February 18, 2008

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"Sunrise Review" Report Recommends Against Licensing of Lay Midwives

On Friday (Feb. 15), The Commissioner of Professional and Financial Regulation submitted the sunrise review report regarding the practice of licensed midwifery to the Joint Standing Committee on Business, Research and Economic Development, which has jurisdiction over professional licensing statutes.  The report was submitted pursuant to Resolve 2007, Chapter 115 which asked the Department to conduct the study under the sunrise statute.  The conclusion of the report is that the state's 22 lay midwives should not be licensed by the state.  MMA,  the Maine Chapter of ACOG, the Maine Academy of Family Physicians and the Maine Chapter of the American Academy of Pediatrics all opposed the legislation which would have licensed the practice of lay midwifery in the state.  The report will be considered by the committee which still has the authority to vote out a licensing bill if members disagree with the Department's recommendation.

Following a somewhat contentious hearing last year, which attracted nearly 100 midwives and their supporters, the Business, Research and Economic Development (BRED) Committee referred the bill (L.D. 1827, An Act to License Certified Professional Midwives to Promote Greater Public Safety and Access) to the Department which has the authority under Maine law (Title 5, section 12015) to evaluate proposals that would establish a licensing board or otherwise regulate an unregulated occupation or profession.  The same process is required when proposals are put forward to substantially expand regulation of an occupation or profession already regulated by the State.  This "sunrise review" process was established in l995 and has been strongly supported by MMA and other specialty societies as it provides for an independent process of evaluating licensing and "scope of practice" issues which can be particularly contentious within medicine.

"Sunrise Review" is a tool for state policymakers to systematically assess proposals to expand the scope of practice of a regulated profession or establish new regulatory requirements for a previously unregulated profession.  Importantly, the purpose of the review is to analyze whether the proposed regulation is necessary to protect the health, safety and welfare of the public.

Lay midwives, also called direct-entry midwives, are individuals who are self-regulated in Maine and in many other states (although about 16 states license them).  They typically attend home births and are not credentialed by most health plans to receive insurance reimbursement.  There are two national accrediting bodies, which are comprehensively described in the Department's report.  These individuals are frequently confused with Certified Nurse Midwives, who are nurses who have undertaken additional training and certification in obstetrics and are licensed by the Board of Nursing as Nurses in Advanced Practice.  Lay midwives are not nurses and are not credentialed to provide obstetrical or newborn care in any hospital in Maine.

In its conclusion and recommendations in the Report, the Department notes that, "the 22 CPMs practicing in Maine are knowledgeable, compassionate and sincerely dedicated to the welfare of women and children. The competence of these CPM's is suggested through good birth outcomes and the absence of examples in which serious medical problems have resulted form the care they provide, as well as through favorable feedback from current and former clients." 

The Report also concluded that the educational and training requirements imposed by the national certifying organizations are "at least adequate to prepare an individual for practice as a CPM".  (MMA would take strong exception to this particular finding.)

Nonetheless, the Department concluded that, "a case has not been made that public health and safety is jeopardized by the unlicensed practice of midwifery by CPMs or any other midwife in the State of Maine.  To the contrary, evidence indicates that current voluntary educational and credentialing options provide adequate protection for the small number of women who choose home birth assisted and supported by midwives."

Slightly over 1% of Maine births are accomplished at home, with many of these attended by midwives.

The Report concludes, Based on the information received and discussed above, the Department concludes that State regulation of midwives is not warranted and recommends no action be taken on the proposal that is the subject of this independent assessment.

