February 3, 2003

 
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Governor Baldacci to Present Biennial Budget on Wednesday
At 6:30pm on Wednesday, Feb. 5th, the 121st Maine Legislature wil meet in joint session to hear Governor Baldacci present the details of his FY 2004-2005 budget.
  At 6:30pm this coming Wednesday, Governor Baldacci will present his biennial budget to a joint session of the Legislature.  This 2-year budget beginning 7/1/03 will have to cover a projected deficit of nearly $1 billion, which represents approximately 1/5 of the state budget.  Because the Governor has expressed his opposition to new taxes and to reductions in Medicaid eligibility, MMA anticipates that the budget proposal may have a significant impact on provider reimbursement in the Medicaid program and on the Fund for a Healthy Maine.  The Fund for a Healthy Maine contains the state share of the settlement with the tobacco companies.  MMA participates in a coalition of organizations that has tried to preserve the bulk of the Fund for prevention and treatment programs.

     Because physician reimbursement represents less than 3% of the Medicaid budget, and because every state dollar cut in medicaid costs the state 2 federal dollars, we are hopeful that physician reimbursement will not take a hit in the budget but we will not know the impact until the budget is released on Wednesday.

     You may contact the Governor about budget issues via email at governor@maine.gov.

MMA meets with CMS
   Maine Medical Association representatives traveled to the Massachusetts Medical Society on Jan. 27th to meet with officials of  the Centers for Medicare and Medicaid Services (CMS).  Officials from Baltimore met wth New England physicians and then conducted their nationwide open door conference call from the MMS office.  Much of the discussion focused on the status of Part B Medicare billing in the face of the Congressional action reported last week that may delay further the proposed 4.4% reduction in Medicare payment rates.

     CMC clarified that until further direction comes from Congress, carriers have been instructed to use the 2002 rates only for claims processed by March lst.  Claims for services provided in January or February but not processed before March 1 will be paid at the 2003 reduced rates.  Obviously, physicians should bill for these services as soon as possible so that the bulk of your work for these two months can be paid at the existing higher rate.  While we certainly hope that Congress will delay the cut until Sept. 30th through the vehicle of the conference reconciliation to take place shortly,  it would be prudent to bill under the 2002 rates in case Congress fails to act.  While we had hoped that all services provided prior to March lst would be paid at the 2002 rates,  CMS had decided differently  and announced that only claims processed by March 1st will be paid at the higher rate.

      CMS also has extended until Feb. 28th the deadline for physicians to make Medicare participation changes.  Participation agreements, however, will be effective Jan. 1 and physicians must bill in accordance with their decision once it is submitted to the carrier.  Until a participation decision is available, carriers will use the physician's 2002 participation status to process 2003 claims. 

     Claims for services with new codes in 2003 will be suspended by carriers until March, but CMS has instructed carriers to pay interest on clean claims that are suspended due to a new code. [return to top]

Health Care System and Health Security Board Releases Preliminary Report on Single-payor System
     Last week, the Health Care System and Health Security Board released to the public and the Legislature its much anticipated Preliminary Report on the feasibility and cost of implementing a single-payer health care system in Maine.  Such a system would be intended to provide universal health care coverage to every Maine resident through a standard benefit plan administered and paid for by a single payer, the State of Maine.

     In its Executive Summary of the Report, the Board concludes that additional time is needed to consider the feasibility study conducted by Mathematica and to develop final recommendations to the Legislature.  However, the Board did make the following preliminary findings and recommendations:

                THE HEALTH SECURITY BOARD SUPPORTS UNIVERSAL COVERAGE FOR ALL MAINE CITIZENS ---EVERY MAN, WOMAN AND CHILD LIVING IN THIS STATE DESERVES COMPREHENSIVE HEALTH CARE COVERAGE.

                THE HEALTH SECURITY BOARD FINDS THAT MAINTAINING THE 'STATUS QUO' FOR MAINE'S HEALTH CARE SYSTEM CANNOT BE SUSTAINED.

              WHILE ADDITIONAL INFORMATION AND FURTHER ANALYSIS IS NEEDED, THE HEALTH SECURITY BOARD FINDS THAT A SINGLE-PAYER HEALTH CARE SYSTEM PROVIDING UNIVERSAL COVERAGE APPEARS TO BE FINANCIALLY FEASIBLE.

