April 18, 2005

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MMA Legislative Committee Savors MaineCare Fee Schedule Success
Determining an appropriate and fair method to allocate the fee increase is now the challenge.

At its regular monthly meeting on Tuesday, April 12, 2005, the MMA Legislative Committee reviewed organized medicine's major success of the 2005 legislative session, passage of a $3 million annual increase in MaineCare physician reimbursement in L.D. 468, the "Part I" budget and discussed the next step in implementing the increase - determining an appropriate allocation of the money to not only address access problems, but also to be fair to all physicians participating in the MaineCare program.  The MMA will establish a process for all physicians to provide their thoughts on this subject as the MMA develops an implementation plan with the Governor's Office of Health Policy & Finance and the Department of Health & Human Services.

Sally Sutton, a consultant to the Bureau of Health, Office of Public Health Emergency Preparedness from the UNE health care ethics, law, & policy program, provided the group with an overview of L.D. 1405, An Act to Prepare Maine for Public Health Emergencies.  The bill updates legislation adopted in the 120th Maine Legislature in the aftermath of the events of September 11, 2001, L.D. 2164, An Act to Provide Government with the Necessary Authority to Respond to a Public Health Emergency Caused by an Act of Bio-terrorism, P.L. 2001, Chapter 694.  The MMA will support the legislation.

The Committee also discussed the continuing implementation of the Dirigo Health Plan and the activities of the Coalition for Health Care Access & Liability Reform.

The Legislative Committee's last scheduled meeting for the Spring of 2005 is Tuesday, May 10, 2005 at the MMA office.  Any interested member is welcome.  Please contact Charyl Smith, Legislative Assistant, at csmith@mainemed.com for more information.

Proposed Rule on "Hardship Exemption" from Electronic Claim Filing Law
In accordance with the Dirigo Health legislation, P.L. 2003, Chapter 469, the Bureau of Insurance has proposed Rule Chapter 825, Procedures and Standards for Obtaining a Hardship Exemption for Submitting Electronic Health Claims.  The Dirigo Health law exempts practices with fewer than 10 FTE employees from the electronic claims submission requirement until October 16, 2005.  After October 16, 2005, the law requires the Superintendent of Insurance to establish standards and a process for review of requests for a continuing "hardship exemption" from the requirement. 

The proposed rule establishes the following standard for demonstrating "hardship."  "There are significant technological impediments that make it difficult for the health care practitioner to submit claim forms electronically, or the cost of compliance would have a significant impact on the health care practitioner, or granting the waiver is warranted based on other considerations or unusual circumstances."

You can find the rulemaking notice and proposed Rule Chapter 825 on the Bureau of Insurance web site at:  http://www.state.me.us/pfr/ins/Rule825.htm.

The Bureau has scheduled a public hearing on the proposed rule for Wednesday, May 11, 2005 at 2 p.m. in the Kennebec Room at the Gardiner Annex, 124 Northern Avenue, Gardiner, Maine.  You may submit written comments no later than Monday, May 23, 2005 at 5 p.m. to Vanessa Leon, Maine Bureau of Insurance, State House Station 34, Augusta, Maine 04333.  If you would like to submit comments through the MMA staff, please contact Andrew MacLean, Vice President & General Counsel, at amaclean@mainemed.com. [return to top]

Legislature Considers Graduate Medical Education Bills
On Wednesday, April 13, 2005, the Business, Research & Economic Development Committee voted unanimously in favor of a BOLIM/MMA compromise on the GME provision of L.D. 398, An Act to Make Technical Changes to the Medical Licensure Laws.  The amended bill will permit graduates of U.S. or foreign medical schools to obtain a medical license, and therefore be qualified to work, if they receive the endorsement of the Director of a Maine residency program.  They also must complete the third year of the residency program.

