June 20, 2005

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122nd Legislature Adjourns First Session Early Saturday Morning
The MMA scores wins with its legislative agenda - MaineCare fee increase, incremental improvement in medical liability laws, extension of provision allocating portion of Capital Investment Fund to non-hospital projects, and preservation of access to medically-necessary breast reduction and varicose vein surgery. Thanks to all members who participated in the MMA's legislative advocacy activities!

Following a hectic final week of work, the 122nd Maine Legislature adjourned its 2005 session early in the morning of Saturday, June 18, 2005.  The Legislature succeeded in enacting a package of new spending cuts and revenue increases to replace a borrowing scheme in the Part I biennial budget that had been strongly criticized by many and the subject of a people's veto campaign organized by the Republican minority.  The Legislature considered a tax reform proposal, but deferred final votes on the package and consideration of a bond package until later in the year.

You can read the Governor's traditional sine die remarks on the web at:  http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=7632&v=article-2004.

The MMA accomplished something with each of its four legislative proposals in the 122nd Maine Legislature:

  • MaineCare Reimbursement Rates.  The clearest win of the session for the MMA and organized medicine generally is the $3 million General Fund increase in MaineCare reimbursement rates in the "Part I" biennial budget for 2006-2007 (L.D. 468).  With the federal match, this initiative will infuse between $8 and $9 million in the physician fee schedule.  This increase of 10-15% will bring Maine's rates up from approximately 40% of Medicare rates to approximately 53% of Medicare rates.  The MMA was able to accomplish this, despite a late session proposal to delay implementation by one year in the borrowing replacement plan, with the strong support of the Baldacci Administration and the Maine Hospital Association.
  • Medical Liability Reform.  While the MMA and its allies in the Coalition for Health Care Access & Liability Reform were unable to find the votes to pass a cap on non-economic damages in medical negligence actions, the group did succeed in enacting "I'm sorry" legislation (L.D. 1378), a provision the Bureau of Insurance estimates could save between 3.5% and 5.9% in total claim costs, and in obtaining a commitment from the Maine Trial Lawyers' Association to discuss other initiatives to improve the medical liability climate in Maine that may be presented to the Judiciary Committee in 2006.
  • Fairness in the CON program.  With the agreement of the MHA, the MMA and the Maine Ambulatory Surgical Center Coalition extended the sunset from 2007 to 2008 on the provision of the Capital Investment Fund statute setting aside 12.5% for non-hospital projects (L.D. 742).  Many physicians believe this provision is critical to ensuring that non-hospital projects receive fair consideration in the CON review process.
  • Access to Medically-Necessary Breast Reduction and Varicose Vein Surgery.  With the help of Plastic & Hand Surgical Associates and the American Society of Plastic Surgeons, the MMA responded to a move by CIGNA to eliminate coverage for these services by enacting legislation to require health insurance carriers to offer coverage for these services through a policy rider (L.D. 596).

The MMA also is pleased to have worked through the Maine Coalition on Smoking OR Health to double Maine's cigarette excise tax from $1 per pack to $2 per pack.  The MSCOH's advocacy for a $1.50 increase in the tax provided strong support for the increase ultimately adopted by the Legislature.  The current Chair of the MCSOH is the MMA's Public Health Committee Chair, Jo Linder, M.D. and the MMA thanks Jo for her leadership on this issue.

The MMA staff, Legislative Committee members, and specialty society representatives were involved in shaping many other pieces of health care legislation among more than 300 monitored by the MMA. 

Thanks to all of you who helped to make this legislative session a success for the MMA and for organized medicine!

Legislature Enacts Bill to Replace Borrowing in Biennial Budget
On Friday, June 17, 2005, the Legislature enacted L.D. 1691, An Act to Eliminate Pension Cost Reduction Bonding and Provide Replacement Budgeting Measures, a party-line majority report finalized in the Appropriations Committee last Tuesday afternoon.  The votes on enactment were 74-72 in the House and 19-14 in the Senate.