The entire Report is available on line at http:mainegov-images.informe.org/pfr/legislative/documents/MidwivesSunriseReport.pdf

No date has yet been set for the BRED Committee to formally receive the report and act upon it.  The Committee has the authority to accept the report or to reject it and vote out the legislation allowing for licensing. "While I hope the Committee will accept the findings and conclusions of the Department, MMA remains concerned that with the sponsor of the bill being one of the two co-chairs of the committee and with several committee members having co-sponsored the original legislation, the Committee may just ignore these recommendations and vote the bill out, noted Gordon Smith, MMA Executive Vice President.  "Should this be the case, MMA will work with the Maine Chapter of ACOG, the Maine Academy of Family Physicians, and  the Maine Chapter of the American Academy of Pediatrics and other medical organizations in opposing the legislation.  The health and safety of Maine's moms and their babies requires no less."


MMA Public Health Committee Focuses on Three Major Initiatives for 2008

MMA's Public health Committee (PHC) members met via teleconference call this past week and in addition to hearing a brief presentation on the status of the Maine Childhood Immunization Program regarding Vaccine Supply and Immunizations, by Jiancheng Huang, MD and Dora Mills, MD with the MeCDC, Committee Chair Charles Danielson, MD led a discussion with the members to enhance the role of the PHC and formalize its' 2008 major initiatives.  Among the issues raised and discussed that may be of interest to Weekly Update readers were the following:

  • The overall role of the PHC was defined to support the MMA, the leadership and staff in enhancing the health of Mainers.  The committee will address issues of healthy communities and clinical preventative services and should maintain an understanding of how core public health services, such as disease control, disaster response, environmental health, vital statistics and other public health data are provided in Maine.
  • The committee has established three major initiatives for 2008 and will conduct an in-depth review of each that will serve as a base for policy recommendations to the Maine Medical Association.
    • Childhood Immunization Supply & Vaccines,
    • Childhood Obesity/Management and,
    • Toxics and Children's Health
  • Members agreed that the PHC should continue its reactive mode of operating regarding emerging public health issues, and constantly be vigil in its efforts; as well as create stronger linkages with other physician public health associated groups and public health initiatives, such as the Public Health Work Group, Physicians for Social Responsibility and others.
  • Members endorsed L.D. 2048, An Act to Protect Children's Health and the Environment from Toxic Chemicals in Toys and Children's Products (sponsored by Rep. Hannah Pingree)

The PHC will meet again on March 26, 2008 from 4-6pm at the MMA office.  Members can also join the meeting by teleconference or video conference (MaineHealth Board Room).  For more information, contact Kellie Miller at MMA at kmiller@mainemed.com or 207-622-3374, ext. 229. [return to top]

Maine Center for Public Health Annual Meeting, March 11, 2008

The Maine Center for Public Health's Annual Meeting will address, "Setting Standards and Measuring Improvement in Public Health" on March 11, 2008 at the Senator Inn, Augusta, Maine from 10am - 4pm.  Leslie Beitsch, MD, JD, Florida State University College of Medicine will lead participants through a discussion on what we should expect from a public health system.  Dr. Beitsch will explain the current status of accreditation and standards in public health, with some examples of opportunities for health system and public health/community collaboration that can emerge from this framework.

For more information and to register visit www.mcph.org/events.htm or call 207-629-9272, ext. 204.  [return to top]

Maine HIV Advisory Committee Update

MMA staff attended the recent meeting of the Maine HIV Advisory Committee, with discussion focusing on the two provisions in the Supplemental Budget (L.D. 2173), the committee is opposing: 1) the imposition of a cap on enrollment of noncategorial adults into the MaineCare Program and, 2)  elimination of HIV prevention funds earmarked for support of the Maine AIDS Alliance.  Key findings from  the recent 2007CPG Needs Assessment Survey indicated that most people (90%) prefer to receive their HIV information from their doctor.  Results of the needs assessment will assist in the advisory committees strategic action plan to further reduce risky behaviors. [return to top]

Political Pulse: Legislative Highlights of the Week

1.  Legislature Takes a Break for School Vacation Week

The Legislature has scheduled no sessions for the week of February 18, 2008 and most committees other than the Appropriations Committee are not working.