At the Board's meeting last week, members discussed a related bill, L.D. 1261, An Act to Allow Physicians Licensed in Other States but Trained Outside the U.S. to Practice Medicine in Maine.  The bill, submitted by Senator Elizabeth M. Schneider (D-Penobscot), is intended to address a shortage of specialists in some parts of the state.  It would permit foreign-trained physicians to be licensed in Maine with no U.S. residency training if certain requirements are met.  The Board is concerned that this bill would dilute the educational standards for physician licensure in Maine and would be contrary to the principles in L.D. 398 and the trend across the country.  Board members emphasized the importance of the apprenticeship model of graduate physician education in our country and pointed out that none of the proposed substitutes in L.D. 1261 are adequate replacements for the apprenticeship model.  Also, they believe that foreign graduates benefit from the three years of indoctrination to the U.S. popular and medical cultures and opportunity to develop communication skills.  Finally, the residency program provides an important opportunity for teaching physicians to evaluate the clinical skills of foreign physicians who may be trained in countries where the standard of care is not the equivalent of the U.S.

The MMA also will oppose the bill. [return to top]

BOLIM Issues Rules on Supervision of PAs & APRNs
In late March, the Maine Board of Licensure in Medicine issued a proposed revisions of its Rule Chapter 2, Physician Assistants and Rule Chapter 3, Physician Supervision of Advanced Practice Registered Nurse Under Medical Delegation.  In addition to updating the rules to conform with current statutes, the revised Rule Chapter 3 will allow the primary supervising physician (PSP) to apply for authorization to delegate schedule II prescribing responsibility to an APRN under supervision.  Prior to this change, PAs and APRNs were treated differently in schedule II prescribing authority causing confusion and scheduling issues in a number of practices.

You can find copies of the proposed rules on the BOLIM web site:  http://www.docboard.org/me/rule.html.

No public hearing has  been scheduled on these proposed rules, but the Board will accept written comments by May 13, 2005 addressed to Randal C. Manning, Executive Director, Board of Licensure in Medicine, State House Station 137, Augusta, Maine 04333-0137.  If you would like to submit comments through the MMA staff, please contact Andrew MacLean, Vice President & General Counsel, at amaclean@mainemed.com. [return to top]

HHS Committee Extends Sunset on CIF Division for Non-hospital Projects
At a work session on Wednesday, April 13, 2005, the Health & Human Services Committee unanimously recommended passage of an amended version of L.D. 742, An Act to Postpone the Repeal Date on Nonhospital Expenditures in the Capital Investment Fund, sponsored on behalf of the MMA by Senator Karl Turner (R-Cumberland).  The amended bill will extend the sunset date on the division in the Capital Investment Fund (CIF) between hospital and non-hospital expenditures by 1 year from 7/1/07 to 7/1/08.  The Committee took this action based upon an agreement between the MMA and the MHA.  This result will give interested parties three years worth of data on which to decide whether the division should be continued in the future and will permit the 123rd Maine Legislature to consider another bill on the sunset, if appropriate. 

The Committee also amended L.D. 16, An Act to Amend the Certificate of Need Process, a bill submitted on behalf of the MHA that would have established a 90 day period for review and decision on a complete CON application and would have required DHHS to issue the CON if it could not meet the deadline.  Instead, the Committee passed a Resolve directing the Department to review its CON procedures, to look for ways to improve its efficiency in reviewing CON applications, and to report its findings back to the Committee.

The Committee has a work session scheduled for Wednesday, April 27, 2005 on the most contentious of the CON bills, L.D. 33, Resolve, Regarding Legislative Review of Chapter 101:  Establishment of the Capital Investment Fund, a Major Substantive Rule of the Governor's Office of Health Policy & Finance. [return to top]

Insurance Committee Considers Insurance Market Reform Bills
On Thursday, April 14, 2005, the Insurance & Financial Services Committee held a public hearing on a series of bills proposing changes to the regulation of the health insurance market in Maine.  The bills, backed mostly by Republican legislators, emphasize a market approach to health care reform and seem to be offered by the minority as a counterweight to the Dirigo Health Plan.  The focus of the public hearing was L.D. 1496, An Act to Reduce Maine's Health Insurance Rates and Expand Consumer Choice, sponsored by Rep. Kevin Glynn (R-South Portland) and co-sponsored by a half-page of other Republican legislators. 

