May 9, 2023

NEED TO KNOW

2023 Legislative Session Advances Toward Adjournment

As agreements on key legislation like childcare financing and the hotel voucher program for those without housing remain elusive, lawmakers are beginning to lose confidence on May 12^th as the adjournment date of the 2023 legislative session. Until there is final agreement on childcare and housing funding, the FY24 Budget Conference Committee cannot vote out the FY24 budget proposal which was scheduled for this afternoon. This proposal is a compromise between the House and Senate conferees who have spent the last week painstakingly going through all remaining sticking points. Despite this agreement, the Governor has threatened to veto several bills, including the FY24 Budget, as he does not believe the legislature put enough in "rainy-day" reserves. The Legislature has scheduled to meet for three days for a veto session in late June, right before the State's new fiscal year. The VMS will continue to advocate for the increase in the Medicaid RBRVS (professional) fee schedule which equals 110% of Medicare for primary care services (a $1,755,041 increase) and provides a 3.8% increase for all other services in the Medicaid professional fee schedule (a $3,804,600 increase). The Governor is also expected to veto H.230, the suicide prevention bill, which includes a safe storage provision for firearms and a 72-hr waiting period to purchase firearms, and now advances to the Governor's desk. While legislators scurry to complete work on must-pass bills, the VMS is watching other bills of interest that have received preliminary work this year and are likely to be taken up further next session, including:

• H.72, an overdose prevention site bill, passed out of the House Human Services Committee on Monday and is now in the House Ways and Means Committee. This bill aims to provide for safe opioid consumption and limited liability for those that use and dispense opioids. 
• S.18, the flavored tobacco ban bill was taken up in the House Human Services Committee last week and Dr. L.E. Faricy delivered compelling testimony. Click here to read it. 
• The House Health Care Committee has scheduled a number of informational meetings related to H.220, a bill that contains provisions to reduce prior authorizations and to increase the primary care spend rate across the State. 

Stay tuned, the VMS will provide a full 2023 Legislative wrap-up after the Legislature adjourns. 

Federal COVID-19 Public Health Emergency Ends Thursday, May 11; DEA Allows Telehealth to Continue for Controlled Substances

As detailed in previous issues of the Rounds, the Department of Health and Human Services (HHS) is allowing the federal Public Health Emergency (PHE) for COVID-19 to expire at the end of the day on May 11, 2023.  HHS has issued a Health Emergency Transition Roadmap, which outlines which regulatory flexibilities will and will not be changing with the end of the federal PHE.  For example:

• Coverage for COVID-19 testing will change, with the timing and out of pocket expense depending on an individual’s health care coverage
• Many Americans will continue to pay nothing out-of-pocket for the COVID-19 vaccine
• Out-of-pocket expenses for certain treatments may change, depending on an individual’s health care coverage
• Major Medicare and Medicaid telehealth flexibilities will not be affected
• FDA’s EUAs for COVID-19 products (including tests, vaccines, and treatments) will not be affected

See the full Roadmap here. See a detailed factsheet for physicians and other clinicians here. VMS has also been informed by Vermont Medicaid (DVHA) that DVHA will continue to reimburse for audio-only telehealth services at parity with in-person services through 2024. Some changes to which services are allowable by audio-only may be announced sooner. The DEA also announced last week that it will continue to allow buprenorphine and controlled substances to be prescribed by telehealth while the agency finalized proposed rules on the topic. Read more here. Contact Jessa Barnard at jbarnard@vtmd.org with questions.

MISC.

Reminder: 8-hour Training Requirement for All DEA-Registrants – Effective June 2023

As previously covered in the Rounds, the US Drug Enforcement Administration (DEA) has issued a letter outlining a new one-time, eight-hour training requirement for all DEA-registered practitioners on the treatment and management of patients with opioid or other substance use disorders. This training was passed as part of the Consolidated Appropriations Act of 2023 and will go into effect June 27, 2023.  Find the full letter outlining ways to meet the training requirement here: https://deadiversion.usdoj.gov/pubs/docs/MATE_Training_Letter_Final.pdf

Comment by May 19^th -  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

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

Vermont Ethics Network Presents: Spring 2023 Palliative Care Virtual Series

May 9th and 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 9th - Clear as Mud: The nuances of hospice eligibility & financial issues at end of life This session will be presented by Joyce Dobbertin, MD, DC Register here.

Other sessions include:

• May 17th - Use of Opioids in Serious Illness: Inpatient and outpatient considerations

Learn more about all sessions 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.

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.

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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