreed to the changes.
• Scope of Practice: Building off of their expanded role during the pandemic, pharmacists have sought to expand their authority to administer CLIA-waived tests and treat certain conditions; while they will keep authority to administer flu and COVID-19 vaccines, VMS has deferred other changes to a summer work group as part of H.305. In H.473, VMS supported a change to allow radiology assistants to be supervised remotely, as long as the radiologist and radiology assistant work for the same facility or an affiliate of the facility.  Psychology prescribing received a hearing but will not be taken up further this session, pending a report by Vermont’s Office of Professional Regulation. VMS was neutral on a number of interstate licensing compact bills, addressing physical therapy, audiology and psychology.   

Telehealth Prescribing for Controlled Substances Permitted Through Nov. 11, 2023

On March 1, 2023, the Drug Enforcement Agency (DEA), in concert with HHS, promulgated two proposed rules related to prescribing controlled substances after the end of the Federal Public Health Emergency (one for buprenorphine, one for other controlled substances).  Those proposed rules generated a total of 38,369 public comments.  After reviewing those comments, DEA, jointly with SAMHSA, last Wednesday issued a temporary rule to extend telehealth prescribing for controlled substances until November 11, 2023.  In summary the rule states:

The DEA has also extended separate regulatory flexibilities related to an ongoing Opioid Public Health Emergency, such as allowing delivery of take-home doses by treatment programs and administration of medically supervised medications in parking lots. See updated guidance here.

For questions contact Jessa Barnard at jbarnard@vtmd.org.

Department of Financial Regulation Seeks Input on Uniform Prior Authorization Form

According to Vermont statute each insurer in Vermont must accept either the national standard transaction information for prior authorizations electronically via online portal or accept a uniform prior authorization form approved by the Vermont Department of Financial Regulation (DFR) for requests for medical procedures (including mental health services) and medical tests when prior authorization is required.  To review background on the statute and see the current form, click here.  DFR is currently reviewing the uniform prior authorization form and accepting comments regarding changes to the form. View the latest draft form here. Please contact Jessa Barnard at jbarnard@vtmd.org with suggestions for changing the form or to be involved in the review process. 

MISC.

Potential Risk for New Mpox Cases

In the United States, cases of mpox (formerly monkeypox) have declined since peaking in August 2022, but the outbreak is not over. The Centers for Disease Control and Prevention (CDC) continues to receive reports of cases that reflect ongoing community transmission in the United States and internationally. This week, CDC and local partners are investigating a cluster of mpox cases in the Chicago area. From April 17 to May 5, 2023, a total of 12 confirmed and one probable case of mpox were reported to the Chicago Department of Public Health. All cases were among symptomatic men. None of the patients have been hospitalized.

Learn more here.

New AHS Grant Opportunity - Nurse Preceptor Incentive Grants Program

The Nurse Preceptor Incentive Grants Program, a grant opportunity for Vermont’s Critical Access Hospitals and other Vermont health care employers, is now accepting applications. Complete applications must be submitted to AHS via email at ahs.nurseworkforcegrants@vermont.gov by May 31, 2023, 11:59 PM.  The Program is being issued by the Vermont Agency of Human Services (AHS) per Act 183 of 2022 and Act 3 of 2023.

The intent of the Nurse Preceptor Incentive Grants Program is to increase compensation for nurses who provide student preceptor supervision in Vermont’s Critical Access Hospitals and in other Vermont health care settings. The Program provides grant funds that will enable successful applicants to distribute incentive pay to eligible employees who provide preceptor supervision for student nurses completing clinical training at their organization. Successful applicants must disburse grant funds for preceptor supervision completed between July 1, 2023 and June 30, 2024.  If funding allows, the grant end period may be extended up to but no later than September 30, 2026.

 More information about the Nurse Preceptor Incentive Grants Program, including program guidance and application materials, is available here.

Grant applicants may join the Agency of Human Services for Office Hours on Thursday, May 18th from 12 PM - 1 PM.  Staff will be available to answer application and program questions from participants.  Click here to join the meeting.