Earlier in the week, the Appropriations Committee voted along party lines (8-5) to approve a plan to replace more than $400 million in borrowing adopted in the "Part I" budget for State Fiscal Years 2006-2007 beginning July 1, 2006 (L.D. 468).  Working with the Maine Hospital Association, the MMA succeeded in persuading both the Appropriations Committee Democrats and Republicans to reject a proposal to delay the $3 million MaineCare physician fee increase until the second year of the biennium and a second proposal to fund the first year of the increase by cutting reimbursement to "provider-based" physician practices.

The report of the Committee's majority Democrats surpasses the $250 million goal in achieving $256,386,760 in cuts or new revenue over the biennium ($107,990,558 in 2006 and $148,396,202 in 2007).  The Committee's minority Republicans recommends cuts totalling $252,108,035 over the two years.

The majority report includes a $1 per pack increase in the cigarette excise tax effective September 16, 2005 and an increase in the tax on smokeless tobacco effective October 1, 2005.  These tax changes yield new revenue of $53,148,108 in FY 2006 and $72,609,461 in FY 2007.

Savings in the DHHS section of the budget include:

  • $600,000 in each year through elimination of the foster care clothing allowance;
  • $1.5 million in the second year by continuing current suspension of new enrollments in the MaineCare non-categorical adults waiver less than 101% of the FPL;
  • $10,431,749 in the second year through managed behavioral health care services;
  • $5 million over the two years from the Fund for a Healthy Maine; of particular concern is $1.6 million in cuts to the tobacco prevention and cessation programs in the second year;
  • $750,000 in each year through personnel savings;
  • $194,731 in each year through the elimination of three contracted housing coordinators;
  • $100,000 in each year through administrative savings by consolidating homemaker and independent housing services;
  • Approximately $213,000 in each year by the elimination of funding for hospital specialty clinics at EMMC, CMMC, and MMC;
  • $1.1 million in the second year by closing Freeport Towne Square;
  • $104,769 in the second year by privatizing advocacy services;
  • $211,378 in each year by restructuring the maternal and child health program;
  • $250,000 in the first year by reducing the nursing home COLA;
  • Approximately $1.6 million in the first year by paying hospital payment lawsuit settlements before September 30, 2005;
  • $1,227,064 in the second year in retired state employee and teacher health care costs;
  • $500,000 in the first year and $1.5 million in the second year through means testing of higher income Katie Beckett program participants; and
  • $1,125,000 in each year from the Dirigo Health Agency.

The majority report also takes $5 million in the first year from the Department of Professional & Financial Regulation, a department funded totally by dedicated revenue.  This amount includes reserve funds from all of the licensing boards, including the physician licensing boards.  Such a "sweep" of these dedicated accounts has happened one other time in the recent past. [return to top]

NHIC Hosts Ask-the-Contractor Teleconference on Medicare Part B Billing Tips, June 24

National Heritage Insurance Company, (NHIC), Medicare Part B is hosting a one-hour ACT on the Medicare Part B Billing Tips, June 24, 2005 at 1:00pm EST. Medicare providers and their staff are encouraged to participate on the conference call.

We solicited input from operational areas including claims processing, customer service, and post payment review. We discovered some of the top billing errors that continually cause claims challenges to both the Medicare providers and the NHIC staff in obtaining timely and accurate reimbursements. The following topics reflect the current billing issues:

  • Your Administrative Records
  • Common Billing Errors
  • Claim Development
  • Medical Record Documentation
  • Comprehensive Error Rate Testing (CERT Program)
  • General Billing Tips

We will discuss these topics and provide important information to help you expedite the efficient handling of your Medicare Part B claims submissions.

We invite you to call in with your questions or comments about general Medicare Part B billing issues, toll-free, at 800-552-9191, Pass code:  ACT. There is no registration needed for your participation on this call. However, there are a limited number of lines available. [return to top]

Centers for Medicare and Medicaid Services Announce Plans to Transition to NPI
Please see below for Medicare's plan:

The Centers for Medicare and Medicaid Services announces the following plans for transitioning to the National Provider Identifier (NPI) in the Fee-for Service Medicare Program:

Between May 23, 2005 and January 2, 2006, CMS claims processing systems will accept an existing legacy Medicare number and reject, as unprocessable, any claim that includes only an NPI.

Beginning January 3, 2006, and through October 1, 2006, CMS systems will accept an existing legacy Medicare number or an NPI as long as it is accompanied by an existing legacy Medicare number.

