September 22, 2003

 
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Revised Timeline for Implementation of Dirigo Health
On Sept. 3rd, the Insurance and Finanacial Services Committee of the Legislature held the first of its interim meetings and received information concerning the implementation of Dirigo Health, which took effect on Sept. 13th, 2003.
The Office of Policy and Legal Analysis prepared a revised timeline for implementaiton of  Dirigo Health and Trish Riley and Ellen Schneiter of the Governor's Office of Health Policy and Finance provided committee members with a brief update on the status of the implementation.  They informed the committee that more than 250 nominations had been received for the 53 appointments to be made by the Governor, including appointments to the Dirigo Health Board, the Maine Quality Forum Advisory Council, the Advisory Council on Health Systems Development, and the Commission to Study Maine's Hospitals.  Appointments are expected to be announced shortly (the five public appointments to the Board have been announced). 

Other aspects of the implementation to date include:

      1.  Development, with volunteer assistance from a managment consultant, of a draft business plan and job description for the Executive Director position for the Dirigo Health Board.

       2.  Consultation with a disease management expect to discuss how Dirigo Health can manage enrollees with high-risk conditions;

        3.  Establishment, by Executive Order, of the Public Purchasers Steering Group.  The Steering Group is expected to make an inventory of health care and related expenditures by public purchasers and develop an overall purchasing strategy.  One priorty is an examination of the feasibility of a group purchasing pharmacy program.

          4.  Transmission of a letter from the governor to Maine's hospitals, reviewing the expectations for the voluntary budget targets established n the Dirigo Health legislation;

           5.  Negotiation with the Muskie School (at USM) to conduct the review of MaineCare reimbursement rates; and,

            6.  Meeting with national policy experts to critique the Dirigo Health legislation, assist in developing a work plan and identify barriers to successful implementation.

          The Insurance and Financial Services Committee of the Legislature is scheduled to meet again on Oct. 1, Nov. 5 and Dec. 3, 2003. 

             Once the Board members are confirmed by the Legislature, the Board will begin the task of hiring an Executive Director and other staff.  The Board, by July 1, 2004, must develop the benefit package, eligibility requirements, mechanisms for subsidies; and other specifications for Dirigo Health insurance.  The Board would then initiate and complete the request-for-proposal process for carriers to offer the Dirigo Health insurance product.  Individuals could begin to enroll in the period between July 1, 2004 and Oct. 1, 2004.  By the end of 2004, the Board must begin quarterly reports to the Governor and the Legislature concerning operation and enrollment in Dirigo Health.

                MMA members may obtain the entire implementation timeline from the MMA office by calling Cheryl Smith at 622-3374 or through e-mail to csmith@mainemed.com.

 

The AMA's Top 12 Fictions & Facts About Medical Liability Reform: #5
FICTION #5:  Plaintiffs' lawyers play a positive role in the civil justice system by advancing the cause of injured plaintiffs.

FACT:  Typically, personal injury lawyers take 40% or so of any amounts awarded to their clients, plus litigation costs.  This provides an incentive for lawyers to represent only those plaintiffs with claims that are likely to produce high awards or settlements.  In addition, these attorneys often aggressively seek out and manipulate individuals who have suffered from a medical problem by asserting that negligent treatment was involved, even when there is no basis for that assumption.  This has led to a proliferation of meritless claims.  A fair schedule for attorneys' fees is important to align lawyers' incentives with their clients.

In addition to opposing reasonable fees for plaintiffs' lawyers, the trial bar has vigorously opposed almost every other reasonable reform, including reforms to:  weed out meritless claims, prevent duplication of payment from multiple sources and allow defendants to pay future damages as they are incurred, rather than at the time of judgment. [return to top]

MMA Considers Impact of Tax Reform Referenda on State Medicaid Budget
During the next several weeks, the MMA Executive Committee will be considering whether to take a position in the tax reform debate brought about by the Maine Municipal Association's property tax relief ballot initiative (Question 1A on the November, 2003 ballot) and the competing measure proposed by the Baldacci Administration and passed by the Legislature on August 22, 2003 (Question 1B).  Physicians should become familiar with the issues in this debate because Question 1A will put tremendous pressure on the state budget in the next two state fiscal years and, accordingly, would put provider reimbursement in the state's health care and social welfare system at great risk.

