January 19, 2004

 
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Governor's MaineCare Budget Cuts Under Attack
Physicians received good news last week when the Baldacci administration announced revisions to its proposed MaineCare list of cuts, as the elimination of some services, such as gastric bypasss surgery and limits on the number of visits in rural health centers were restored. MMA and other advocacy groups had strongly opposed the cuts.
The Legislature's Appropriations Committee concluded four days of public hearings on the administrations $109 million supplemental budget on Friday and legislative leaders were predicting that significant changes would have to be forthcoming if the budget were to receive anything close to a two-thirds vote.  Most of the objections center around the $22 million proposed to be cut from MaineCare, the state's Medicaid program which now covers over 250,000 Mainers.

The Association was pleased to hear from MaineCare officials that some of the cuts the Association had opposed in connection with emergency rule-making hearings earlier this month had been restored.  Significant among these restorations were surgery for gastric-bypass and limits on the number of visits at an Rural Health Center.  In addition, proposed limits on physical therapy, occupational therapy and speech therapy have been removed, as has been the proposed discontinuation in coverage of adult dentures.

MMA will still have to be very vigilant as additional cuts are likely to be proposed to make up for those proposed cuts restored.  The budget must be balanced by July 1, which is the end of the state's fiscal year.  The Governor needs to have the Legislature enact the package on an emergency basis by the end of February in order to begin recoup the savings immediately.  Passage of the supplemental budget on an emergency basis will require a two-thirds vote to compromise will be required.

For more information on this topic, and other legislative topics as well, go to the following link which contains the MMA's weekly Political Pulse which is published each Friday during the legislative session.  If you would like to have the Political Pulse sent to you directly, contact Cheryl Smith at csmith@mainemed.com

                                 http://www.mainemed.com/members/Me-Med/index.html

Baldacci Calls DHS/DBDS Merger Essential
On Friday, Governor Baldacci received recommendations from the Advisory Council for the Reorganization and Unification of the Department of Human Services and the Department of Behavioral and Developmental Services, the council he established 10 months ago to study the concept of such a merger.

After 10 months of work, the council recommended that the merger take place, and , in fact, called the merger essential.  Since the report was released, editorial support from Maine's major newspapers has been strong, while legislative support had been more subdued.

During the 2002 gubernatorial campaign, then-candidate Baldacci had recommended the merger of the two departments, claiming that such a move would improve their performance.

Since last May, several volunteers have met regularly in six subcommittees headed up by 17 different appointed council members.  The council report consists of twenty pages of specific recommendations for improving services, streamlining administration, enhancing communications and saving money.  As usual, the state has already "booked" the proposed $5.8 million in savings associated with the merger.  This fact alone pretty much assures that the merger will happen.  On the other hand, the specifics of the merger must be approved by the legislature and several legislators last week were less than enthusiastic about the plan.  It will be subject to much scrutiny as the plan makes its way through the legislative process, particularly because of the high visibility of the two departments and also because of the difficulties the departments have had (AMHI consent decree, DHS audit etc).

Public health officials have begun to take notice of the proposal and express concern about the relatively low status accorded to public health in the planned reorganization.  What would be left of the Bureau of Health, after some functions are transferred to other departments, would report to a Deputy Commissioner for Programs.  Other Bureaus would include a Bureau of Family Independence; Children and Families, Medical Services; Adults; three regional directors and an Office of Planning, Policy and Quality Assurance.  Currently the Bureau of Health reports directly to the Commissioner, and maintains a fairly high profile.

By next week's newsletter, we should be able to link you to the full report on the proposed merger. [return to top]

Blood Donors Needed; Reminder of Criteria
Many times potential blood donors ask their physicians if they are eligible to give blood.  Recently, the Blood Services Division of the New England Region of the American Red Cross asked MMA to remind members of the current criteria for eligibility.

To be eligible, donors must:

                   *  be 17 years of age or older

                    *  Weigh 110 pounds or more

                     *  be in general good health and not have a history of hepatitis or other potentially infectious disease.

There is no upper age limit and most medications do not preclude a person from donating.  Should you have a question regarding patients' eligibility to donate, you may call Richard Benjamin, MBChB, PhD, Chief Medical Officer of the New England Region of the American Red Cross at 1-800-462-9400 ext. 2222 or e-mail him at Benjaminr@usa.redcross.org

This year alone, Maine patients will require 50,000 units of red cells.  Members of the public are encouraged to call 1-800-GIVE-LIFE to obtain further information about donating blood, or to schedule an appointment to donate blood.