             THE HEALTH SECURITY BOARD RECOMMENDS THAT THE LEGISLATURE AUTHORIZE THE BOARD TO CONTINUE ITS WORK UNTIL JANUARY 1, 2004 TO REFINE AND EXTEND THE FINANCIAL FEASIBILTY STUDY AND TO DEVELOP A TRANSTION AND IMPLEMENTATION PLAN FOR ACHIEVING UNIVERSAL COVERAGE THROUGH A SINGLE-PAYER HEALTH CARE SYSTEM IN MAINE.

     The Legislature this week will conduct a public hearing on a bill to extend the life of the Board for an additional year.  Governor Baldacci has continually expressed his opposition to expanding coverage based upon the model of a single-payer system.

       Reacting to release of the report, the Maine Association of Health Plans predictably expressed doubts about the validity of the study and made available to the public an analysis it had commisioned by Milliman USA.  In short, the Milliman USA analysis finds fault with the Mathematica study.

        MMA is working on its own plan for universal coverage through its ad hoc Committee on Health System Reform  chaired by Maroulla Gleaton, M.D. of Augusta.

         MMA members wishing to receive either report may contact the office at 622-3374 or via email to gsmith@mainemed.com.

 

  [return to top]

Licensing Fees Still Major Issue
As noted last week, the Governor's proposal to use some dedicated license  fee revenue from regulatory boards to help bridge the $44 million gap in the existing year budget is currently before the Appropriations Committee.  Unfortunately, on Jan. 30th the Business, Research & Economic Development Committee recommended that the Appropriations Committee accept the proposed diversion of dedicated revenue, including $57,589 from the Board of Licensure in Medicine, to the General Fund.  However, other Committees have recommended finding the revenue elsewhere.

      It is not too late to communicate your opposition to this theft of your license fees.  For Senators call 1-800-423-6900;  for House members 1-800-423-2900.

       Talking points are as follows:

                           l.  This use of dedicated funds will result in increases in your licensing fees sooner than the board otherwise would have planned.

                             2.   'Dedicated revene' is an assessment paid by a regulated community for the sole purpose of funding the regulatory agency.

                              3.   Transferring dedicated revenue to the General Fund amounts to an inequitable, hidden tax on the regulated community.

                               4.   The amount may seem small, but such a transfer would be an extrememly bad precedent. [return to top]

MMA Committees to Meet With Anthem Officials
    Representatives from the Association's Executive Committee and Payor Liaison Committee will meet with officials of Anthem Inc. on Thursday eveing, Feb. 13th.  While a final agenda has not been nailed down, Anthem officials apparently wish to discuss the Association's participation in the class action suits pending against the various health plans, including Anthem.  Attending from Anthem will be Samuel Nusbaum, M.D., Corporate Medical Director from Indianapolis, Marjorie Dore, head of Anthem East, from Connecticut and Karen Bell, M.D., Medical Director for Anthem Blue Cross Blue Shield of Maine.

      If your practice has payor issues with Anthem that you would like to have considered, please communicate through e-mail or otherwise to gsmith@mainemed.com. [return to top]

Tri-State Region Tops Medicare Quality Rankings, Again!
Maine, New Hampshire and Vermont have, once again, retained their top three rankings in the quality of care provided to Medicare patients.  New Hampshire ranked first, Vermont second and Mane third of the fifty states.

 The study, published in the Journal of the American Medical Association, updates a Medicare report on patients treated in l998-1999.  The new study is based upon data drawn from years 2000 and 2001.

 The study ranked states on 20 of 22 quality indicators involving services provided to Medicare beneficiaries suffering from heart attacks, heart failure, stroke, pneumonia, breast cancer and diabetes.  It also reviewed the timeframes for administering certain medications, immunizations and screening tests.

It is instructive to note that Maine physicians provided high quality despite some of the lowest Medicare fees in the nation.  In l998, Maine received $3,818 per Medicare beneficiary while the national average was $5,465.  This ranked Maine in the bottom five states in terms of average Medicare spending per beneficiary.  This ranking is based upon both low utilization and low reimbursement.  The MMA is currently an active participant in the Medicare Geographic Equity Coalition which advocates for a uniform Medicare fee schedule.  Nineteen state medical societies currently particpate in the Coalition, along with the American Academy of Family Physicians. [return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association