Related bills included:

  • L.D. 394, An Act to Create a High-Risk Pool in the Health Insurance Market;
  • L.D. 898, An Act to Preserve Dirigo Health;
  • L.D. 1475, An Act to Establish a Simplified Package of Health Care Insurance Affordable by All; and
  • L.D. 1168, An Act to Reduce Individual Health Insurance Premiums.

The Committee postponed the hearing on L.D. 1168 because the sponsor was not present. 

The principal supporters of these bills were representatives of insurance agents and financial services providers who believe that Maine has unusually high health insurance rates when compared to other small states largely because of the regulatory climate. 

The opponents included the Governor's Office of Health Policy & Finance, the American Lung Association of Maine, the American Cancer Society, Consumers for Affordable Health Care, NAMI-Maine, and several small business owners.

Anthem, the Maine State Chamber of Commerce, the Maine Bankers' Association, and the Maine Auto Dealers' Association were "neither for nor against" L.D. 1496.

The MMA testified in opposition to the bills because of concern about the radical changes to insurance regulation proposed in them.  The MMA expressed opposition to:

  • the elimination of our modified community rating system;
  • the elimination of mandated health insurance benefits;
  • the elimination of the guaranteed issuance, portability, and continuity provisions; and
  • the elimination of the BOI Rule Chapter 850 geographic access standards.

The MMA did not, however, categorically reject any changes to insurance regulation in Maine.  The MMA expressed support for the following concepts in the bills:

  • health savings accounts (HSAs) and giving beneficial tax treatment to all health care spending by individuals;
  • increasing MaineCare reimbursement rates;
  • capping non-economic damages in medical malpractice actions; and
  • elimination of the CON program.

The MMA currently has no position on the concept of a state high-risk pool for individuals who may be uninsurable because of high health care costs. 

The MMA also expressed its support for the Dirigo Health Plan. [return to top]

Education Committee Hears Final Bill from "Obesity" Commission
On Thursday, April 14, 2005, the Education & Cultural Affairs Committee held a public hearing on L.D. 796, An Act to Implement the Recommendations of the Commission to Study Public Health that Concern Schools, Children and Nutrition, a bill containing a series of recommendations to improve the nutrition and exercise culture in our schools.  Lisa Letourneau, M.D., M.P.H. testified in favor of the bill on behalf of MaineHealth and the MMA Public Health Committee.  Robert Holmberg, M.D., M.P.H., a member of the Commission, submitted testimony in support of L.D. 796 on behalf of the Maine Chapter of the American Academy of Pediatrics.

Other proponents included a number of School Health Coordinators, Medical Care Development, and the American Heart Association.  Opponents included the Food Services Director for the Bath Schools, the Maine Association of Broadcasters, H.P. Hood, and other food providers.  Speaking "neither for nor against" the bill were the Bureau of Health, the Maine Center for Public Health, the Maine Coalition on Smoking OR Health, the Department of Education, and the Maine School Management Association.

L.D. 796 is the fourth and final bill to come to the legislature from the work of the Commission to Study Public Health, the first concentrated effort by the legislature to address the obesity problem in our state.  The other 3 bills were:

  • L.D. 110, An Act to Implement the Recommendations of the Commission to Study Public Health Concerning Chain Restaurants, killed in the Business, Research & Economic Development Committee;
  • L.D. 439, An Act to Implement the Recommendations of the Commission to Study Public Health Concerning Alternative Roadways, killed in the Transportation Committee; and
  • L.D. 134, An Act to Implement the Recommendations of the Commission to Study Public Health, killed in the Health & Human Services Committee.