As of January 28, 2004, all people who come to donate blood at an American Red Cross location will be required to present positive identification before they can donate.  Volunteer donors can use a government-issued picture identification, like a driver's license, or an American Red Cross donor card to positively identify themselves.  If the donor does not have either one of those identifications, then he/she must present two other means of acceptable identification. [return to top]

Expanded Definition of Acupuncture Passed by Legislative Committee
L.D. 263, An Act to Expand the Scope of Practice of Acupuncture, was the subject of a work session last Thursday by the Legislature's Committee on Business, Research and Economic Development.  The legislation, which would include within the definition of acupuncture several additional techniques and modalities associated with eastern medicine, has been strongly opposed by MMA.  The bill had been the subject of a "sunrise" report by the Department of Professional and Financial Regulation, which is required of any group of licensees attempting to expand their scope of practice.

At the work session, the Commissioner of the Department, Robert Murray, presented the sunrise review report which recommended that the bill be defeated as not being required to protect public safety.  In a surprise move, the acupuncturists then changed their strategy and argued for the first time before the committee that the bill was needed in order to have malpractice insurance cover the additional modalities they were practicing.  Despite not having heard this argument before, a majority of  committee voted to pass the bill.

While the majority report was "ought to pass as amended,"  two minority reports were also filed.  One includes language submitted by the Maine Chiropractic Association that would require acupuncturists who practice the additional modalities to be certified, under a certification process to be determined by the licensing Board.

The final language of the amendments will come back before the committee sometime during the next week, or perhaps later.  MMA will continue to strenuously express its objection to the bill as it continues to move through the system.

The additional modalities in the definition include oriental diagnostic procedures, electrical and magnetic stimulation, moxibustion and other forms of heat therapy; sound, light and vibrational therapy; cupping techniques and qua sha; Chinese herbology and lifestyle and dietary counseling; sotai; shiatsu; qi gong; zero-balancing; tui na; and acupressure.  Much of the MMA's objection to the bill has been based upon the fact that while these designated techniques may all be in the same family of eastern  medicine, they are most assuredly NOT acupuncture.

The members of the Committee considering this ill-advised measure are listed below.  Be advised that Senator Shorey of Calais, and Representatives Austin and Berube opposed the bill, thus supporting MMA's position.  All the remaining members of the committee supported one version of the bill or the other, both of which are strongly objectionable.

Senators

  • Lynn Bromley (D-Cumberland), Chair  
  • Christopher Hall (D-Lincoln)
  • Kevin Shorey (R-Washington)

Representatives: 

  • Nancy Sullivan (D-Biddeford), Chair
  • Lillian LaFontaine O'Brien (D-Lewiston)
  • Guy Duprey  (D-Medway)
  • Edward Pellon (D-Machias)
  • Nancy Smith (D-Monmouth)
  • Susan Austin (R-Gray)
  • Robert Berube (R-Lisbon)
  • Lawrence Jacobsen (R-Waterboro)
  • Christopher Rector (R-Thomaston)
  • William T. Rogers, Jr. (R-Brewer)

Sen. Bromley is the sponsor of the bill.  During the session, House members can be reached at 287-1400 or 1-800-423-2900.  Senators may be reached at 287-1540 or 1-800-423-6900. [return to top]

Asthma Supplies for MaineCare Members
Over the past few months, some MaineCare members have experienced difficulty finding a provider to supply asthma medication spacers and peak flow meters.  These items continue to be MaineCare covered services.  Previously, these devices were primarily provided to MaineCare members via pharmacies that also supplied durable medical equipment (DME).

Several pharmacy providers, including some major commercial pharmacy chains, have recently chosen to no longer provide services to MaineCare members as DME providers.  Under the rules existing when these providers dropped out, only DME providers could be reimbursed for asthma supplies.  Therefore, there were only a limited number of providers who were left supplying asthma supplies to MaineCare members.

In response to this situation, the Bureau of Medical Services proposed emergency rules that allow pharmacies to receive reimbursement for asthma supplies, even if the pharmacy is not a DME provider.  These rules became effective on 1/1/04.  The list of covered asthma supplies is available at http://www.ghsinc.com/ghs.com/genpharmfiles.jsp. [return to top]

Governor's Task Force on Veterans Health Holds Second Meeting
The Governor's Task Force on Veterans'  Health, established in the Dirigo Health legislation, held its second meeting at Camp Keyes in Augusta on Friday, January 9th.  The Task Force will meet at the same time and place the second Friday of each month (10:00am to noon.)  The meetings are open to the public.

