March 22, 2004

 
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SFY 05 Supplemental Budget Hearing Draws More Than 1000 Speakers
Members of the Appropriations and H&HS Committees heard emotional testimony from many people who would be affected by MaineCare cuts. In recommendations to the Appropriations Committee Friday, the H&HS Committee unanimously opposed cuts in hospital-based physician practice reimbursement, radical changes to the Medical Eye Care Program, and the elimination of 15 services in the "MaineCare Basic" benefit re-design. The Committee voted 7-5 with Democrats in favor of and Republicans opposed to expanding the hospital "tax & match" concept included in the SFY 04 supplemental budget.
Work on Governor Baldacci's FY 05 supplemental budget was the focus of much attention at the State House this week.  So many people turned out for the public hearing at the Augusta Civic Center on Monday that members of the Appropriations and H&HS Committees split into two groups to take testimony and the hearings still lasted from 9 a.m. until about 6:30 p.m.  On Tuesday, Wednesday, and Thursday afternoons, the H&HS Committee labored over the Governor's attempt to save about $80 million in the MaineCare budget.

In its final report back to the Appropriations Committee, the H&HS Committee recommended against a substantial portion of the Governor's proposed savings. The following are some highlights from the H&HS Committee report.

  • $6 M in new revenue from expanded hospital "tax & match:"  7-5 vote in support (Democratic majority)
  • $900,000 in savings from reducing reimbursement for hospital-based physician practices:  unanimous opposition
  • $6.25 M in new savings in the MaineCare drug budget:  10-2 vote in support with language "to protect consumers"
  •  $3 M in savings from instituting a strict formulary for the Low Cost Drugs for the Elderly & Disabled Program:  unanimous opposition
  • $203,000 in savings from major revisions to the Medical Eye Care Program:  unanimous opposition
  • $5.8 M in savings from cuts in nursing facility reimbursement:  unanimous opposition
  • $23 M in savings from "MaineCare Basic" benefit re-design:  unanimous opposition to most of the services proposed for elimination; directed DHS to use managed care tools to achieve savings to be determined by the Governor's Office of Health Policy & Finance
  • The Committee recommended against most of the proposed DBDS cuts

The Legislature's leaders were scheduled to be in budget negotiations over the weekend and the Appropriations Committee will begin work sessions on the budget this week.  The Appropriations Committee likely will not accept many of the H&HS Committee recommendations so if you have an opinion on any of the Governor's proposals, contact Appropriations Committee members this week.

Appropriations and Financial Affairs

 

     Senate:   Mary R. Cathcart, Chair (D-Penobscot)

                                            (H)  866-3054

                                             maryorono@aol.com

 

                      Margaret Rotundo (D-Androscoggin)

                                            (H)  784-3259

                                            mrotundo@bates.edu

 

                      Karl W. Turner (R-Cumberland)

                                            (H)  829-9231

                                            KwTurner@yahoo.com

 

      House:   Joseph C. Brannigan, Chair (D-Portland)

                                            (H)  772-6047

                                             joebrannigan@aol.com

 

                      Richard H. Mailhot (D-Lewiston)

                                            (H)  783-0841

                                            Rilmail@exploremaine.com

 

                      Scott W. Cowger (D-Hallowell)

                                            (H)  622-0655

                                            RepScott.Cowger@legislature.maine.gov

 

                      Benjamin F. Dudley (D-Portland)

                                            (H)  774-3623

                                            benfdudley@hotmail.com

 

                      Sean Faircloth (D-Bangor)

                                            (H)  941-8339

                               

                      Hannah Pingree (D-North Haven)

                                            (H)  867-0966

                                            Hannah@pingree.com

 

                      Richard W. Rosen (R-Bucksport)*

                                            (H)  469-3779

                                            rrosen113@aol.com

 

                      S. Peter Mills (R-Cornville)

                                            (H)  474-3821

                                            pmills@mainelegal.net

 

                      H. Sawin Millett, Jr. (R-Waterford)

                                            (H)  583-4842

                                            RepSawin.Millet@legislature.maine.gov

                                            hsawinmillet@midmaine.net

 

                      Julie Ann O'Brien (R-Augusta)

                                           (H)  623-2930

                                           mobrien41@aol.com

Read the MMA's Budget Testimony

TESTIMONY OF THE MAINE MEDICAL ASS0CIATION

 

SUPPORTING IN PART & OPPOSING IN PART

 

L.D. 1919, GOVERNOR BALDACCI’S SFY 2005 SUPPLEMENTAL BUDGET

 

Joint Standing Committee on Appropriations & Financial Affairs

Joint Standing Committee on Health & Human Services

Augusta Civic Center

Monday, March 15, 2004

 

            Good morning Senators Cathcart and Brennan, Representatives Brannigan and Kane, and Members of the Appropriations and H&HS Committees.  My name is Lawrence B. Mutty, M.D. and I am the President-elect of the Maine Medical Association (MMA), a professional organization representing more than 2600 Maine physicians.

