October 10, 2025

Vaccines are essential to the health of communities in Virginia. On October 6, 2025, the Centers for Disease Control and Prevention (CDC) made minor updates to its immunization schedules, including changes to recommendations for the MMRV (Measles, Mumps, Rubella & Varicella) and COVID-19 vaccines. These vaccines have been through rigorous testing and continuous evaluations and have been demonstrated as safe and effective. These vaccines also protect those
who are unable to be vaccinated.

COVID-19

• People aged 6 months and older can receive the COVID-19 vaccine based on individual- based decision-making with a healthcare provider, such as physicians, nurses and pharmacists.
• Individual-based decision-making allows for immunization coverage through all payment mechanisms, including entitlement programs; however, insurance coverage should be verified before vaccination. This includes programs such as Medicare, Medicaid, the Children’s Health Insurance Program, the Vaccines for Children (VFC) Program, and insurance plans regulated by the Affordable Care Act.
• Pharmacists can now administer COVID-19 vaccination without a prescription to persons aged 3 years and older, now that the CDC immunization schedule includes the 2025-26 COVID-19 vaccine. This is pursuant to the Public Readiness and Emergency Preparedness Act (PREP Act) for Medical Countermeasures Against COVID–19, 12th amendment.
• Pharmacies may have different policies about the ages of patients they will vaccinate. Encourage parents to verify the acceptable age of their local pharmacy before making appointments or visiting a pharmacy for vaccination.
• The Virginia Board of Pharmacy has updated its statewide protocol for adults effective October 1, 2025.
• With the CDC recommendations in place, the Virginia Commissioner’s Standing Order is no longer needed and has been revoked effective October 10, 2025.

MMRV (Measles, Mumps, Rubella & Varicella)

• MMRV vaccine remains FDA approved for children 12 months – 12 years.
• Children under the age of 4 years should receive the measles, mumps, and rubella vaccine and the varicella vaccine separately (MMR+V). The combined MMRV vaccine is no longer recommended for children under the age of 4 years.
• Children aged 4 years and older can still receive the combined MMRV vaccine. The recommendation for this age group has not changed.
• Per the VFC Provider Agreement, providers participating in the Vaccines for Children (VFC) program are required to comply with vaccine schedules, dosages, and contraindications established by the Advisory Committee on Immunization Practices (ACIP). As such, VFC providers can no longer give MMRV to children under the age of four years. Please see the VFC Provider Agreement for exceptions to this policy.
• If providing MMRV to a child younger than 4 years of age, insurance coverage should be verified before vaccination, as it may no longer be covered.

Additional Information

• It is strongly recommended that all Vaccines for Children (VFC) providers carry a minimal stock of COVID-19 vaccine to ensure access for this population, who may not have options to seek it elsewhere. If you have questions about the VFC program, please contact [email protected].
• Existing Vaccine Information Statements should be used until new ones are published by the CDC.
• All administered vaccines in Virginia must be reported to the VIIS within 7 days of administration.
• CDC’s updated recommendations differ from recommendations from professional medical organizations. This includes:
  o American Academy of Family Physicians
  o American Academy of Pediatrics
  o American College of Obstetricians and Gynecologists

Thank you for your partnership in keeping Virginians safe and healthy.

Sincerely,

Karen Shelton, MD

State Health Commissioner

via American Medical Association | September 26, 2025

The AMA has long called for Congress to enact legislation that would: (1) permanently allow Medicare patients in every geographic area, not just patients in rural areas, to receive telehealth services by waiving the geographic restrictions in current law; and (2) permanently allow Medicare patients to receive telehealth services in their homes instead of having to go to a medical facility to receive telehealth from a distant site. To date, however, Congress has passed legislation that only temporarily waives these requirements. Most recently, in March 2025 Congress extended these telehealth flexibilities for a six-month period that ends Sept. 30, 2025.

Physicians who provide telehealth services to Medicare patients should be aware that if Congress is not able to pass legislation before Oct. 1, 2025, that extends government funding, then the current Medicare telehealth flexibilities will lapse. This means that telehealth services would be limited to rural areas as they were before the COVID public health emergency and that patients would not be able to receive telehealth services in their homes. In addition, the ability to provide audio-only services to Medicare patients would lapse, as would the Acute Hospital Care at Home program.

In past government shutdowns, whenever Congress passed legislation to reopen the government, it made the funding and policies retroactive to the effective date of the shutdown. Physician practices may want to consider adjusting their patient schedules for telehealth services, however, as neither the likelihood nor the duration of a shutdown are known.

