June 6, 2023

NEED TO KNOW

Your Voices Made a Difference - H.230 Will be Law!

That means as of July 1, 2023 Vermont will require:

1. A 72-hour waiting period for the purchase of firearms that starts after the National Instant Criminal Background Check System (NICS) check comes back;
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.

For full details on what the bill will do click here.

The Governor decided to allow the bill to go in to law without his signature.  In his letter to the general assembly explaining his decision, he stated that the bill started as something he could not support, but after a lot of time and effort from various parties, it ended in a better place, where he supported two out of the three major provisions.  He has concerns about the constitutionality of the waiting period, but felt that his “constitutional concerns will be addressed through the legal process”.

Thank you to each of you who wrote, called, testified – you made this possible!

You can also see how your legislator voted on this bill by clicking on the House and Senate links below - they would love to have your support!  To find your legislator and their contact information click here.  To view the voting record on H.230 click House and Senate.

To thank the Governor you can call his office at 802-828-3333 or send a message here. 

For an update on other VMS priority legislation that has received action this session, click here.  Bills that have been vetoed, including the State Fiscal Year 2024 budget, will be addressed by the legislature in a veto session on June 20-22^nd. 

Payer Claims Editing Policies Impact Vermont Practices  

VMS has been contacted by multiple practices regarding concerns with Blue Cross Blue Shield of Vermont’s Claim Editing Policy that went into effect in January.  VMS is aware that this new policy is leading to delays in payments and administrative burden when the edits require submission of office notes or additional documentation.  VMS is working with stakeholders, including BCBSVT and the Department of Financial Regulation, to try to make the policy more workable for Vermont practices.  VMS has also heard from practices with concerns about MVP’s new policy to reduce payment by 50% for sick E&M visits (99202-99205, and 99211-99215) billed on the same date-of-service and by the same Provider as a preventive E&M visit. In April, VMS joined with the AMA and other state and national specialty societies to oppose a policy by Cigna to require documentation with all Modifier-25 claims.  Cigna recently announced it is delaying implementation of this policy.  Please contact jbarnard@vtmd.org or swinters@vtmd.org to share your practice’s experience with these policy changes or to learn more about VMS’ efforts.   

GMCB Holds Hospitals to Budget Guidance

Earlier this spring, the Green Mountain Care Board released FY24 Hospital Budget Guidance, the written guidance that hospitals use when starting to prepare their proposals for the upcoming budget cycle.  (For an overview of the hospital budget process in Vermont, click here.).  The Vermont Association of Hospitals and Health Systems sent a letter to GMCB on May 3, 2023 requesting the Board reconsider the guidance, stating that the likelihood of hospitals being able to meet the FY 24 Guidance, allowing only a 8.6% net patient service revenue growth rate on FY 2022 actuals, will be very difficult.  The Board received dozens of public comments regarding the reconsideration request.  VMS weighed in expressing concern that an unsustainably low growth target will force hospitals to reduce real clinical services exacerbating issues the state has worked hard to address, like ED wait times for mental health services and wait times for specialty care.  Last Wednesday, the GMCB members discussed the request and unanimously agreed to continue with a 2-year 8.6% growth rate, stating that this is only guidance and the Board will review budget requests above this rate by individual hospital on a case by case basis during the budget hearing process taking place this summer.  Follow the budget submissions: https://gmcboard.vermont.gov/FY24-Hospital-Budgets.

Save the Date: 210th Annual and Collaborative Meeting Taking Place from November 3-4, 2023

The 210th VMS Annual Meeting will be held on November 3rd and 4th in person at Topnotch Resort, Stowe, VT, with virtual options. The weekend will be filled with educational content, time spent with colleagues, policy-setting meetings, and the opportunity to honor physicians and other health care leaders across the state.

Stay up to date on details here and nominate Vermont leaders who have provided outstanding contributions to the medical profession, to health organizations and to the welfare of the public for a VMS Leadership Award here.

Resources for Health Care Partners -  Pandemic Emergency Housing Ending

The Department for Children and Families released a memo last week providing information for health care and community partners on the wind-down of the Pandemic Response to Emergency Housing program.   Absent further action by the legislature during the June 20-22 veto session, the memo outlines the current wind-down schedule, which will take place over three phases: June 1 (690 households); July 1 (45 households); end of July (475 households); and late-September (600 households). 

The memo encourages partners to reach out to AHS with questions or to help solve non-emergency challenges with households exiting the program.

• For general questions please contact the Economic Services Division main line 1-800-479-6151
• If you are working with someone who has specific complex health needs and need help making a plan, please contact your local field services director: https://humanservices.vermont.gov/about-us/field-services
• To reach the Economic Services Deputy Commissioner’s office call 802-241-0637 or email AHS.DCFESDASU@vermont.gov
• To see weekly data updates and information for communities and municipalities visit https://dcf.vermont.gov/pandemic-era-ga-program-2023

VMS Visits College of Medicine 

VMS President Elect Rebecca Bell, MD, and staff Jessa Barnard and Stephanie Winters visited the Larner College of Medicine last week to introduce students to VMS and explain opportunities for engaging in advocacy.  Thanks to LCOM 1^st year student Surya Radhakrishnan for helping organize the event and supporting more medical student-VMS connections. 

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

Deadline Extended: Urge VT Delegation to Sign “Dear Colleague” Letter To Address Prior Auth

Recently, champions in the U.S. House and Senate introduced “Dear Colleague” letters urging the Centers for Medicare & Medicaid Services (CMS) to strengthen and finalize proposed rules to improve the Medicare Advantage prior authorization process for physicians and patients.  