            Thank you for the opportunity to share the views of the MMA on the latest supplemental budget.  Also, I am presenting testimony on some aspects of the proposal on behalf of the Maine Psychiatric Association.

Maine physicians realize that the Governor and his staff faced a difficult challenge in assembling a balanced budget.  With the presentation of L.D. 1919 to you, the challenge is now yours.  In good financial times, the Legislature has, with the support of the MMA, expanded eligibility for the MaineCare program and for related health care, mental health and mental retardation, and substance abuse services in a strategy of incremental health care reform.  Given the 2-to-1 federal match in the Medicaid program, this has been a rational strategy. 

            The last half dozen or more budgets have, however, preserved eligibility while cutting provider reimbursement and the benefits available to the public under these programs.  During the debate on each of the recent budgets, the MMA has expressed concern about the impact of continued cuts in our health care, MH/MR, and substance abuse services on patients and on the practitioners and facilities who serve them.  Our concern grows more acute with each budget that attempts to balance the MaineCare budget solely by adjusting the MaineCare budget.  Today, we cannot warn you strongly enough that you cannot run the programs Maine has built during the last 5 years while cutting reimbursement and benefits without harming patients and threatening the financial viability of some providers.

            Governor Baldacci and the Legislature’s leadership have asked for public feedback about alternatives to the proposed cuts in L.D. 1919.  One alternative is obvious - - the MMA and other public health advocates argued during the SFY 2004 supplemental budget that you should consider raising the cigarette tax by $1 to $2 per pack.  Not only will this generate somewhere between $50 and $70 million in new revenue, it will have the greatest impact on consumption of any single tobacco policy decision you may make.  In the course of one short year, Maine has moved from having the second highest cigarette tax in New England to the second lowest.  This certainly is a more rational policy decision than the “tax and match” approach affecting Maine’s nursing homes and hospitals.  I have attached a fact sheet on the cigarette excise tax prepared by the Maine Coalition on Smoking OR Health.

            The MMA has the following specific comments about portions of L.D. 1919.

 

1.            MaineCare Basic.            The MMA objects to the elimination of coverage for the 15 services in the MaineCare Basic package.  The MaineCare system is certain to experience additional costs elsewhere in the system if these services are eliminated.  The Maine Psychiatric Association is particularly concerned about the proposed elimination of psychological services from the benefit package.  Appropriate mental health care depends upon the skills of both psychiatrists and psychologists being involved in the patient’s care.

 

2.            Hospital “tax and match.”  The MMA is concerned that the expansion of the hospital “tax and match” in Part HH of the budget is poor health policy that we should not come to depend upon.

 

3.            Paying hospital based physician practices on the same basis as independent physician practices.  The MMA opposes this $900,000 (General Fund) cut in physician reimbursement.  The MMA supports the principle that physicians performing the same medical services should be reimbursed the same, regardless of setting.  But, the State should accomplish this by bringing reimbursement for physicians in private practice up to reflect their practice costs as is the case for hospital based practices, federally-qualified health centers, and others.  As members of both committees know very well, the MaineCare program’s reimbursement rates for individual practitioners are among the worst in the country - - 44th according to one recent study (Comparing Physician and Dentist Fees Among Medicaid Programs, Medi-Cal Policy Institute, June 2001).  I have attached, for your information, a comparison of 2002 MaineCare, Medicare, and Anthem rates for 20 common primary care codes - - this is a document that members of the H&HS Committee will recognize from a bill earlier in the 121st Legislature.

 

4.            Stricter prior authorization criteria in the MaineCare drug management program.  The MMA acknowledges the need to save money in the MaineCare drug budget and we have worked in good faith with the Bureau of Medical Services staff and contractor to ensure that patients still are able to obtain medically necessary drugs with as little burden on physician practices as possible.  The Preferred Drug List (PDL) program, however, still imposes an overwhelming administrative burden on physician practices.  Many practices have found it necessary to devote a staff member almost full-time to processing MaineCare prior authorization requests.  Physicians are concerned that the proposal to seek an additional $6.25 million in savings through “stricter PA criteria for the PDL” will make it even more difficult for physicians to negotiate the PDL and will raise the risk of harm to patients.

 

5.            Redesign of the Medical Eye Care Program.  Section DD-2 of the budget would save $203,000 by severely restricting both the eligibility for and scope of services available under the Medical Eye Care Program.  Saving this small amount of money will threaten the eyesight of a significant number of poor elderly and other vulnerable Maine citizens.