You will find more information about all of the ballot questions on the November ballot at the Secretary of State's web site.

Question 1A (MMA Citizen Initiative) asks:

Do you want the State to pay 55% of the cost of public education, which includes all special education costs, for the purpose of shifting costs from the property tax to state resources?

Question 1B (Competing Measure) asks:

Do you want to lower property taxes and avoid the need for a significant increase in state taxes by phasing in a 55% state contribution to the cost of public education and by providing expanded property tax relief?

Mainers for Real and Responsible Property Tax Relief, the campaign supporting Question 1B has provided the following comparison of the two questions:

Question 1A, the MMA initiative requires:

  • The State to provide 55% of the total allocation for education or equivalent under any new funding formula;
  • The State to provide 100% of the cost of funding special education
  • $245,465,847 in new state spending in the fiscal year that begins July 1, 2004, and more than $480 million in the biennium that begins July 1, 2005.

Question 1B, the competing measure offered by the Baldacci Administration and the Legislature requires:

  • Transition to Essential Programs and Services (EPS) funding model, with the state share of education increasing according to the following schedule:  FY 05-06 (49%), FY 06-07 (50.5%), FY 07-08 (52%), FY 08-09 (53.5%), FY 09-10 (55%);
  • Special education would be a shared responsibility, with special education costs included in the cost sharing formula;
  • Doubling of the funding for the so-called Circuit Breaker Program that provides direct rebates to homeowners;
  • Restores Homestead Exemption to $7000 for all homesteads effective April 1, 2004;
  • $14,783,184 in new state spending in the fiscal year that begins July 1, 2004, and $81 million in the biennium that begins July 1, 2005.

If you have an opinion on whether the MMA should take a public position in this matter, please contact Gordon Smith, Executive Vice President, gsmith@mainemed.com; Andrew MacLean, General Counsel & Director of Governmental Affairs, amaclean@mainemed.com; or Anna Bragdon, Assistant Director of Governmental Affairs, abragdon@mainemed.com.

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Some Businesses Pushing Decrease in Workers' Comp. Conversion Factor
The Workers' Compensation Board will hold a public hearing on its annual update of its Rule Chapter 5, Medical Fees; Reimbursement Levels; Reporting Requirements this Thursday, September 25, 2003 at 9:30 a.m. at the Board's central office in the AMHI complex in Augusta. 

While the Board's proposed update of the rule is technical and poses no threat to overall reimbursement rates, some Maine businesses have been lobbying the management members of the Board to decrease the fee schedule's conversion factor.  The MMA will present testimony in opposition to this move. 

If you would like to attend the hearing, or if you have comments you would like considered as we prepare the MMA's testimony, please contact Andrew MacLean, General Counsel & Director of Governmental Affairs at amaclean@mainemed.com. [return to top]

More Medicaid Shortfall
Two separate holes in the MaineCare program are causing some angst in Augusta.  The first hole has been identified as roughly $30 million, from accounting errors going back eight years.  These errors were uncovered after the attention given DHS accounting this past summer.  PriceWaterhouseCoopers has been retained to study the State's accounting system and provide guidance going forward.  The Department said not to be surprised if more holes are uncovered in the next few months as they institute new accounting procedures.

The amount of the other hole has so far been undefined but has been caused by a number a factors.  Last year's MaineCare budget was flat funded  and had included $5 million a week to cover the existing caseload.  However, MaineCare had been spending $8-9 million a  week in the current year, as new eligibility categories were added.  When MaineCare increases outreach for one program, it also experiences a growth in others as a byproduct of the increased attention.  The MaineCare program is roughly expected to grow by 10%, which would put the hole at $50 million.   The Bureau of Behavioral and Developmental Services is also experiencing a shortfall this year.

