May 2, 2023

NEED TO KNOW

Vermont Legislature Enters Final Few Weeks

As the Legislature enters the final stage of the session, the VMS Policy team is working to follow final negotiations and horse-trading on the FY24 Budget and other health care bills that have yet to pass. Last Friday, the House and Senate named a budget Conference Committee, which will meet over the next two weeks to reach an agreement on the sticking points between the two chambers on Vermont's $8.5 billion state fiscal year 2024 budget. Governor Scott has set a veto session for mid-June as he has foreshadowed vetoes on a number of high profile bills, including a bill to establish a statewide, mandatory paid family leave program, expanding financial support for childcare, and likely the state budget. The legislature, with a Democratic supermajority in both the House and Senate, has the votes to override the Governor's vetoes, but not every legislator will be able to return after the session. 

VMS is closely watching the budget conference hearings to ensure that the increase in Medicaid rates remain 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.   

Other VMS priority legislation that continues to advance 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, S.230 passed the Senate and heads back to the House for final approval. The bill as passed 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 has indicated he will veto this bill. 
• “Shield laws,” protecting those who receive or provide reproductive health care services and gender-affirming care: H.89 and S.37 have both passed the House and Senate and would 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. These bills await being sent to the Governor's desk.  
• S.18, Flavored Tobacco Ban bill: this bill passed the Senate and will receive one hearing in the House Human Services Committee this session and L.E. Faricy, M.D. will testify this week. The Chair has given a commitment that the bill will be taken up next session for action.
• S. 36, Addressing Violence Against Health Care Workers: the bill would 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.   
• 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.   
• Forensic Mental Health: S.89, would create a forensic mental health care facility and S.91 would establish competency restoration practices in Vermont.  Both bills continue to move forward and are a priority for Vermont psychiatrists. 

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 our “symptom relief” program and expand advertising.  
• 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.
• 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 has been removed in the Senate.
• 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. 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 compact bills, addressing physical therapy, audiology and psychology.   

Feedback Sought on Updates to VDH Hub & Spoke Rule

The Department of Health has reached out for feedback from VMS on what updates, if any, might be needed to Vermont’s rule governing the “hubs” and “spokes.”  (Officially, the VDH Rules Governing Medication-Assisted Treatment for Opioid Use Disorder for Office-Based Opioid Treatment (OBOT) Providers & Opioid Treatment Programs (OTP)).  They are opening the rule to revision in part to incorporate emergency changes made recently to remove references to the X-waiver, since that requirement has been removed at the federal level.  However, this is also an opportunity to suggest other changes Vermont MOUD prescribers might see as necessary or beneficial.  You can review an annotated draft that already incorporates the x-waiver changes here. Please provide any feedback to Jessa Barnard at jbarnard@vtmd.org by May 19^th. 

MISC.

Blue Cross and Blue Shield of Vermont and Blue Cross Blue Shield of Michigan Pursue Affiliation

In a statement released yesterday, Blue Cross and Blue Shield of Vermont and Blue Cross Blue Shield of Michigan announced an agreement to formally affiliate.  According to the statement, the affiliation will enable Blue Cross and Blue Shield of Vermont to gain additional expertise as well as operational and information technology resources.  Under the affiliation, Blue Cross and Blue Shield of Vermont becomes part of the Blue Cross Blue Shield of Michigan enterprise family of companies. The agreement, approved by the respective plans’ boards of directors, maintains a Vermont organization with governance, operational, and policy decisions made locally. Blue Cross and Blue Shield of Vermont will continue under the same name with the executive leadership team and workforce headquartered in Berlin, VT. The agreement is pending approval of state regulators.

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

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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