Congress approves, President signs bill that permanently repeals SGR

This week, the U.S. Senate approved and President Obama signed H.R. 2, thereby enacting sweeping changes in the way Medicare pays physicians and other health professions.  The bill, drafted in the House in negotiations between Speaker John Boehner and Representative Nancy Pelosi, the Democratic leader, permanently repeals the sustainable growth rate (SGR) formula and also extends the Children’s Health Insurance Program (CHIP) for two years, through 2017.  Without action by Congress, physicians would have faced a 21-percent cut in Medicare fees. 

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Legislation removing the philosophical exemption from immunizations reborn in Senate

On Wednesday, Senators Kevin Mullin, John Campbell and Dick Sears submitted an amendment to H.98, an act relating to reportable disease registries and data, to remove the philosophical exemption to vaccines for school entry.  After much debate, the vote on the bill was delayed until next Wednesday, April 22, to allow the Senate Health and Welfare Committee to hear testimony.  VMS will be working to gather witnesses for the testimony and will keep members informed of this progress.  If this amendment passes it would be sent back to the House Human Services Committee for approval.

H. 481 - Medicaid Reimbursement Increases, Loan Repayment Restored, Tobacco Tax and Sweetened Beverage Tax

IA bill that would restore Medicaid reimbursement for primary care to the Medicare level, raise reimbursement for specialty care from 80 percent of Medicare to about 84 percent of Medicare, restore level funding for the primary care educational loan repayment program, and increase primary care medical home payments has cleared two committees and will be reviewed this week by the House Appropriations Committee. 

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S. 8 - Interstate Licensing Compact

The Vermont Board of Medical Practice (Board) is supporting S. 8, a bill that would establish and Interstate Licensing Compact for physicians.  If Vermont joined the interstate licensing compact, by passing the compact law, qualified physicians would be able to obtain licenses in other states through an expedited procedure.  To be eligible for expedited compact licenses, physicians would have to meet a number of specific criteria, including board certification.  They would be required to have background checks and could not have been the subject of license discipline. 

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Telemedicine Policy

The Vermont Board of Medical Practice (Board) is proposing to adopt a policy on appropriate use of telemedicine when practicing medicine.  The policy requires physicians to be licensed in the state where the patient is located when telemedicine is used.  A physician-patient relationship must be established and a medical history and evaluation of the patient must be performed and documented in the patient’s medical record.  The proposed policy describes the components of informed consent for telemedicine, which include providing information about the physician’s credentials, the type of transmission used, and details on security measures.  

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S. 62 - Surrogate Consent to DNR Orders and COLST Orders/DNR Identification Rules

Vermont is one of a handful of states that does not have a law addressing health care decision making for patients who have not appointed agents through an advance directive and do not have guardians appointed by the probate court. Last year Act 127 created a process for a family member or a person with a known close relationship to a patient to elect hospice care for a patient who does not have an agent or guardian.  S. 62 establishes a similar process for identification of surrogates to consent to Do Not Resuscitate (DNR) orders or Clinician Orders for Life Sustaining Treatment (COLST).

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S. 108 - Physician Assisted Suicide

A bill repealing a sunset on the Vermont physician aid in dying law passed in 2013 has passed the Senate.  The effect of this bill is to maintain the current requirements in the physician aid in dying law.  Not all patients are eligible to participate in this process and there are 15 legal requirements that physicians must follow in order to write a lethal prescription for a patient without legal liability.  Physicians not required to participate in this process (Link to Department of Health Patient Choice website - Link to VMS Physician Assisted Suicide policy).
 

S.141 – An act relating to possession of firearms

S.141 was voted out of House Judiciary on Tuesday.  The bill in its current state would make it a crime for people convicted of violent or drug-related offenses to possess a firearm.  The bill would also require the Vermont Department of Mental Health to report people with mental illness that have been adjudicated by a court to the National Instant Criminal Background Check System (NICS).  In the previous version of the bill, there would have been an 18-month waiting period for people who want to remove their names from NICS, but that waiting period has been removed and instead replaced with a higher level of evidence.

License renewal fees for physicians to increase in 2016

License renewal fees for physicians will increase from $500 to $525 in 2016.  The fee will continue to include $25 for the Vermont Practitioner Health Program (VPHP) that is operated by VMS. Fees for initial license applications for physicians will increase from $625 to $650, and fees for limited temporary licenses for residents will increase from $115 to $120.  Fees for physician assistants will increase from $170 to $225.  Physician assistants have changed from a certification model to a licensing model and will no longer be required to obtain additional certificates for additional sites where they work.  Anesthesiologist assistants and radiologist assistants’ fees will increase from $115 to $120 for initial certification and renewal, and from $50 to $55 for each additional application for certification or renewal if they work at different sites.

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Mental Health – Secure Residential Facility – H. 241 Capital Bill 

The capital appropriation bill requires the Agency of Human Services to conduct an examination of the needs of the Agency for siting and designing a secure residential facility, and report back to the legislature by February 1, 2016.  The examination must address the operating costs for the facility including staffing, size of the building, quality of care and options for ownership and management of the facility.  This facility will not be available to relieve the pressure on emergency departments anytime soon. 
 

Organ Donor Taskforce extended

H. 141, which has not passed the House, extends the work of the Organ and Tissue Donation Working Group through June of 2017.  The charge of the group is to develop recommendations to the Vermont General Assembly and the Governor

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