MMA Advocates for MaineCare Fee Increase Before Appropriations Committee

The Joint Standing Committee on Appropriations and Financial Affairs took testimony last Thursday on that portion of the Governor's proposed budget calling for a $3 million increase ($8.2 with federal match) in physician fees paid by MaineCare.  The lead testimony was presented by MMA Executive Vice President Gordon Smith who noted that, despite a similar increase in 2005, MaineCare fees remain among the lowest in the country.  A copy of Mr. Smith's testimony may be found on the MMA website at www.mainemed.com.

Thursday's hearing was part of a week long series of hearings on the DHHS portion of the budget which drew criticism from a number of quarters including objections to the proposals for managed care initiatives for mental health, standardized rates for mental health providers, the cap on state expenditures for adults covered under what is known as the noncategorical waiver and the COLA for nursing homes. 

There was also considerable testimony Thursday ragarding the MECMS debacle and the Department's plans to move to an outside vendor (fiscal agent) for claims processing leaving the $53 million MECMS system to be mothballed.  In responding to Commissioner Harvey's presentation on the current status of MECMS and the plans submitted to CMS, Smith objected to the lack of provider input into the options.  Smith suggested that the Appropriations Committee require DHHS to re-structure the operations of the Provider Advisory Group on MECMS in order to assure appropriate input from the persons actually providing the care to MaineCare patients.  Smith also emphasized to committee members the two year impact on providers and the continuing inability of MECMS to electronically process cross-over claims and to provide the additional functionality required to meet federal requirements.  The upcoming problem with the National Provider Identification number was also noted.  The state has indicated that it will not be ready to process claims with the new number on the federal implementation date of May 23rd.  This will require Maine physicians to stockpile both the old forms and the new forms in order to bill MaineCare and commercial insurers which may require the new form.

In addition to the proposed fee increase, there are a number of  other items in the budget of interest to physicians, including the "savings" of $47 million through various managed care initiatives, claims review and other initiatives through the OMS vendor Schaller Anderson.  Other initiatives include use of "the medical home", nurse care management and chronic disease management.

Work sessions on the budget will continue through March with the Health and Human Services Committee due to make its recommendations on the HHS part of the budget this coming Friday afternoon, March 2.

Dr. Biczak Resigns MaineCare and MECMS Posts

Laureen Biczak, D.O. resigned her position as Medical Director of MaineCare this past week to accept a position as Associate Clinical Director for Goold Health Systems. The previous MaineCare Medical Director Timothy Clifford, also left for a position at Goold.

Dr. Biczak joined OMS in 2001, and in 2005 was also given responsibility as Project Director for MECMS.  As more and more of her time was required in connection with the MECMS problems, she was assisted on the medical director side by Dan Mingle, M.D. on a part-time basis. 

"We are sorry to see Laureen leave, as she has been a steadfast supporter of physician interests during her time at OMS," noted Gordon Smith, MMA Executive Vice President.  "She was an important part of the physician fee increase in 2005 and certainly no one can blame the MECMS mess on her.  She did the best she could under extremely challenging circumstances", he added.

As Dr. Biczak will be working at Goold which has substantial contracts with OMS, she will continue to be available to OMS on a sporadic basis as Acting OMS Director Tony Marple searches for a new Medical Director. 

Effective immediately, Brian Erdahl with Deloitte will become MECMS project director and will report directly to Commissioner Brenda Harvey and the MECMS Steering Committee.

In addition to managing activities related to the current system, Erdahl will implement strategies to transition project management from CNSI to the State in the next couple months.  [return to top]

Open Invitation to Attend Legislative Event Tuesday night, Feb. 27

On Tuesday evening, Feb. 27, The MMA Legislative Committee will host some key legislators and regulators for a discussion of legislation pending on MaineCare.  The event will be held from 5:30pm to 7:30pm and refreshments will be served.  Any MMA member is welcome to attend the event which will be held at the MMA offices in Manchester.

Legislators expected to attend include the two physicians serving in the Legislature, Sen. Lisa Marrache and Rep. Robert Walker and Sen. Karl Turner.  Also attending will be Acting MaineCare Director Tony Marple and Medical Director Laureen Biczak, D.O.

The MaineCare fee schedule, the MECMS debacle and the attempts to cut MaineCare funding through aggressive managed care initiatives are all expected to be part of the discussion.

Feel free to come and participate in the discussion.  Practice managers as well as members are welcome. [return to top]

Applications for Rural Medical Access Fund Now Available

The Maine Office of Rural Health and Primary Care has released the 2007 application for assistance from the Rural Medical Access Fund and established April 27th as the deadline for returning a completed form to the state.