AHRQ Safety Program for Telemedicine, Improving the Cancer Diagnostic Process – Deadline May 25^th

Is your practice interested in improving the cancer diagnostic process for your patients who receive some or all of their care via telemedicine? The Agency for Healthcare Research and Quality (AHRQ)  is recruiting ambulatory and primary care facilities, including OB/GYN practices for a free 18-month program to improve diagnostic verification, timeliness, and communication with patients diagnosed with breast, colorectal, and lung cancer.  Practices will receive training and one-on-one expert coaching to implement sustainable improvements to effectively close the loop at critical points in the cancer diagnostic process. The application deadline is May 25, 2023 and the program will begin in June. Learn more here. 

AMA: One in Three Physicians Previously Sued in Their Career

A new analysis from the American Medical Association (AMA) finds the possibility of being sued during a career in medicine is very real for most doctors, which is notable given that most claims end with no finding of negligence or error. According to the analysis of claim frequency, nearly one-third (31.2%) of U.S. physicians in 2022 reported they had previously been sued.  The AMA analysis shows it is virtually a matter of time before a physician is sued. The longer a physician is in practice, the higher their exposure to risk. However, the analysis shows that in addition to age, a physician’s medical specialty and gender are prominent factors in the likelihood of being sued during a career in medicine.  The new analysis on claim frequency is the latest addition to the AMA's Policy Research Perspective series that studies trends in the medical liability market. The series is available to download from the AMA website.

Medicaid Clinician License Notification Reminder

Vermont Medicaid (Department of Vermont Health Access/DVHA and Gainwell) will be implementing system automation to ensure all applicable provider’s license information is current and in good standing in accordance with VT Medicaid active enrollment criteria.  Beginning June 5, 2023, DVHA may suspend and/or terminate network contracts for any provider whose license is out of compliance due to non-renewal or inability to validate. When a renewal license cannot be validated, Gainwell will continue to send notification 30 days in advance to providers whose license is expiring. The notification will be sent to the contact information on file and delivered via the preferred communication method assigned (mail or email). When you receive this notification, please update the provider’s license through the Provider Management Module (https://vermont.hppcloud.com/Home/Index/) in the Provider Portal before the license expires.  If you have questions or need access to the Provider Portal in the Provider Management Module, please contact the provider help desk at 800-925-1706.

Medicaid Renewals have Restarted for Vermonters

Vermonters currently enrolled in Medicaid and Dr. Dynasaur are once again seeing renewal notices in their mailboxes. Vermont Medicaid asks for your help to educate and encourage people to learn more about the Medicaid renewal process. Vermont Medicaid needs members’ current mailing address, email, and mobile phone number. Resources are available for community partners at https://dvha.vermont.gov/unwinding/communications-toolkit.

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 June 1st 

The next Public Health Update call with Commissioner of Health Mark Levine, MD will be on Thursday, June 1st 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 May 4, 2023 call here.

You can join the zoom meetings here.

EVENTS

Impact of the End of the PHE on Opioid Use Disorder Treatment

May 16, 2023, 3pm to 4:30pm 

Virtual

The federal Public Health Emergency for COVID-19 (PHE) has dramatically transformed the landscape for opioid use disorder and other drug treatment in the United States.

Now, with the PHE ending on May 11, 2023, it is a critical moment to take stock of what this will mean for opioid use disorder treatment.

Please join Manatt in partnership with the Foundation for Opioid Response Efforts (FORE) for a discussion on policy implications and next steps after the end of the PHE and provide some recommendations for the field.

Learn more and register here.

Vermont Ethics Network Presents: Spring 2023 Palliative Care Virtual Series

May 17th and May 24th from 12pm to 1:15pm

Virtual

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

May 17th - Use of Opioids in Serious Illness: Inpatient and outpatient considerations. This session will be presented by Allen Hutcheson, MD. Register here.

Next upcoming session:

• May 24th - Medical Aid in Dying Update: Recent Changes to Act 39 & Non-Resident Access

Learn more about all sessions here.

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

June 6th, and June 27th, 2023

View the topics of the webinar series here.

Medical Mutual's 2023 Risk Management Seminar: Workplace Violence in the Healthcare Setting: Mitigating the Risks

June 3, 2023, 12pm to 4:15pm

In-person

In a follow-up to last fall’s Medical Mutual Risk Management seminar, Monica Cooke, a behavioral health specialist and nationally-recognized expert on healthcare workplace violence, returns to provide a deeper dive on the subject. This afternoon seminar will include added tips and insights, as well as case studies and group discussions designed to identify effective strategies to de-escalate potentially violent situations and reduce risk.

Learn more and register 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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