Obviously, MMA is watching this closely and keeping in touch with members of the Appropriations Committee who will be expected to fill these holes in the next session, starting in January.  The Governor's office will likely introduce an emergency supplemental budget in January to deal with the MaineCare program's budget problems.  To date, they have not agreed to hold a special session before January to deal with this. 

It is early in the process and therefore there haven't been any specific discussions regarding how they will fill this hole.  The Governor did mention that they still have $26 million from the "Susan Collins money" from this past session.  MMA is obviously concerned about the Physician Incentive Payment, considering its history of being at times in and out of the budget.  It is currently in the budget as part of Dirigo Health.  Future increased reimbursements are also part of Dirigo but are obviously dependent on the current budget situation.  We have spent considerable time with the Administration stressing the importance of increased reimbursement and we would be disappointed if, once again, provider reimbursements are cut..  We will do what we can to avoid this situation. [return to top]

Environmental Exposures Conference
A conference titled Making the Connection: Human Health and Environmental Exposures will be held at the University of New England on Friday, October 24, 2003.  The conference is sponsored by American Lung Association of Maine, the Environmental Health Strategy Center, the Maine Bureau of Health, Physicians for Social Responsibility/Maine, and the UNE College of Osteopathic Medicine.  The MMA is a co-sponsor.  

The conference is directed toward physicians and other health care providers to increase their understanding regarding the identification and management of significant adverse environmental health effects.  Their keynote speakers are Richard Jackson, MD, MPH, Centers for Disease Control and Prevention and Sandra Steingraber, PhD, author of "Living Downstream."  The conference offers many clinical, policy and health science workshops.  Six hours of category one CME will be offered.

For more information, contact Raina Rippel, Director, PSR/Maine at 207-772-6714 or psr_maine@yahoo.com. [return to top]

Only 16 Working Days until HIPAA Compliance Deadline; Can "Train Wreck" be Averted?
Only 16 more workdays (assuming your medical practice is open for work on Columbus Day) before Oct. 16, 2003, the deadline to comply with the HIPAA Electronic Transactions and Code Sets Standard.  In Maine, the MaineCare program (formerly Medicaid) has announced that it will not be ready to receive HIPAA compliant claims by Oct. 16th and the electronically transmitted claims should continue to be sent in the current format until sometime in the new year. 

Medicare officials (CMS) will decide by Sept. 25th whether to deploy its contingency plan to continue to accept noncompliant Medicare transactions after Oct. 16th.  It is widely speculated that the contingency plan will be launched, however, as CMS officials have disclosed that currently less than 11 percent of electronic transactions to the Medicare program are compliant with the new standards.

Among the problems covered entities have unearthed during the testing phase of their systems is that ther submissions are missing data elements.  The system rejects transactions that do not include all the elements required under the transaction and code set rules.  In an "Answers to Frequently Asked Questions" document posted on its Web site Sept. 8th, CMS outlined its contingency plan for the Medicare program aimed at trading partners who are not complaint by the Oct. 16 deadline.  The Frequently Asked Questions are available by searching the CMS Web site at http://www.cms.hhs.gov/hipaa/hipaa2/.

In another Frequently Asked Question, CMS reiterated that is Office of HIPAA Standards is responsible for enforcing the Transacton and Code Sets rule.  "When OHS receives a complaint about a covered entity, it would ask the entity to demonstrate their reasonable and diligent efforts to become compliant and, in the case of health plans, to facilitate the compliance of their trading partners," the FAQ said. "Strong emphasis will be placed on sustained actions and demonstrable progress in determining a covered entity's good faith effort.."

Some observers are predicting a HIPAA "train wreck" on and after Oct. 16th as many covered entities - providers, payers, and clearinghouses - will not be ready for the deadline.  This may result in the processing of millions of paper claims thus slowing up the payment process and causing severe cash flow problems.  If your practice is in this situation, you may wish to make sure that you have an adequate supply of paper forms.  [return to top]

MMA Offers Fall Seminars to Medical Staffs, Specialty Societies
MMA staff has developed a series of seminars that can be available to medical staffs, CME programs and specialty society programs this Fall.  Faculty consists of Andrew MacLean, the Association's Gneneral Counsel and Gordon Smith, Esq., the Association's Executive VIce President.  The seminars, which can be delivered in a one-hour segment, are as follows:

1)  Legislative Update from the First Regular Session, 121st Maine Legislature.  This program highlights the new laws, including the Dirigo Health Legislation, which impact upon the practice of medicine.