Samuel Solish, M.D., an ophthalmologist from Falmouth who is the President of the Maine Society of Eye Physicians & Surgeons, has offered the following initial comments about this proposal.

 

By deleting "or" they make it that they have to have both a blinding disease and bilaterally severely impaired to be treated.

 

Example:

 

Pt has an eye injury in only one eye....the state will not treat! Absurd!

 

Example:

 

Patient has cataracts in both eyes. They have to wait until both eyes are worse than 20/70 to have surgery AND only one eye can be operated on! There goes any chance that they could POSSIBLY have a job which involves vision prior to meeting eligibility and forget a job that involves driving.

 

Example:

 

Glaucoma is a potentially blinding disease but central visual impairment is often a late manifestation of this disease.  Peripheral vision loss can be very severe before vision decreases to 20/70 best corrected.

 

These kind of rules keep people in poverty.

 

If I am not mistaken, I think 20/70 is used by the state division for the blind as visual impairment and qualifies for assistance from the division!  I know the Iris Network (formerly the Maine Center for the Blind and Visual Impairment) is able to assist people with 20/70 or worse.

 

6.            Authority of the Commissioner of DHS to amend the MaineCare benefit and service structure without legislative review.  The MMA strongly objects to Section DD-6 of the budget that appears to give the Commissioner of DHS broad authority to make major changes to the MaineCare program for adults without legislative approval “in order to manage the program.”  Such an amendment would eliminate the Legislature’s proper oversight role and would jeopardize the public’s opportunity to participate in the policymaking process.

 

7.            Expansion of the mental health parity law to include coverage for crisis and crisis residential services.  The MMA and Maine Psychiatric Association long have advocated for parity in health insurance coverage for mental health care services and for medical services and both organizations support this limited expansion of Maine’s mental health parity law. 

 

8.            Reporting of infants with prenatal exposure to drugs.  Part Z of the budget amends the provision of Title 22 requiring health care practitioners, among others, to report instances of suspected child abuse or neglect to DHS by including a reporting requirement if “the provider knows or has reasonable cause to suspect [the infant] has been born affected by illegal substance abuse or suffering from withdrawal symptoms resulting from prenatal drug exposure.”  The MMA is uncomfortable with the inclusion of this substantive proposal in a budget document.  Part Z suggests that the intent of the change is to ensure that the infant receives appropriate services and that the proposal does not require prosecution for illegal behavior.  Still, the MMA believes that such a significant change should be presented as a stand alone bill to the committee of jurisdiction - - probably in the next Legislature - - when the committee and all interested stakeholders can consider the merits of the proposal without the pressure of the budget process. 

 

The MMA urges you to seek alternatives to the proposed cuts to health care, MH/MR, and substance abuse services in L.D. 1919.  After several years of budget cuts in our health and social welfare system, further cuts will cause real harm to the Maine citizens who depend upon these programs and will damage the moral and effectiveness of the providers upon whom the success of these programs depend. 

Thank you and I would be happy to respond to any questions you may have. [return to top]

MMA Confirms Position on Proposed Reduction in MaineCare payments to "Provider-based" Practices
Because of incorrect information distributed last week by various interest groups involved in advocacy on the Governor's supplemental budget, MMA last week sent out clarifying information regarding the Association's position on the proposed reduction in MaineCare payments to those medical practices owned by hospitals but designated as "provider- based."  These practices currently receive higher MaineCare and Medicare payments based upon their costs, rather than the payment normally received from the provider fee schedule.  These MaineCare payments are sometimes three to four times more than payment to a private practice.  It was stated in one publication that the Administration had proposed the reduction under pressure from MMA.  This was not an accurate statement and the Administration has acknowledged as much.  The MMA opposes the reduction, as explained below.

The Governor had proposed a reduction in the MaineCare payment to such practices to the fee paid to other physicians, whether in private practice or in a hospital-owned practice.  The proposed reduction in the period July 1, 2004 to June 30, 2005 was $900,000 of state funds.  The Administration has now agreed to restore these funds and to study the issue.  To make up for the proposed savings, the hospital tax will be increased slightly.  MMA and MHA will work with the administration as the issue is studied.

While MMA supports the priniciple that physicians performing the same services should be reimbursed the same, regardless of setting, the Association opposed the opposed reduction because it believes that reimbursement needs to be equalized by increasing MaineCare payments to all physicians.  To impose a reduction currently on the cost-based facilities would be likely to cause access issues.  MMA has agreed to be a part of the study of this issue, which necessarily will have to include the broader issues of adequate reimbursement for all physicians and preserving access to care for MaineCare patients.