Update from October 9, 2025

COVID SHOT CHANGE — The CDC and its panel of expert advisers quietly expanded access to Covid-19 vaccination during pregnancy, undoing an earlier recommendation from HHS Secretary Robert F. Kennedy Jr. to stop recommending that pregnant women get the shots.

The CDC’s Advisory Committee on Immunization Practices voted in September to recommend that adults can choose to get the Covid shot after consulting with their providers, also known as shared clinical decision-making. The panel didn’t specifically vote on whether the shot should be administered during pregnancy, yet the vote appears to encompass pregnant women, according to an update this month on the CDC website that reflects the new guidance.

That development surprised some, including legal experts.

“Covid-19 vaccine in pregnancy had been discussed initially — ACIP recommended them — then the secretary took that back,” said Dorit Reiss, a vaccine law expert at the University of California’s law school in San Francisco.“Under these circumstances, if they were going to change the decision about pregnancy, I would have expected them to address it expressly, since it was changed expressly [by Kennedy].”

It’s unclear whether all 12 panel members, handpicked by Kennedy, were aware that the move would undo his decision. Much of the panel’s two-day September meeting in Atlanta was marked by confusion as recently appointed members struggled with the procedures. ACIP Chair Martin Kulldorff did not immediately respond to a request for comment, nor did a spokesperson for HHS.

Why it matters: The new guidance for adults means that pharmacies can administer the vaccine to pregnant women, and almost all insurers must cover the shots with no cost-sharing — guaranteeing expanded access for people who want to be vaccinated.

Vaccinating children under 6 months against Covid-19 isn’t recommended, so many providers see vaccination during pregnancy as a key tool for protecting vulnerable infants from the infection.

The panel’s Covid recommendation contradicts what many public health experts had expected from the September meeting. Kennedy fired all the panel’s members in June, and some new members have argued that Covid vaccines aren’t safe, spurring concerns that the panel would vote to drastically narrow access to the shots.

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Update from October 8, 2025

CDC Recommends COVID-19 Vaccination After First Consulting A Clinician

The Washington Post reports the CDC on Monday “announced it had officially recommended updated coronavirus vaccines, creating a new system to get a shot that’s slightly more complicated than in previous years.” The agency “approved a federal vaccine advisory panel’s recommendation last month urging people to first consult a clinician before getting the coronavirus shot. The move marked a shift from previous CDC policy that made vaccines widely available to nearly all Americans without question or cost.” Specifically, the CDC vaccine panel “recommended the shots to people regardless of age or health conditions under the concept of ‘shared clinical decision-making,’ meaning people should first consult a medical professional.” 

        CNN reports that prior to “the finalized recommendation this year, access to Covid-19 shots has differed from state to state as pharmacies and providers navigated new federal vaccine policies.” The signoff also comes “later than usual for the fall respiratory virus season. With the recommendation, the government can finally distribute Covid-19 vaccines through its Vaccines for Children program, which provides free inoculations to about half of US children.” HHS stated it was bringing back “informed consent” ahead of vaccination. 

        NBC News notes that “prior to the CDC’s announcement, 26 states (mostly blue states with Democratic governors) had already set their own Covid shot guidance to keep access as broad as possible, according to KFF, a nonpartisan health policy research group. The result is a complex hodgepodge of Covid vaccine policies nationwide.”

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Update from September 23, 2025

Advisory Committee On Immunization Practices Votes To Limit Access To COVID-19 Vaccines

The New York Times reported the Advisory Committee on Immunization Practices “voted unanimously on Friday to further limit access to Covid vaccines,” recommending “that adults 65 and older receive the shots only after discussing the potential benefits and risks with a health care provider.” The panel also said that everyone between 6 months and 64 years old could get the vaccine after consulting with a provider. The two decisions “raise questions about whether Americans can continue to walk into their neighborhood pharmacies for routine vaccinations or whether in some states they will first need a doctor’s permission.” While the approved recommendations “were less restrictive than many had expected,” they will still “make it more difficult for pharmacists in some states to administer the shots to older adults.” 

        The AP reported that in addition to “declining to recommend” COVID-19 vaccines to anyone, the panel “also urged the CDC to adopt stronger language around claims of vaccine risks, despite pushback from outside medical groups who said the shots had a proven safety record from the billions of doses administered worldwide. The divided panel narrowly avoided urging states to require a prescription for the shot.” The actions come after the FDA had already “placed new restrictions on this year’s shots from Pfizer, Moderna and Novavax, reserving them for people over 65 or younger ones who are deemed at higher risk from the virus.” 