The Rural Medical Access Program, created by the Legislature in 1990 as the result of MMA's liability reform package that year, is jointly administered by the Office of Rural Health and Primary Care and the Bureau of Insurance.  The program promotes obstetrical and pre-natal care in federally designated medically underserved areas and Health Professional Shortage Areas of Maine through assistance (up to $15,000) with insurance premiums for eligible obstetricians and family physicians.  To be considered for assistance from the program, physicians must be practicing in Maine  and have had malpractice insurance for prenatal care and/or obstetrical services for at least the period of July 1, 2006 thorugh Dec. 31, 2006.

Category determination:

1.  Physicians whose practices are located in federally designated medically underserved areas or Health Professional Shortage Areas, who practice at least 50% of the time in underserved areas, and whose practice includes at least 10% MaineCare patients.

2.   Physicians whose practices are not located in federally designated medically underserved areas or Health Professional Shortage 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.  Applications may be downloaded from the MMA website at www.mainemed.com or requested from:

                                                     Matthew Chandler, Manager

                                                     Maine Office of Rural Health and Primary Care

                                                     #11 SHS, 286 Water St, 6th Floor

                                                      Augusta, Maine 04333-0011

Questions may be directed to Mr. Chandler at 287-5524,

                                                  ,

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A Few Spots Available at HIPAA Annual Training Session Friday, March 2

There are currently nine (9) seats available at the upcoming Annual HIPAA training session this coming Friday (March 2) at MMA's offices in Manchester.  The three hour program, for which category one CME is available, will be presented from 9:00am to noon.  There is a $60 charge which includes breakfast and all course materials.

The program is Co-sponsored by OfficeMax, an MMA Corporate Affiliate. OfficeMax will have some privacy related products on display at the program.

This course would be ideal for a new employee who has not received HIPAA training or for office staff who need a refresher.  The HIPAA regulations require that employees be trained annually in the HIPAA privacy and security regulations.

You may register on-line at the MMA website at www.mainemed.com or call Gail Begin or Jessica Violette at MMA at 622-3374 (press O to get beyond voice mail). [return to top]

Practices Still Needed for Voluntary Practice Assessment Initiative

The Voluntary Practice Assessment Initiative offered by MMA and the Maine Osteopathic Association and funded by the Maine Quality Forum is still available for participation by primary care practices across the state.  There is no charge for the program which is intended to assist independent practices in meeting the challenges of quality improvement and pay for performance.  Participating practices elect to be measured against benchmarks in diabetes or CVD for adults and asthma care and immunizations for children.

The reviews are scheduled to be completed by April 30 so call MMA today to get on the shedule (622-3374) or you may call the Project Manager, Jean Eichenbaum directly at 207-332-9405 or contact her through e-mail to jeaneichenbaum@aol.com.

The goal is to assess at least 100 physicians in 50 different practices. [return to top]

Open Invitation to Attend Payor Liaison Com Meeting Thursday, March 1

Peter Hayes from Hannaford Brothers will present to MMA's Payor Liaison Committee this coming Thursday evening, March 1, at 6:30pm at the Association offices in Manchester.  Hayes will discuss the concept of "Care Focused Purchasing" which is being supported by various businesses and business coalitions across the country. 

Dinner will be available beginning at 6:00pm.. If you are not on the committee but would like to attend (practice manager or physician), please call Diane McMahon at 622-3374 ext. 216. [return to top]

Pre-book Vaccine Now for Next Year's Flu Season

Even though the current flu season isn't over, it is time to start planning for next year.

Pre-booking orders for flu vaccine are now being accepted for the 2007-2008 season and may be placed either through your pharmaceutical distributor or directly from the manufacturers below.  The state CDC will not be furnishing adult vaccine to private offices.

• Sanofi Pasteur.........(800) 822-2463. www.vaccineshoppe.com (2% discount if ordered online)
• Henry Schein, Inc....(800) 772-4346, www.henryschein.com
• STAT Pharmaceuticals......www.fluvaccine.com
• ASD Healthcare.......(866) 281-4358,www.asdhealthcare.com
• PSS/World Medical....(904) 332-3000, www.pssworldmedical.com

        (The above list is not meant to be exclusive)

Your practice may also wish to consider utilizing Maxim Health Systems to do a clinic in your office for your patients, thus avoiding the hassles associated with ordering the vaccines and waiting for delivery.  Maxim offers two options, one in which they collect from the patient or insurer and a second in which they charge a flat fee per shot to the practice and the practice bills.  The shots are provided by Maxim employed nurses at your site.  Maxim is currently utilized to provide clinics for hospitals in Rumford, Houlton, Lewiston and Damariscotta.  If your practice is interested in this option, call the New England Account Executive for New England, George Nightingale, Jr. at 617-558-0395.

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