It is regrettable that MMA's position was incorrectly stated.  MMA opposed the reduction and will continue to do so.  A complete copy of MMA's testimony on this issue  before the Appropriations Committee last week is the second article in the week's newsletter. [return to top]

Physicians Wanted - No Weekends, Nights or Holidays
The Maine Workers' Compensation Board is searching for physicians to perform independent medical exams under Section 312.  The health care provider must be licensed/certified by the State of Maine, have an active, treating practice, be Board certified and demonstrate experience in the treatment of work-related injuries.  Any exams performed under Section 207 (second opinion) will disqualify physicians from performing Section 312 exams until 52 weeks have elapsed since the last Section 207 exam.  Various specialties are needed, including orthopedics, general medicine, physiatry, neurology and psychiatry.  In addition to generous compensation for this service, the satisfaction of offering fair, unbiased expertise is a professional contribution to the public interest.

Interested practitioners may send questions or submit CV's to:

Elizabeth A. Inman, Deputy Director
Office of Medical and  Services
106 Hogan Road
Bangor, ME  04401
(207) 941-4557
Betty.Inman@maine.gov

or contact:                

Richard C. Dillihunt, MD
41 Berkeley Street
Portland, Maine  04103
Dillihunt8@aol.com

[return to top]

CMS Slows Legacy Claims Payment in Push for HIPAA TCS Compliance
The Centers for Medicare & Medicaid Services (CMS) on Feb. 27 instructed Medicare carriers and fiscal intermediaries to pay electronic claims that are not HIPAA-compliant no earlier than 27 days after receipt.  Medicare currently pays electronically submitted claims no earlier than 14 days after receipt.  CMS ordered the slowing down of payments on "legacy" claims as " a measured step toward ending the contingency plan completely."  The new payment structure, intended to encourage HIPAA transactions and code sets (TCS) compliance as soon as possible, has an implementation date of July 6.

Read more:  http://www.hipaadivisory.com/news/index.cfm#0302cms [return to top]

2004 Rural Medical Access Program Application
Rural Medical Access Program Background:

The Rural Medical Access Program promotes obstetrical and prenatal care in federally designated underserved areas of Maine through assistance with insurance premiums for eligible obstetricians and family or general practice physicians.  To be eligible for this program, physicians must be practicing in Maine as of May 1, 2004 and have malpractice insurance for prenatal care and/or obstetrical services.

Eligibility is determined in two categories:

     1.  Physicians whose practices are located in federally designated underserved areas,  who practice at least 50% of the time in underserved areas, and whose practice includes at least 10% MaineCare clients.

     2.  Physicians whose practices are not located in federally designated unserved areas but are located in Primary Care Analysis Areas of under 20,000 population and at least 50% of the visits are patients from federally designated underserved areas and/or MaineCare.

The 2004 application for the Maine Rural Medical Access Program is now available.  These applications must be completed and returned to the Office of Rural Health and Primary Care by May 3, 2004.  Late applications cannot be accepted.  Please contact Mr. Chandler for an application.

Matthew Chandler, Program Manager
Office of Rural Health
#11 SHS, 161 Capitol Street
Augusta, Maine  04333-0011
Tel. (207) 287 5524

[return to top]

Prevnar Deferral Requires Tracking of Missed Doses
The Centers for Disease Control and Prevention (CDC) has recommended temporary deferral of the third and fourth doses of Prevnar.

Wyeth Vaccines has a tracking and callback kit available to physicians. The kit contains a variety of items to aid in the callback of children once the supply issue has been resolved.  The postcards in the kit have proven highly effective in getting children to return for missed doses during the previous supply issue.

The kit includes:

  • postage-paid, HIPAA-complaint callback postcards,
  • deferred-dose tracking forms,
  • deferred-dose chart flags,
  • file box and divider tables,
  • immunization wallet cards, and
  • global medical communication Rolodex cards

To request a complimentary kit, contact Sales Manager Chris Zechman at Zechmac@wyeth.com [return to top]

Penobscot County Medical Society Meeting Tuesday
Tuesday, March 23, 2004 - Miller's Restaurant, Crystal Room, Main Street, Bangor

5:30 p.m. - Executive Committe - Gordon Smith/Dr. Gleaton attending

6:00 p.m. - Social Hour/Cash bar

7:00 p.m. - Dinner, followed by brief business meeting and speaker: Mr. Art W. Cleaves, Director, Maine Emergency Management Agency; Topic: "Homeland Security: Are we better prepared today?"

Dinner Selections: Roast Prime Rib of Beef, Chicken Provencale, Broiled Fresh Haddock

RSVP - Reservations a must, call or email reservation meal selection, number attending to voicemail: 989-5779, or email BARANDALL1@juno.com [return to top]

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