Jack Sims, Director of the VAMC and ROC Togus, attended and shared an explanation on eligibility for VA services.

There was further discussion at the Task Force of the issue of duplicate work ups of patients by the VA physicians in order to fill prescriptions at the VA pharmacy.  Mr. Sims noted that the VA had suddenly been overwhelmed by demands for access to low co-pay VA medications so that eligibility was tightened.  Other problems leading to the duplication include VA requirements that every veteran eligible for VA scripts have a VA physician and VA physicians had objected to simply authorizing the filling of the script without examining the patient.  An additional concern is the increase in the VA budget, despite the hefty drug discounts that the VA negotiates.  Finally, there is also concern by the VA because the reimbursement of VA facilities is based upon the number of individual social security numbers served. There is a belief that simply opening pharmacy benefits to every eligible veteran might cause an overall drop in the case load, thus reducing funding.

The question then is, by what means access to VA medications could be achieved without running afoul of VA regs and funding concerns?  The option of more fee for service coverage by primary care physicians was considered, as was the possibility of private physicians being credentialed at VAMC Togus.

A sub-group was named to determine how many physicians are seeing veterans eligible for VA pharmacy benefits, who don't want care transferred to Togus and what the number of such veterans is.  Susan Shaw, D.O., Lawrence Mutty, M.D. and Arthur Newkirk, M.D.  were asked to serve on the sub-group.

The Task Force also considered the risk to veterans of the widely prevalent SPAM offering drugs through the internet.  It was suggested that the Attorney General's office be advised of the group's interest in this issue.  This item will be included on the agenda for the February meeting.  (Thanks to Dr. Lawrence Mutty for assisting with this article) [return to top]

CMS Extends Medicare Participation Enrollment
Due to changes that occurred so late in the year, the Centers for Medicare & Medicaid Services (CMS) is extending the Medicare participation enrollment period for 2004.  The participation enrollment period is continuing beyond December 31, 2003, because the Medicare carriers will accept enrollment forms that are postmarked as late as February 17, 2004.  Thus, the complete enrollment period runs from November 14, 2003, through Feb. 17, 2004.  Although the enrollment period runs until Feb. 17, 2004, the effective date of the agreement will be January 1, 2004, and Medicare will be ready to process your claims.  If a physician changes his/her participation status by submitting a form after Dec. 31, 2003, the physician should begin submitting claims in accordance with the participation decision conveyed as soon as the form is submitted.

Enrollments and withdrawals for 2004 that are received after Dec. 31, 2003, will be recorded in the carrier's system as soon as possible after receipt.  Until the agreement form is received and recorded in the carrier's system, the 2004 claims filed will be processed using the physician's 2003 participation status.  Such claims will not be reopened or reprocessed once the form and participation status are recorded unless the physician specifically notifies the carrier to do so. [return to top]

Senator Snowe Appointed to Republican Panel Working on Coverage for Uninsureds
Senate Majority Leader William Frist, M.D. has appointed a panel of 10 Republican senators to work on proposals to extend coverage to the nation's 43.6 million uninsured residents. The panel is headed by Sen. Judd Gregg (R-NH) and also includes Sens. Don Nickles (R-OK), Olympia Snowe and Jim Talent (R-MO). The group is considering a multifaceted approach to help different segments of the population.  Members of Congress and the Administration have discussed proposals that would provide tax credits to individuals and families to help them buy insurance, expand eligibility for existing health programs and allow small business to band together to create association health plans.

It is expected that legislation to address the uninsured issue, taking into account the recommendations of the Bush Administration, will be introduced in the Senate as a result of the task force proceedings. [return to top]

Maine Medical Group Management Association sponsors 3rd Party Payor Seminars
Maine Medical Group Management Association is sponsoring two Third Party Payor Seminars. Representatives from Cigna, Aetna, Harvard, Anthem, Medicare, Maine Care/Medicaid, Medical Network and the Maine Network for Health will be providing updates and speaking to participants.

Tuesday, 2/10/04, Keeley's Banquet Center, 178 Warren Avenue, Portland, Maine

Wednesday, 2/11/04, Jeff's Catering, 5 Coffin Avenue, Brewer, Maine

The hours are 9:00 a.m. until 4:00 p.m. at both locations. Lunch will be provided. For further information, please contact Peter Allen at 1-800-640-0545 or Karen Gurney at 207-743-8766. [return to top]

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