Due to overwhelming advocacy, the House and Senate sponsors were inundated with colleagues who wanted to sign on and the sponsors have extended the sign-on deadline to June 9. 

Please urge Senator Sanders to sign the  “Dear Colleague” letter today (Senator Welch & Congresswoman Balint have already signed on). 

The proposed rules align with many of the key provisions of the Improving Seniors' Access to Timely Care Act, which despite passing the House last year with over 300 cosponsors and having strong bipartisan support in the Senate, failed to receive a vote on the Senate floor leaving millions of patients without these prior authorization protections they so desperately need. 

These proposed rules would require Medicare Advantage plans to: identify and issue real-time decisions for routinely approved services; adopt federally developed standardized electronic prior authorization processes; provide greater transparency surrounding the development and use of utilization management guidelines and provide rationales for denials.

Mildred Reardon Medical Student Scholarship Open for Applications

Do you dream of becoming a Vermont doctor?  See below to apply for a $10,000 scholarship for a rising 3rd year student committed to practicing medicine in Vermont.

The Vermont Medical Society’s Education and Research Foundation (VMSERF) is now accepting applications for the Mildred Reardon scholarship, which awards $10,000 to a University of Vermont Larner College of Medicine third year student committed to practicing medicine in Vermont. The scholarship is made to a student interested in any specialty, with a preference for specialties in high need in Vermont.  The scholarship is tuition-linked and is paid directly to the College of Medicine towards tuition. This year the award will be made at the VMS Annual Meeting, being held at Topnotch in Stowe and virtually on November 3, 2023.  Click here for more information and details on applying for the scholarship.

MISC.

VMS Neutral on I CAN Legislation

The AMA, along with many state and national medical societies, recently submitted a letter to Congress expressing its opposition to the “I CAN Act,” which would expand federal authority for APRNs and PAs to perform certain tasks.  After several discussions and receiving input from the full Board, the VMS Executive Committee informed the AMA that VMS would not join the letter at this time.  VMS stated that while there are sections of the I CAN Act that raised serious concern for the Board, particularly those that relate to the unsupervised management of complex, sometimes seriously ill patients (eg anesthesia patients, in-patient care), other changes proposed in the bill would be beneficial with regard to reduction of paperwork and co-signatures by physicians, particularly those in primary care, and would seem within appropriate scope for APPs in Vermont, who already serve as primary care providers.  For more information, contact jbarnard@vtmd.org.

UVMHN Submits Proposal for Mental Health Service Expansions

Last week, the University of Vermont Health Network submitted a proposal to the Green Mountain Care Board for investment of surplus funds that have been held from the FY2017 budget year.  In its memo to the GMCB, the UVMHN stated that the proposal was developed through a collaboration between the Department of Mental Health and the UVMHN with the shared goal to address some of the most pressing needs in the state by increasing capacity for mental health services, with particular attention to services that will reduce the need for inpatient care. The specific proposals include:

A GMCB presentation and public comments regarding the proposal can be found here (under March 2023). 

The VMS is trying to gain insight on whether VMS members, Specialty Society Members, and their families would be interested in participating as a  “walk and wave”  group for the Montpelier Alive's 2023 July 3rd parade. The theme for this year’s parade is "Resilience” and we know that Vermont’s health care professionals have demonstrated resilience like no other!

A "walk and wave" is when a group of people holding a banner or signs simply walk and wave at the crowd while marching in the parade.

Complete the interest survey here.

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.

Vermont Medicaid Renewals Continue

Vermont Medicaid renewals, which were paused during the COVID-19 federal emergency, restarted in April 2023.  Notices are mailed the month a member’s renewal is due. Most households will receive a text message or phone call in advance of this mailing. They will also receive text and email reminders 2 weeks after the initial notice. It is important that members pay close attention to all notices. Many resources are available to assist community partners and can be found at https://dvha.vermont.gov/partners-providers. It is also important for practices to check member eligibility prior to each visit to ensure claims aren’t denied for lack of eligibility.

Vermont Vaccine Program Updates May/June 2023

The Vermont Vaccine Program has released its May/June Update, addressing many current topics including updated COVID-19 vaccine clinical guidelines, vaccine availability post-PHE and updates on MPox.  The issue can be found here. Up to date information can be found on the Immunization Program Website.

Commissioner of Health Public Health Update on Thursday, July 6th

The next Public Health Update call with Commissioner of Health Mark Levine, MD will be Thursday, July 6th 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 June 1, 2023 call here.

You can join the zoom meetings here.

BCBSVT Offers Lifestyle Medicine Training and Board Certification Scholarships

Blue Cross and Blue Shield of Vermont, in partnership with the American College of Lifestyle Medicine (ACLM) and the American Board of Lifestyle Medicine (ABLM), is offering Lifestyle Medicine training and board certification to our clinical provider network through a unique scholarship program. ACLM/ABLM Certification typically costs over $2500 per provider, but BCBSVT is funding fifty (50) awards free of charge to eligible healthcare clinicians who are interested in pursuing a high level of professional training in lifestyle medicine and who are committed to the expansion of lifestyle medicine education, programs and initiatives to better serve their patients.

Learn more here. With questions or to apply for one of the scholarship awards, email Keri LeCompte at lecomptek@bcbsvt.com, BCBTVT Program Director for Lifestyle Medicine.

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.

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.

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

June 13, 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.

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

Vermont Medical Society

134 Main Street

Montpelier, VT 05602

-- Unsubscribe --