March 29, 2004

 
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Public Voices Concern Over DHS/DBDS Merger
The Baldacci Administration announced last week that it changed the organizational chart, putting the Bureau of Health back to its original position reporting directly to the Commissioner.
 

The public health and medical communities were unified in their opposition to taking the Bureau of Health out of the direct chain of command.  There was quite a bit of testimony in support of the bill, although everyone had words of caution.  Many were concerned that the Department of Behavioral & Developmental Services would be swallowed up by the larger Human Services Department.  The Maine Public Health Association floated the idea of transforming the BOH into a Maine Center for Disease Control and Prevention, much like the Atlanta-based Centers for Disease Control and Prevention.  The Committee seemed interested in the concept. 

The Committee began to work the bill this week.  As members went through the bill line by line, it was clear that they had many issues of concern.  One of biggest was the absence of a Bureau of Elder & Adult Services in the new organizational chart.  The Administration had thought the Committee was more concerned about the administrative/financial aspects of the merger.  But in truth the Committee was more concerned with the provision of services to the people and reminded the Administration, as well as each other, to make that a priority.  The Committee questioned the role of the new Advisory Council and seemed to be concerned that much of the Committee's role would be assumed by the Council.  Senator Brennan seemed particularly concerned that the new Commissioner of DHS would be automatically transfered as the Commissioner of the DHHS. 

Nominations for 04 Dan Hanley Leadership Award Due April 12th
Dr. Dan Hanley's outstanding leadership in the Maine medical community improved health care in our state and across the country during a career that spanned nearly a half-century.  In addition to serving as the long-time head of the MMA, Dr. Hanley played a key role in establishing the Maine Medical Insurance Company, the Maine Health Information Center, and the Maine Medical Assessment Foundation and helped countless other organizations and individual health care professionals.

Since Dan's death in 2001, his family and many of the leading health care organizations in Maine have formed the Dan Hanley Memorial Trust, which has developed this leadership award.  The award this year will be presented at the annual Hanley Trust Healthcare Forum Luncheon to be held at Bowdoin College on June 18, 2004.

The Leadership Award is intended to recognize an individual who is making a sustainable difference in Maine health care and shares Dan's values of collaboration and inclusion, courage, hard work, innovation, kindness, and leadership.  The work may have been done in the past but contributes in a unique way to the health of Maine citizens today.  Stephen Shannon, D.O., M.P.H., Dean of the University of New England College of Osteopathic Medicine, was the recipient of the award in 2003, the first year of the award.

You may download a brochure about the Award and the selection criteria, as well as the nomination form, from the Trust's website, www.hanleytrust.org.

PLEASE NOTE THAT THE DEADLINE FOR NOMINATIONS IS APRIL 12, 2004. [return to top]

Governor Baldacci & Dr. McAfee Announce "CareWorks" - Dirigo Plan
At a State House news conference on Thursday, 3/25/04, Governor Baldacci and Dirigo Health Board Chair Robert McAfee, M.D. announced the benefit design and pricing strategy for the Dirigo Health products.  The plan design includes 2 options with estimated monthly premiums from $260 for a single employee to $846 for a family.  A request-for-proposals (RFP) from interested insurers should be released soon.

Read the Governor's press release on the CareWorks plan. [return to top]

Appropriations Committee Faces 3/31/04 Deadline on FY 05 Budget
The Legislature made little progress in resolving issues in the Governor's proposed FY 05 Supplemental Budget (L.D. 1919) this week.  The Legislature's leadership has set a deadline of Wednesday, 3/31/04 for the Appropriations Committee to complete its work.  The Appropriations Committee worked a few hours on Saturday and plans to work all day on Monday and into the evening.

The Maine Hospital Association has completed negotiations with the Administration on the Governor's "tax and match" proposal.  The agreement includes the elimination of the proposed $900,000 cut in hospital-based physician practice reimbursement and an increase in the hospital tax from 0.074% to 2.23% of hospitals' 2002 net patient service revenue.  The new tax is projected to bring in $49.8 million.

The Governor's Office of Health Policy & Finance briefed the Health & Human Services Committee on a proposed revision of the MaineCare Basic benefit restructuring, but the Committee rejected the new ideas as inconsistent with its previous recommendations to the Appropriations Committee. [return to top]

MaineCare Drug Utilization Committee to Review Preferred Drug List (PDL)
The MaineCare Drug Utilization Review (DUR) Conmittee will meet at least twice to review drug classes in preparation for possible changes to the Preferred Drug List.  The meeting dates are:  April 5, 1:00 - 9:00pm (discussion of non-psych drugs) and April 13, 1:00 - 9:00pm (discussion of anxiety drugs, antidepressants, antipsychotics, hypnotics, stimulants, and anticonvulsants).  The public is invited to listen in on the part of the meeting in which pharmaceutical manufacturers make their presentation, however public comment will not be taken until a meeting later in April which has yet to be scheduled.