2)  Dirigo Health;  The Good, the Bad and the Ugly.  This program goes into more depth concerning the provisions of Dirigo Health.  The 73 page law is the text book for the class.

3)  Legal and Regulatory Issues Impacting the Treatment of Pain.  This seminar brings attendees up-to-date on the major regulatory and legal issues impacting the treatment of pain and offers recommendations on how to effectively treat pain while also preventing the illegal diversion of prescription drugs.

4)  HIPAA; the Continuing Saga.  Now that the privacy rule is in effect and the transacton and code set rule is about to go into effect, medical practices can begin to examine the practical implications of this federal law which has taken on a life of its own.

These seminars are available for category one CME through the Maine Medical Education Trust.  A fee is charged ranging from $300 to $500 depending upon length of presentation and location.  Any group or institution interested in one of these programs should contact Gordon Smith at 622-3374 or through e-mail at gsmith@,mainemed.com.

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Maine Medical Association to Recognize 150th Anniversary at Nov. 8th Gala
On  Saturday evening, Nov. 8th, 2003, the Maine Medical Association will recognize and celebrate its 150th Anniversary with a Gala event in Portland.  Beginning wqith a cocktail reception at the Portland Museum of Art at 6:00pm, the evening promises to be a memorable one.  Following the reception, dinner and a brief program will be held at the Holiday Inn by the Bay.  Dancing to the popular Tony Boffa band follows dinner.

Special guests include AMA President Donald Palmisano, M.D., J.D.  Governor John Baldacci and Maine's Congressional Delegation have also been invited to attend.  A special video-documentary of the history of medicine in Maine has been prepared to be debuted at the Gala.

All MMA members will receive an invitation to the event in the next two weeks.  All proceeds from the event will benefit the Maine Medical Education Trust.  TIckets are $100 each or $150 per couple.  The attire is black tie optional.  Questions about the event can be directed to Susan Feener at MMA (622-3374 or sfeener@mainemed.com). [return to top]

Medicare Conferees Close to Resolving Electronic Prescribing Issue -- Grassroots Action Needed
Medicare conferees have been hard at work in recent weeks and are close to resolving at least one of the difficult issues before the committee - that being the issue of Electronic Prescribing.  The AMA and many specialty societies oppose the unfunded mandate in the House bill which would mandate electronic prescribing by 2006.  The Senate provision does not include a mandate and would instead focus on developing standards for an e-prescribing system.  If enacted, the costly unfunded mandate would force physicians to purchase untested electronic prescribing technology in order to write prescriptions for Medicare patients.

The financial burden of such a mandate would be highest on small and rural practices.  Preliminary estimates show that the 5-year recurring cost for a 5-physician practice could exceed $140,000 for hardware, software, training and maintenance.  It would be one more in a list of unfunded government mandates on physicians, added to HIPAA and the requirement of physicians bearing the cost of providing interpreters.

Physicians should call or otherwise communicate with Representatives Allen and Michaud and Senators Snowe and Collins and indicate support for the Senate language.

In addition, the Maine delegation needs to be reminded to suuport the inclusion of the House passed-provision on the Physician Medicare Payment Update in the final Medicare bill.  This provision would provide for two years of positive payment updates rather than two years of cuts which would begin with a cut of more than 4% on Jan. 1, 2004.  The payment formula is flawed!  It must be fixed!

You may communicate with the delegation by using the AMA Grassroots Hotline (800-833-6354) or through the AMA in Washington website at www.ama-assn.org/grassroots.  You may also send a fax to Senator Snowe at 202-224-1946 and to Senator Collins at 202-224-2693. [return to top]

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