Most Recent Updates Related to Covid-19

Vermont Now Reporting COVID Cases by Vaccination Status - July 27, 2021 

At today’s press conference by the Scott Administration, Commissioner of the Department of Financial Regulation Mike Pieciak shared new slides as a part of his modeling report that track Vermont’s COVID-19 cases by vaccination status (slides 5 & 6). He stated that while the absolute number of cases per 14 days among vaccinated Vermonters looks higher in July compared to April, as a percent of the population, the case rate among vaccinated Vermonters has fallen. Commissioner of Health Mark Levine added that over the course of the pandemic the state is aware of five fully vaccinated Vermonters who have been hospitalized and one who has died and that vaccination is the best protection against hospitalization and death. In response to questions, Governor Scott and Commissioner Levine stated they do not believe the Vermont will need to reinstitute mandatory mitigation measures although Commissioner Levine stated that people who had traveled to high prevalence areas might want to be tested when they return to Vermont, regardless of vaccination status. Levine also stated that more information about requirements for schools for the fall can be expected at next week’s press conference. Notes from the press conference can be found here. Today, the CDC also announced new mask guidelines recommending indoor masking even for those who are vaccinated in “high” or “substantial” COVID-19 transmission counties – none of which are in Vermont – and for all students and staff in school.

2022 Medicare Physician Fee Schedule Proposed Rule Released – Changes to Payment Rates, Telehealth - July 15, 2021

The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2022 Medicare physician fee schedule. It is open for comment until September 13, 2021. AMA and VMS staff continue to analyze the full proposal. Notably, the 2022 Medicare conversion factor would be reduced by approximately 3.89% from $34.8931 to $33.5848. This is largely a result of the expiration of a 3.75% increase to the conversion factor at the end of calendar year 2021, as averted for 2021 by Congressional action. The AMA will strongly advocate that Congress avert this significant cut and extend the 3.75% increase for 2022. Regarding telehealth access, CMS is proposing to retain a number of services added to the Medicare telehealth services list on a temporary basis through the end of December 31, 2023, so that there is a path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 public health emergency. CMS also proposes to implement recently enacted legislation that removes certain statutory restrictions to allow patients in any geographic location and in their homes access to telehealth services for diagnosis, evaluation, and treatment of mental health disorders and proposes to allow payment to eligible practitioners when they provide certain mental and behavioral health services to patients via audio-only telephone calls from their homes. For other audio-only services, CMS proposes to continue with their plan to end reimbursement for telephone codes 99441, 99442 and 99443 after the federal public health emergency ends but to permanently adopt coding and payment for HCPCS codes G2252 (extended virtual check in for 11–20 minutes of medical discussion) and reimburse at the same level as CPT 99442. The rule also proposes a number of other regulatory changes in areas including electronic prescribing of controlled substances for Medicare Part D, telehealth services offered by FQHCs and to the Medicare Shared Savings ACO program.

The full text of the proposed rule can found at: https://public-inspection.federalregister.gov/2021-14973.pdf.CMS Press Release: https://www.cms.gov/newsroom/press-releases/cms-proposes-physician-payment-rule-improve-health-equity-patient-accessPhysician Fee Schedule Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-proposed-ruleQPP Fact Sheet: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1514/2022%20QPP%20Proposed%20Rule%20Resources.zip


What Ending the State of Emergency Means for Health Care Practices; Check Status of Telehealth Licensure

Updated June 28, 2021

As has been well publicized by the media, Governor Phil Scott has announced that since more than 80 % of Vermont’s eligible population - those age 12 and older - have received at least one dose of the COVID-19 vaccine, he has rescinded all state COVID-19 restrictions. Additionally, Vermont’s State of Emergency was allowed to expire on June 15th.

At this time, Vermont will no longer require sector-specific guidance for health care settings, such as the Guidance for Inpatient and Outpatient Procedures and Hospital Visitor Guidance. Instead, health care settings may establish their own guidance and are expected to follow CDC guidance, including Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. This document includes updated testing recommendations for health care workers, visitation guidance and guidance for communal gatherings/activities in the health care setting. Some sectors, such as hospitals and long-term care settings, may be required to follow CDC guidance by federal accreditation/inspection standards. A brief summary is available from the Department of Health here.

Practices should note that in early June OSHA released a new Emergency Temporary Standard (ETS) for health care workers related to minimizing the risk of exposure to COVID-19. See the VMS article below for further details regarding these requirements and compliance dates.

With Vermont ending the State of Emergency related to COVID-19, members are reminded that there are some regulatory flexibilities pegged to the State of Emergency, although S. 117/Act 6 extended many to a date certain and are not dependent on the State of Emergency. A summary of Act 6 is available here. Note the following that are linked to the State of Emergency:

  • Waiver of obtaining/documenting a patient’s informed consent for use of telemedicine (sunsets 60 days after the State of Emergency or August 14, 2021) (informed consent for audio-only telehealth currently required, see sample);
  • Liability protections for health care providers engaged in emergency management services or response activities.