Most observers believe that L.D. 796 stands the best chance of producing some results during this legislative session. [return to top]

Maine Coalition on Smoking OR Health Update
Three key bills from the Maine Coalition on Smoking OR Health were in work sessions last week.  On Monday, April 11, 2005, the Health & Human Services Committee voted 9-1 in favor of L.D. 885, An Act to Discourage Further the Sale of Tobacco to Minors and unanimously in favor of L.D. 886, An Act to Promote Parity in the Laws Governing Smoking in the Workplace.

The amended version of L.D. 885 would make the restrictions on face-to-face sales of tobacco products in retail stores the same as those for alcohol sales - the individual must be at least 17 years of age and  between 17 and 21, the individual must have a supervisor present who is at least 21 years of age.  The amended bill would permit a minor to enter a tobacco specialty store only when accompanied by a parent or legal guardian.

The amended version of L.D. 886 would require private clubs to hold a membership vote on whether or not to permit smoking in the club at least once every 3 years and to demonstrate that they have a secure admissions process.

The new language will be presented to the HHS Committee for final approval.

On Tuesday, April 12, 2005, the Appropriations Committee held a work session on L.D. 1311, An Act to Preserve the Integrity of the Fund for a Healthy Maine, a bill that would require a specific and separate vote on any proposed diversions from the Fund for a Healthy Maine.  The Committee has not yet completed its work on the bill and it now appears that it may have majority support in the Committee.  Apparently, neither of the chairs are supporting the bill. 

Please contact the members of the Appropriations Committee to urge their support for L.D. 1311 to keep the Fund for a Healthy Maine intact for its intended "health purposes."  You can find contact information for the Appropriations Committee on the web at:  http://janus.state.me.us/house/jt_com/afa.htm. [return to top]

Hospitals, People's Alliance Reach Compromise on Financial Disclosures
At a work session on Friday, April 15, 2005, the Health & Human Services Committee unanimously voted "ought to pass as amended" on L.D. 725, An Act to Require the Disclosure of Certain Financial Information from Hospitals and Their Affiliates, sponsored by Rep. Marilyn Canavan (D-Waterville).   The compromise between the principal promoter of the bill, the Maine People's Alliance, and the Maine Hospital Association requires hospitals to file IRS Form 990 with DHHS as well as the IRS Form 1120 for any for-profit entity controlled by the hospital.  The IRS Form 990 includes the compensation for the 5 highest-paid employees of the non-profit entity.  The IRS Form 1120 include compensation for officers and directors.

Pursuant to the bill, the Department will make the documents available for public inspection and copying and will post them on the Department's web site. [return to top]

Compliance Deadline for HIPAA Security Rule is 4/21/05
Practices are reminded that the deadline for compliance with the HIPAA security rule for all medical practices covered by HIPAA is April 21, 2005.  There is a one year delay for small health plans with gross revenues under $5 million, but that exception applies only to health plans and not to medical practices.

MMA has a few sets of the recent meeting seminar packets which are available for $25.00.  If you are interested, contact Chandra Leister at MMA at 622-3374 or via e-mail to cleister@mainemed.com.

The HIPAA privacy rules dealt primarily with patient rights and how a patient's Protected Health Information (PHI) could be used.  The HIPAA security rule deals with how a practice will secure PHI in electronic format.  The security rule is much briefer than the privacy rule, but for some practices it is proving more difficult to implement.  The cornerstone of security involves conducting a risk assessment for the practice.  The regulations also have several implementation specifications.  Some are required, but others are "addressable," which means you must review the specification and make a documented decision about why you either did not implement it or chose to implement a lesser version.

Much of the security rule was based on documents from the National Institute for Standards and Technology (NIST).  The NIST Web site has information about HIPAA implementation at http://csrc.nist.gov/publications/drafts/DRAFT-sp800-66.pdf.  This draft version, however, is 96 pages long.

Another good resource is the Workgroup for Electronic Data Interchange (WEDI).  Good information for the physician practice can be found on the WEDI Web site at www.wedi.org/cmsUploads/pdfUpload/White Paper/pub/2004-04-20SmallPractice.pdf. [return to top]

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