        Reuters reported ACIP “earlier on Friday abandoned a vote that would have delayed the first hepatitis B vaccine dose for newborns, giving a temporary win to doctors, public health experts and patient advocates who had decried the move.” Meanwhile, AHIP, the insurance industry lobbying group, “said it stood by its comment earlier this week that it would cover COVID vaccines through 2026.”

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Update from September 11, 2025

Below and linked here is the latest provider letter from VDH Health Commissioner, Dr. Karen Shelton. The standing order that has been put in place expands the ability for pharmacists to administer COVID vaccines to adults 18-64 years of age who do not have an underlying health condition. Underlying condition has not yet been defined. There are currently no guidelines for anyone under 18 years of age. There will be a CDC meeting held this Wednesday (9/17/25) where more guidelines will be put forth.

Please ensure that you stay current as things will continue to change. MSV will keep our news page as current as possible, but please be sure to check the Health Department site regularly as well. If you have any questions, please contact the MSV Government Affairs Team at [email protected].

Dear Colleague,

 This letter provides important updates about the 2025–2026 COVID-19 vaccine.

On August 27, the U.S. Food and Drug Administration (FDA) approved updated 2025–2026 COVID-19 vaccines for adults 65 years of age and older and certain individuals under 65 years of age who have at least one underlying condition that puts them at high risk for severe outcomes from COVID-19. The Advisory Committee on Immunization Practices (ACIP) will meet on September 18–19, 2025. It is anticipated that the ACIP will discuss recommendations for the 2025-2026 COVID-19 vaccine and offer its recommendations to the Centers for Disease Control and Prevention (CDC) to include its Immunization Schedule. Until then, challenges exist for patients seeking to obtain the COVID-19 vaccine from a pharmacy. Therefore, I have issued a Statewide Standing Order authorizing pharmacists to administer the COVID-19 vaccine to adults consistent with FDA indication.

This statewide standing order will facilitate adults accessing the COVID-19 vaccine within pharmacies across the Commonwealth. Minors and adults between 18 and 64 who do not have an underlying condition should consult with their healthcare provider. Currently, a pharmacist may not administer a COVID-19 vaccine to these populations without a healthcare provider’s medical authorization.

Thank you for partnering with VDH to keep Virginians safe and healthy.

Sincerely,

Karen Shelton, MD
State Health Commissioner

Comments due: Sept. 12, 2025

There are two new and controversial proposals in the rule that will cut most specialties and facility-based (hospital and ambulatory surgical center) practices while increasing payment to some office-based practices. The attached impact analyses were provided by CMS on their website. The impacts relate to the efficiency adjustment and the practice expense adjustment. They do not include the 2026 conversion factor increases. Note the first chart includes all physicians and other qualified health care professionals, even low volume practitioners, while the second is weighted by relative value units.

Efficiency Adjustment

• CMS proposes applying an arbitrary 2.5% decrease to the work RVUs and physician intra-service time of most services in the MPFS on the assumption that physicians have gained efficiency in providing them. This includes brand new services, surveyed for physician time and work within the past year. The decrease would be applied to 8,961 physician services.
• CMS arrives at a 2.5% efficiency adjustment by tallying the last five years’ productivity adjustments in the MEI. Note that physicians do not receive an MEI-based update and that other Medicare providers receive a productivity adjustment applied to their annual baseline updates (e.g., hospital market basket minus productivity).
• CMS states that it will exempt time-based services, such as E/M, care management, maternity care, and services on the telehealth list. Only 393 services will be exempted from the decrease. Of note, although CMS states that they will exempt time-based services and services on telehealth list from the efficiency adjustment, several of these codes remain on the pending cut list.
• The adjustment impacts most specialties by reducing overall payment by 1%. The only specialties or professions to gain at least 1% from this proposal are: clinical psychology (3%), clinical social work (4%), geriatric medicine (1%), and psychiatry (1%), the individuals who perform a more significant amount of telehealth services, which CMS has exempted from efficiency adjustments.
• This proposal, combined with the AMA/Specialty Society RVS Update Committee’s recommendations on individual CPT codes, results in the 0.55% budget neutrality adjustment to the conversion factor.
• This proposal is based on the premise that physician time in the RBRVS is inflated, with criticism of utilizing physician surveys to estimate physician time. The following statement was prepared related to this unfair criticism:

Statement attributed to:

Bobby Mukkamala, MD

President, American Medical Association

“The American Medical Association believes that proposals to exclude or limit the input of expert practicing physicians and health care professionals in the development of Medicare payment policy would ultimately harm patients and represents a radical departure from the time-tested CMS decision-making process. This proposal would have negative repercussions for appropriately determining the resources required for effective patient care. To label practicing physicians conflicted when all they are doing is sharing their real-world patient experiences where empirical data often do not exist is biased, unfair and a skeptical opinion of community-based physicians.