The following will continue to a date certain:

  • Health insurance companies must continue to reimburse for audio-only telehealth services at parity with in-person services (through the remainder of 2021);
  • Ability for out-of-state licensed health care professionals to provide services to patients located in Vermont by telehealth (through March 2022);
  • Buprenorphine prescription renewals without an office visit (through March 2022); and
  • Waiver of using HIPAA compliant telehealth platforms (through March 2022, if federal waiver continues to allow – dependent on Federal Public Health Emergency).

Waiver of licensure requirements for telehealth services provided to patients located in other states, such as New Hampshire or New York, are determined by those states’ laws, and in many cases are dependent on the status of a declared emergency in those states. See the charts from the Federation of State Medical Boards to confirm if you will need to seek licensure to provide services to patients located in other states when the state of emergencies end in those jurisdictions. New Hampshire announced last week that all COVID-19 Emergency Licenses issued prior to June 12, 2021, expired on that date with the expiration of the State of Emergency. All healthcare COVID-19 Emergency Licenses will automatically be converted to a temporary license that will be valid for a period not to exceed 120 days (October 20, 2021) from June 12, 2021. As of June 25th, New York State ended its state of emergency, immediately ending the waiver of licensure for telehealth, however the New York Office of Professions will “take into consideration” the short notice of the ending of the state of emergency “in the event of any potential inquiries.” For questions or concerns regarding this transition, contact jbarnard@vtmd.org.

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New OSHA Rule Requires COVID 19 Safety Measures in Health Care Settings

June 22, 2021

Last week, the Occupational Safety and Health Administration (OSHA) released new standards for health care settings “where suspected or confirmed COVID-19 patients are treated.” According to the OSHA fact sheet, the Emergency Temporary Standard (ETS) is aimed at protecting workers facing the highest COVID-19 hazards. This includes employees in hospitals, nursing homes, and assisted living facilities; emergency responders; home healthcare workers; and employees in ambulatory care facilities where suspected or confirmed COVID-19 patients are treated. For more information see the “Is your workplace covered by the COVID-19 Healthcare ETS?” flow chart

Some of the key requirements of the ETS are:

  • COVID-19 plan: Develop and implement a COVID-19 plan (in writing if more than 10 employees)
  • Patient screening and management: Limit and monitor points of entry to settings where direct patient care is provided; screen and triage patients, clients, and other visitors
  • Develop and implement policies and procedures to adhere to Standard and Transmission-Based precautions based on CDC guidelines
  • Personal protective equipment (PPE): Provide and ensure each employee wears a facemask when indoors*
  • Physical distancing: Keep people at least 6 feet apart when indoors*
  • Physical barriers: Install cleanable or disposable solid barriers at each fixed work location in non-patient care areas*
  • Health screening and medical management: Screen employees before each workday and shift
  • Ventilation: Requirements for employer-owned or controlled existing HVAC systems
  • Vaccination: Provide reasonable time and paid leave for vaccinations and vaccine side effects
  • Training: Ensure all employees receive training so they comprehend COVID-19 transmission, tasks and situations
  • Recordkeeping: Establish a COVID-19 log (if more than 10 employees) of all employee instances of COVID-19

* There are exceptions to masking, distancing, and barrier requirements for fully vaccinated staff when in well-defined areas with no reasonable expectation that a COVID-19 patient will be present

The ETS is effective immediately upon publication in the Federal Register (OSHA is working to have the standard published “as soon as possible”). Employers must comply with most provisions within 14 days, and with provisions involving physical barriers, ventilation, and training within 30 days. OSHA will use its enforcement discretion for employers who are making a good faith effort to comply with the ETS.

For more information, see the Fact Sheet, Full Text and FAQs regarding the ETS.

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State Has Reached 80% Vaccination Goal – Health Care Practices Still Must Follow CDC Guidance, New OSHA Rule

June 22, 2021

As has been well publicized by the media, Governor Phil Scott announced last week that 80.2% of Vermont’s eligible population - those age 12 and older - have received at least one dose of the COVID-19 vaccine, making it the first state to reach this major milestone. Governor Scott also announced he has rescinded all state COVID-19 restrictions. Additionally, Vermont’s State of Emergency, slated to expire at midnight tonight, June 15, will not be renewed.

At this time, Vermont will no longer require sector-specific guidance for health care settings, such as the Guidance for Inpatient and Outpatient Procedures and Hospital Visitor Guidance. Instead, health care settings may establish their own guidance and are expected to follow CDC guidance, including Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. This document includes updated testing recommendations for health care workers, visitation guidance and guidance for communal gatherings/activities in the health care setting. Some sectors, such as hospitals and long-term care settings, may be required to follow CDC guidance by federal accreditation/inspection standards.

