November 17, 2003

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Medicare Drug Benefit Conferees Reach Agreement on Plan Outline
Contact Maine's delegation this week to urge them to vote for the bill - - another temporary Medicare reimbursement "fix" depends on passage of this bill!
Late last week, the House and Senate conferees who have been seeking compromise on a bill to establish a prescription drug benefit in the Medicare program and to address a variety of provider reimbursement issues, reached an agreement in concept.  The actual language of the bill likely will not be available until late Wednesday and votes in the House and Senate probably will take place late in the week or over the weekend.

The AMA has endorsed the compromise and plans an ad campaign this week in the Washington, D.C. area urging members to vote for the bill.  AARP also has formally endorsed the bill.

MOST IMPORTANTLY FOR PHYSICIANS, the bill blocks proposed cuts in Medicare reimbursement for 2004 and 2005 of 4.5% and replaces them with a 1.5% increase.  Once again, the structural problems with the sustainable growth rate (SGR) are deferred.  Also, the bill adds a point on the work geographic payment adjuster (GPCI) from 2004 through 2006 and includes physician scarcity bonus payments from 2005 through 2007.

The so-called "premium support" aspect of the bill (competition between private plans and traditional Medicare) remains the most contentious issue.  31 Democratic Senators and 7 Republican Senators have signed a letter seeking elimination of the premium support provisions in the bill.  The 7 Republicans include both Senators Snowe and Collins as well as Senators McCain (AZ), Specter (PA), Campbell (CO), Allard (CO), and Chafee (RI). 

Click here to view a Summary of Medicare Conference Agreement prepared by the Hill staff.  Click here to view G.O.P. Begins Push for Medicare Bill from today's New York Times.

TIME IS CRITICAL - - NO TIME FOR LETTERS!  Call or email Maine's delegation today!

Senator Olympia J. Snowe, 202-224-5344,

Senator Susan M. Collins, 202-224-2523,

Representative Tom Allen, 202-225-6116,

Representative Mike Michaud, 202-225-6306,

Or, call the member's local office number listed in your phone book. 

Insurance Superintendent Hears Public Comment on Rule Ch. 850 Changes
This morning Insurance Superintendent Alessandro Iuppa received public testimony on draft amendments to Bureau Rule Chapter 850, Health Plan Accountability.  Rule Chapter 850 is a significant component of Maine's Patient Bill of Rights and addresses health plans' network adequacy, including geographic access requirements, utilization review, and grievance procedures. 

The proposed changes are the result of legislative action during the last session.  The first proposed amendment would bring the rule into compliance with L.D. 423, the "timely credentialing" bill passed following negotiations among the MMA, the Maine Hospital Association, and the Maine Association of Health Plans.  The second, and more substantial, proposed amendment would bring the rule into compliance with the Dirigo Health Plan bill's (L.D. 1611) provision enabling the Superintendent to permit health plans to provide financial incentives, within certain limits, for members to use high quality/lower cost providers beyond the geographic access standards in the rule. 

Providing comments today were the Maine Health Care Purchasing Collaborative, the Maine Hospital Association, the MMA, and Consumers for Affordable Health Care.  The Superintendent will hold a second public hearing this Wednesday, November 19th, at 7 p.m. in Room A at the Skowhegan Community Center, 39 Poulin Drive, Skowhegan.

Click here to view the proposed amendments to Bureau of Insurance Rule Chapter 850, Health Plan Accountability.  Please provide any comments you may have to Andrew MacLean, MMA General Counsel, at  Or, you may submit written comments to the Bureau of Insurance until 5 p.m. on December 5, 2003, attention:  Jennifer Rice, 34 State House Station, Augusta, Maine 04333-0034. [return to top]

Legislative Committee Meets Tomorrow Evening
Legislative Committee Chair Katherine Pope, M.D. has called the final committee meeting of the year for 6 p.m., Tuesday, November 18, 2003 at the MMA office.  The Committee will discuss 2 key new bills to be considered this session on psychologist prescribing and disposal of pharmaceuticals, bills of interest carried over from the first session, the Rule Chapter 850 amendments (see related article), and the conference call/meeting schedule for 2004.  A planned discussion of emergency contraception legislation will be deferred to the next committee meeting in January 2004.

Any member who is interested in the legislative advocacy activities of the MMA is welcome to attend.  Please contact Charyl Smith, Legislative Assistant, at if you would like to participate. [return to top]

Encourage Your Patients to Join the Great American Smokeout Thursday!
This Thursday, November 20th is the 2003 Great American Smokeout sponsored by the American Cancer Society.  The Great American Smokeout started in the 1970s to challenge people to stop using tobacco and to raise awareness in the community about the dangers of tobacco.  This is a great opportunity to encourage your patients who smoke to quit!

Click here for more information about the Great American Smokeout. [return to top]

New GAO Report on Physician Supply Shows 26% Increase 1991-2001
The report is entitled, Physician Workforce:  Physician Supply Increased in Metropolitan and Nonmetropolitan Areas but Geographic Disparities Persisted (GAO-04-124) and may be found at  Click on "GAO Reports" and then click on "Today's Reports" and "November 3, 2003."

Key findings include:

  • Although nonmetropolitan areas experienced higher proportional growth in physicians, metropolitan areas still had more than twice as many doctors per 100,000 people as nonmetropolitan areas in 2001;
  • Increase in physicians per 100,000 in metropolitan areas during the decade:  242 to 267;
  • Increase in physicians per 100,000 in nonmetropolitan areas during the decade:  99 to 122;
  • Increase in average number of physicians per 100,000:  214 to 239;
  • Mix of generalists and specialists remained approximately 1/3 generalists, 2/3 specialists;
  • During the decade all statewide nonmetropolitan areas and 301 of 318 metropolitan areas gained physicians per 100,000.
[return to top]

Baldacci Administration Exploring Access to Canadian Drugs
Following in the footsteps of the City of Springfield, MA and the State of Illinois, among others, the Governor's Office of Health Policy & Finance is preparing a report for the Legislature's Health & Human Services Committee on the "feasibility of drug importation" from Canada according to yesterday's Maine Sunday Telegram.  Trish Riley expects to deliver the report to the Legislature before the end of the year.

The U.S. Food & Drug Administration (FDA) continues to cite safety concerns in opposing such efforts.  On November 6th, the FDA sent a warning letter to CanaRX Services, Inc., the company that dispenses Canadian drugs to the City of Springfield, that its activities are illegal and put public health at risk.  The warning letter is available at

Also on November 6th, a federal judge in Oklahoma granted a preliminary injunction ordering Rx Depot, Inc. to close its 15 nationwide outlets immediately.  The company is based in Tulsa and helps U.S. residents to purchase cheaper prescription drugs from Canada.  The FDA issued a statement praising the decision while the company says it will appeal. [return to top]

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