Beginning October 2, 2006, and through May 22, 2007, CMS systems will accept an existing legacy Medicare number and/or an NPI. This will allow for 6-7 months of provider testing before only an NPI will be accepted by the Medicare Program on May 23, 2007.

Beginning May 23, 2007, our systems will only accept an NPI .
For additional information, to complete an NPI application, and to access educational tools, visit
https://nppes.cms.hhs.gov on the web. [return to top]

Fiscal Note Forces Carry Over of Involuntary Psychiatric Treatment Bill
Following a strong vote (32-3) in the Senate last week, the House voted to enact the 9-2 "ought to pass as amended" report on L.D. 151, An Act to Improve the Delivery of Maine's Mental Health Services, sponsored by Sen. John Nutting (D-Androscoggin) on Friday, June 17, 2005. 

Sen. Nutting, whose son has suffered from a severe mental illnesss, has pushed all session for a positive outcome on his bill to permit the involuntary treatment of individuals suffering from mental illness, under certain conditions, if they do not follow their prescribed course of medication.  While the Department, the Maine Association of Psychiatric Physicians, the MMA, and several other groups have supported the concept of the legislation, the Disability Rights Center, the Maine Association of Mental Health Services, and other patient advocacy organizations have steadfastly refused to agree to any sort of involuntary treatment law.

In part, the majority report amends current involuntary commitment laws to establish a type of release from involuntary mental health commitment for persons who are committed to Riverview Psychiatric Center or Bangor Mental Health Institute.  Under this status, patients would be ordered by a judge to participate in a "progressive treatment program," which would provide treatment and care through an assertive community treatment program for a period of 6 months.  Successful completion of the progressive treatment program results in termination of progressive treatment services.  Failure to fully participate and follow the individualized treatment plan that results in deterioration of the person's mental health so that hospitalization is in the person's best interest or the person poses a likelihood of serious harm results in the treatment team applying for the person to be rehospitalized, under the current emergency admission procedure.  If the person is admitted on an emergency basis, and if the Superintendent determines that continued hospitalization is required, within 3 days of admission an application for commitment must be filed with the court under the current involuntary commitment law.  This provision of the law sunsets in 2010.

Senator John Martin (D-Aroostook), a supporter of the bill in the HHS Committee, submitted a floor amendment to reduce a fiscal note attached to the bill, but even the reduced fiscal note has resulted in the bill being carried over to the second session in 2006. [return to top]

Legislature Enacts Several Health Care Bills in Session's Final Days
In addition to the bills mentioned above, the legislature enacted the following bills of interest to Maine physicians in the last 2 weeks of the session:

  • L.D. 1618, An Act Regarding Advertising by Drug Manufacturers.  This bill requires drug manufacturers to disclose the results of clinical trials.  According to one consumer advocacy organization, Maine is one of 15 states that has considered such legislation this year.  This bill was enacted in the House on a 73-72 vote.
  • L.D. 1178, An Act Regarding Prescription Drugs and Reimportation.  This bill reconvenes the Governor's task force on drug reimportation and enables the state to act upon a reimportation plan if the federal government permits the states to do so.
  • L.D. 1302, Resolve, Establishing the Task Force to Study Cervical Cancer Prevention, Detection, & Education.  This study bill passed by strong margins in both the House & Senate.
  • L.D. 835, Resolve, to Establish the Blue Ribbon Commission on the Future of MaineCare.  This bill to study the cost effectiveness of the MaineCare program passed without roll call votes in each house.
  • L.D. 1577, An Act to Modify the Calculation and Implementation Date of the Savings Offset Payment under the Dirigo Health Act, a bill that became a partisan referendum on the Dirigo Health Act, passed by votes of 17-15 in the Senate and 73-71 in the House.
[return to top]

Information Still Available from 14th Annual Physician Survival Seminars
If you missed the MMA's Annual Physician Survival Seminars on May 18 and June 8, you can still receive the materials on topics including:  Pay for Performance, Dirigo, Mainecare, Electronic Medical Records, Compliance, and Managing the Angry Physician.  Attendee books may be ordered by contacting Chandra Leister at 207-622-3374, cleister@mainemed.com.  A fee of $25 will be charged while supplies last. [return to top]

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