For more information, see the GHS Data Management website, www.ghsinc.com.  Go to MaineCare Pharmacy Services. [return to top]

Medical Board to Require Reporting of Sexual Misconduct
As previously reported in Political Pulse, the Maine Board of Licensure in Medicine has submitted legislation as part of its periodic legislative review under the Government Evaluation Act to address several current issues.  The bill, L.D. 1933, An Act to Implement the Recommendations of the Joint Standing Committee on Business, Research & Economic Development Regarding the Board of Licensure in Medicine Pursuant to Reviews Conducted under the State Government Evaluation Act, among other things, amends the provision of the Health Security Act requiring physicians to report to the licensing board any indication of professional incompetence by a colleague to include a specific reference to "sexual misconduct identified by board rule."

Click here to review 24 M.R.S.A. sec. 2505, the reporting statute as currently drafted.

The current board rule on sexual misconduct refers to a physician's sexual misconduct with a patient only, not with a staff member.  Click here to review Board of Licensure in Medicine Rule Chapter 10, Sexual Misconduct.

This change has been referred to the ethics committees of the MMA and the Maine Psychiatric Association for further review. [return to top]

DHS Proposes Major Revision of MaineCare Rule on Physician Services
The DHS Bureau of Medical Services has proposed substantial revisions to MaineCare Benefits Manual, Chapters II and III, Section 90, Physician Services.

The revisions include expanded use of prior authorization for certain surgeries and procedures including bunion surgery, circumcision, and skin tag removal.  It includes new service limits and updates the guidelines for preventive services including physical exams and tobacco cessation services.  The rule has a number of coding updates including the requirement that physicians bill all injectible drugs with NDC codes rather than J-codes.  Finally, the rule makes a variety of amendments to sections on anesthesiology, vision, laboratory, obstetrical, psychiatric, psychological, imaging, preventive, and surgical services so physicians in the relevant specialties should review these sections.

Click here to find the PDF version of MCBM, Chapters II and III, Section 90, Physician Services.

The MMA will be collecting comments on the proposed rule until Monday, 4/5/04.  Please contact Andrew MacLean, amaclean@mainemed.com, with questions or comments. [return to top]

Patients Appreciate Their Doctors: Survey in Modern Physician, 3/17/04
A recent patient satisfaction survey by Press Ganey Associates, involving more than 300,000 patients regarding 50 aspects of a patient's hospital stay, revealed that patients' satisfaction with their physicians' medical skills ranks at the top of the list.  More than 1300 hospitals from across the country provided data for the survey.  "For physicians' skill to emerge as the greatest satisfier this year . . . is a tribute to physicians across the country," said Sabina Gesell, Senior Research Associate for Press Ganey.  "Not only did this element of care receive the highest ratings, patients across the country had more consistent feelings about this issue than any other on the survey." [return to top]

Protect the Fund for a Healthy Maine!

L.D. 1612, Resolution, Proposing an Amendment to the Constitution of Maine to Preserve the Fund for a Healthy Maine, proposed by the Governor last session as part of a package with the Dirigo Health Plan bill (L.D. 1611), remains to be debated before the end of this session.  Unfortunately, the merits of the bill have been lost in the partisanship that has dominated this session.  While some members of both parties remain philosophically opposed to limiting the Legislature's authority to spend this money, the biggest obstacle to achieving the 2/3 vote necessary for passage is Republican insistence that this be paired with a constitutional cap on state spending.

 

The MMA and other members of the Maine Coalition on Smoking OR Health remain hopeful that the Legislature will pass L.D. 1612 this session.  We also are concerned that the FHM may be at risk in the FY 05 supplemental budget debate. 

 

YOU CAN HELP PASS THE CONSTITUTIONAL AMENDMENT AND AVOID CUTS IN THE FHM TO BALANCE THE BUDGET BY CONTACTING YOUR OWN LEGISLATORS AND/OR WRITING A LETTER TO THE EDITOR OF YOUR LOCAL PAPER!

 

FHM Talking Points

  • The legacy of the 121st Legislature can be to preserve and protect the FHM – the foundation of Maine’s health care system.  A universal health care plan cannot be sustained without a comprehensive, community-based disease prevention program.  The FHM is that program. 

 

  • The Fund for a Healthy Maine is a special pot of money with a special purpose.  We receive this money because Maine people have become sick and died as a result of using tobacco products.  The Legislature created the Fund for a Healthy Maine (FHM) with the promise of critical disease prevention and prevention-related treatment initiatives to keep Maine people healthy.

 

  • The FHM has already sustained large cuts, eliminating or delaying full implementation of the FHM vision.  About 38.7% of the $222 million in tobacco settlement monies that Maine will have received by June 30, 2003 has been diverted to the General Fund to help fill budget gaps.  That’s $86 million in lost prevention and treatment investment opportunities.

 

  •  The FHM is a group of highly successful prevention and treatment programs that more than pay for themselves in health cost savings.  Despite never receiving the funding to match the original vision, FHM prevention and treatment programs have made a tremendous impact on communities across Maine – saving health care costs today and in the future.
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