Practices should note that last week OSHA released a new Emergency Temporary Standard (ETS) for health care workers related to minimizing the risk of exposure to COVID-19. See article below for further details regarding these requirements and compliance dates.

With Vermont ending the State of Emergency related to COVID-19, members are reminded that there are some regulatory flexibilities pegged to the State of Emergency, although S. 117/Act 6 extended many to a date certain and are not dependent on the State of Emergency. A summary of Act 6 is available here. Note the following that are linked to the State of Emergency:

  • Waiver of obtaining/documenting a patient’s informed consent for use of telemedicine (sunsets 60 days after the State of Emergency or August 14, 2021) (informed consent for audio-only telehealth currently required, see sample);
  • Liability protections for health care providers engaged in emergency management services or response activities.

The following will continue to a date certain:

  • Health insurance companies must continue to reimburse for audio-only telehealth services at parity with in-person services (through the remainder of 2021);
  • Ability for out-of-state licensed health care professionals to provide services to patients located in Vermont by telehealth (through March 2022);
  • Buprenorphine prescription renewals without an office visit (through March 2022); and
  • Waiver of using HIPAA compliant telehealth platforms (through March 2022, if federal waiver continues to allow – dependent on Federal Public Health Emergency).

Waiver of licensure requirements for telehealth services provided to patients located in other states, such as New Hampshire or New York, are determined by those states’ laws, and in many cases are dependent on the status of a declared emergency in those states. See the charts from the Federation of State Medical Boards to confirm if you will need to seek licensure to provide services to patients located in other states when the state of emergencies end in those jurisdictions. New Hampshire announced last week that all COVID-19 Emergency Licenses issued prior to June 12, 2021, expired on that date with the expiration of the State of Emergency. All healthcare COVID-19 Emergency Licenses will automatically be converted to a temporary license that will be valid for a period not to exceed 120 days (October 20, 2021) from June 12, 2021. As of publication, New York State continues to waive licensure requirements for telehealth under and executive order. For questions or concerns regarding this transition, contact jbarnard@vtmd.org.


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AAPVT Offers Guidance to Families with Children on How to Navigate the Summer and Stay Healthy and Active

June 15, 2021

Vermont pediatricians are offering guidance to families with children on how to navigate the summer and stay healthy and active.

Vaccines are the most effective tool we have to end the COVID-19 pandemic. Pediatricians are thrilled that Vermont is nearing the benchmark of 80% of its eligible population receiving at least one dose of the COVID-19 vaccine. Case rates, hospitalizations, and deaths have decreased thanks to these highly effective vaccines. As Vermont moves forward with its reopening plan, it is important to remember that young children are not yet eligible for the vaccine and so warrant special consideration.

All families and child-serving settings will make their own decisions based on local factors, but AAP-VT is recommending the following based on current COVID case rates and rates of vaccination in VT:

  • Unvaccinated children over 2 years of age as well as unvaccinated adults should continue to wear masks indoors when they are around other unvaccinated people.
  • Given the low risk of transmission during outdoor activities, it is reasonable for unvaccinated children to not wear masks outside.

Masks have shown to be effective in preventing the spread of COVID-19 as well as the spread of other respiratory infections. Pediatric hospitalizations due to respiratory syncytial virus (RSV), influenza, and other viruses were at a record low this year even among children attending full-time childcare and school. As restrictions are loosened, many parts of the world have seen an increase in common respiratory viruses. These viruses can cause serious illness especially among the very young. Currently we are seeing an increase in pediatric hospital admissions in Vermont for respiratory illness caused by rhinovirus, a common respiratory virus.

  • Adults and children who are sick should continue to stay home whether or not they are vaccinated. Employers can help in this effort by supporting a flexible sick day policy.
  • When planning activities, we encourage families to have honest and clear conversations about comfort level with other families regarding masking, vaccination, illness, and other expectations.
  • We are hopeful that children and adolescents will have a fun and rejuvenating summer. Recently, more summer activity and job opportunities have been made available. Visit the Vermont Afterschool website for more details.
  • We recommend all adolescents eligible for the vaccine get it as soon as possible. AAP-VT has hosted a series of virtual family forums to discuss questions with families and give parents and caregivers the information they need about vaccination. Check out the AAPVT website for past recordings and announcements of future forums.

As always, please feel free to reach out to your child’s medical provider with any questions or concerns. We anticipate younger school-aged children will be eligible for the vaccine in the fall and infants and toddlers may be eligible by the winter. We are pleased that Vermont is leading the nation in vaccination rates but pediatricians won’t fully breathe a sigh of relief until all of our patients are protected from COVID-19.

View the Press Release in PDF