2.  Governor's FY 2008-2009 Supplemental Budget/HHS Committee Work Sessions 

The Health & Human Services Committee conducted several work sessions on L.D. 2173, the supplemental budget proposal, this week.  On Thursday, February 14, 2008, Commissioner Harvey provided an update on the Department's role in addressing the additional budget gap that could be as much as $100 million.  The Administration has not yet given the legislature its proposal to fill the additional gap.  The Commissioner and staff then briefed the Committee on the Department's responses to a series of questions raised by members during the public hearings.  The Committee chairs and leads concluded that the Committee could make no progress on its recommendations until it received the new plan to cover the additional gap.   The Committee, therefore, has delayed its report back to the Appropriations Committee and will pick up its budget work again during the week of February 25, 2008 or later.

The MMA and MHA continue to need your grassroots assistance as we work to persuade both committees to reject the proposed $20 million reduction in reimbursement for hospital-based physicians.  Dr. Flanigan's testimony has been posted on the MMA website for your reference.  The MHA's talking points on the budget issues may be found on the web at:  http://www.themha.org/advocacy/physcuts.htm.

You can find members of the HHS Committee and their contact information on the web at:  http://janus.state.me.us/house/jt_com/hum.htm.

You can find members of the Appropriations Committee and their contact information on the web at:  http://janus.state.me.us/house/jt_com/afa.htm.

You also can leave messages for any Senator at the State House by calling toll free, 1-800-423-6900.

You can leave messages for any Representative at the State House by calling toll free, 1-800-423-2900

If you have further questions or comments about this matter, please contact Andrew MacLean, Deputy EVP, at amaclean@mainemed.com or 622-3374, ext. 214.

3.   DPFR Releases Sunrise Report on "Lay Midwives"

The Department of Professional & Financial Regulation has released its report, Sunrise Review of the Practice of Licensed Midwifery and it may be found on the web at:  http://mainegov-images.informe.org/pfr/legislative/documents/MidwivesSunriseReviewReport.pdf.  While the MMA staff has not had a chance to read the report, we understand that it recommends against licensure.  The Legislature's Business, Research & Economic Development (BRED) Committee likely will take up the report in late February or early March.

4.  Joint Order on Parental Consent to Dispense Contraception

On Tuesday, February 12, 2008, the Legislature again took up the Joint Order (S.P. 842) Directing the Joint Standing Committee on Health and Human Services to report out, to the Senate, a bill regarding parental consent to dispense prescription drugs to children.  The Joint Order again passed in the Senate by a vote of 27 to 8, but it failed again in the House by a vote of 75 to 64.  The matter is now closed for this session.  Drs. Dan Summers and Russ DeJong submitted an op-ed that appeared in the Kennebec Journal on Thursday, February 14, 2008:  http://kennebecjournal.mainetoday.com/view/columns/4764352.html.

5.  Legislative Committee Forum on the MaineCare Budget Scheduled for Monday, February 25, 2008 

Building upon the success of two similar events conducted during the 2007 session, the Legislative Committee has planned a forum on the MaineCare budget situation, including the physician reimbursement issues, for Monday, February 25, 2008 from 5:30 to 7:30 p.m.  The MMA will invite several legislators from the Appropriations and HHS Committees to participate in the forum.  Any member is welcome to attend.  Please RSVP to Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

6.  Public Hearing Schedule 

You can find the most recent public hearing schedule on the web at:  http://www.maine.gov/legis/senate/Documents/hearing/ANPHFrame.htm.
[return to top]

Dirigo Health Agency Board Considers Schedule for Year 4 Aggregate Measurable Cost Savings