“Academic researchers and federal officials established survey protocols that are currently used to gather information from practicing physicians. They did this because they knew Medicare depended on expert physician insight to create Medicare payment policy that mirrors the evolution of science, technology, and innovations in patient care.

“There is no substitute for relying on experienced practicing physicians when creating Medicare payment policy. No one knows more about what is involved in providing services to Medicare patients than the physicians who care for them. The valuable expertise of physicians makes them an indispensable source of survey information that Medicare can count on to create payment policy. By substituting arbitrary and flawed proposals in place of front-line, real-world knowledge from expert physicians, Medicare is proposing to cut itself off from the most credible insights into the complexities of patient care, which will ultimately lead to lower quality care, inferior health outcomes and a less sustainable Medicare system.”

Indirect Practice Expense Adjustment

• CMS proposes an arbitrary reduction in indirect practice expense RVUs for all services provided in the facility setting.
• The mechanism for the reduction is highly technical as CMS would reduce the portion of facility PE RVUs allocated based on work RVUs to half the amount allocated to non-facility PE RVUs.
• CMS cites AMA and MedPAC studies showing the growing number of employed physicians and physicians in hospital-owned practices and the shrinking number of private practices as its rationale for this proposal. CMS believes that physicians who provide services in the facility no longer maintain a separate office and receive “duplicative payments” under the MPFS and the facility fees under the outpatient or the ASC payment schedules.
• Facility-based payment to physicians will decrease overall by -7% while non-facility-based payment to physicians will increase by 4%. The results to individual physicians and specialties are proposed to be substantial.
• While CMS proposes no exceptions, it seeks comment on the impact of this proposal on maternity care.
• As the AMA explained in detail in our letter to MedPAC when the Commissioners were debating this so called issue of “duplicative payments,” this policy is likely to result in unintended consequences, including further incentivizing consolidation.
  • When a private practice physician performs a service or procedure in the facility setting, their physician practice still must handle coding and billing for the physician’s claim and scheduling as well. Physician practices would still have administrative staff, and their clinical staff often perform some work supporting services that are performed in the facility.
  • The results from the 2024 Physician Practice Information (PPI) survey data showed $57 in indirect expenses per hour of direct patient care for hospital-based medicine and $62 for hospital-based surgery.
  • For surgical global codes performed in the facility setting, the bundled post-operative office visits are often performed in a physician office even though the major surgery was performed in the facility setting.

Links to CMS’ detailed specialty impact tables and a new RUC infographic.

via The American Medical Association

Dear Registrant, 

The Drug Enforcement Administration (DEA) is warning registrants of new fraud schemes in which scammers impersonate DEA personnel and notify registrants that they are under investigation, presumably in an attempt to obtain personal information. 

DEA has recently received reports of false letters and phone calls being used to contact both DEA registrants and non-registrants. It is not the DEA’s practice to call registrants regarding investigative matters.  

If you are contacted by a person purporting to work for DEA and stating that you are under investigation, please report the incident to the FBI at www.ic3.gov. You may also wish to submit the incident to the Federal Trade Commission, which takes reports at ReportFraud.ftc.gov and shares information with more than 3,000 law enforcement agencies. For any victims who have given personally identifiable information like a Social Security number or DEA registration number to a scammer, go to www.identitytheft.gov to learn how to protect against identity theft. Reporting these scams will help authorities find, arrest, and stop the criminals engaged in this fraud. 

As a reminder, DEA personnel will never contact registrants or members of the public to demand money or any other form of payment, will never request personal or sensitive information, and will only notify people of a legitimate investigation or legal action in person or by official letter. In fact, federal law enforcement officers are prohibited from demanding cash or gift cards from a member of the public. 

The best deterrence against these bad actors is awareness and caution.

Joaquin Falcon, MLIS

Director, Federation Relations

Federation of Medicine

Specialty and Service Society