At its regular meeting on Monday, February 11, 2008, the Dirigo Health Agency Board received a briefing from William Laubenstein, AAG on a proposed schedule for determining the Aggregate Measurable Cost Savings for Year 4 of the Dirigo Health Program, the process for arriving at the "savings offset payment" (SOP), the principal funding mechanism for the Program.  The Agency plans to begin the process in early March and hold 2 days of hearings on July 22 and 23, 2008.  Director of the Governor's Office of Health Policy & Finance, Trish Riley, advised the Board that House Majority Leader Hannah Pingree is working on a bill that combines some private insurance market reform measures and a long-term funding alternative to the SOP that the legislature hopes to take up before adjournment.  She also provided an update on the status of the latest State Health Plan.  Dirigo Executive Director Karynlee Harrington told members that there now are 14, 087 members enrolled in DirigoChoice and gave an update on other activities of the Dirigo staff.  MQF Director Josh Cutler, M.D. told members that the MQF Advisory Council would provide input to the state health planning process in 3 areas:  the "medical home" concept, variation analysis, and clinical infection-related measures.

The Board is next scheduled to meet on Monday, March 24, 2008.  [return to top]

Mila Kofman, J.D. Confirmed as Maine Insurance Superintendent

Mila Kofman, J.D., Governor Baldacci's nominee for the position of Insurance Superintendent, won State Senate confirmation last Thursday in a straight party line vote of 18 to 17.  The vote is closer than it looks as following an 8 to 5 vote in favor of the nomination by the Insurance and Financial Services Committee on Tuesday, it would have taken a two-thirds majority in the Senate to reverse the committee's recommendation.

At the confirmation hearing on Tuesday, MMA testified in favor of Ms. Kofman, believing that her extensive background in health insurance would serve the state well at this time.  A copy of the testimony is posted on the MMA website at www.mainemed.com.

"While it is unfortunate that Mila's confirmation was done on a strictly partisan basis, I am pleased to see her confirmed and look forward to working with her," said Gordon Smith, Esq., MMA's Executive Vice President.  "Given that Maine has just about the highest health insurance premiums in the nation, her expertise and interest in this field will assist her greatly in getting up to speed in Maine."

MMA representatives have had an opportunity to meet with the new Superintendent who will serve in the position until April, 2009 (serving the remaining term of Alessandro Iuppa) and then may be renominated for a full term. [return to top]

Toxics and Tomorrow's Children Conference, March 14, USM

Physicians for Social Responsibility presents "Toxics and Tomorrow's Children", March 14, 2008 at the Abromson Center, USM, Portland, Maine.

 The objective of this conference is to increase the understanding of the current state of scientific knowledge regarding the adverse health impacts of toxics on children and to engage health care providers, educators, environmental health scientists, members of the public health community and state agencies in collaborative work to identify the highest priority toxic threats to Maine children's health and identify steps to be taken to reduce those risks.

Keynote speaker is Philip J. Landrigan, M.D., M.Sc., a pediatrician and the Ethel H. Wise Professor and Chair of the Department of Community and Preventive Medicine of the Mount Sinai School of Medicine in New York City.  He directs the Mount Sinai Center for children's Health and the Environment.  Local speakers include:  Sydney Sewall, M.D., MPH, Maine Chapter, American Academy of Pediatrics will be speaking on Respiratory Health & Children.

For more information, and to register, visit www.psrmaine.org or call 207-772-6714  [return to top]

MMA Participates in Academic Detailing Informational Summit

On last Monday (Feb. 11), MMA representatives attended an informational summit on the topic of academic detailing in Concord, New Hampshire. The summit was sponsored by Prescription Policy Choices, a nonprofit educational and public policy organization founded in 2005 to provide independent, objective information and on-the-ground expertise on prescription drug policy.  The organization is based in Hallowell.  The Academic Detailing Planning Initiative (ADPI) was made possible through funding by the Endowment for Health, the New Hampshire Medical Society, Community Catalyst/The Prescription Project, Maine Health Access Foundation, the Bingham Program, and the Nathan Cummings Foundation.

Representatives of the New Hampshire Medical Society and the Vermont Medical Society also attended the program which featured presentations by academic detailing initiatives in Vermont, So. Carolina, Pennsylvania, Canada and Australia.

The purpose of the summit is to advance an objective, scientific approach to physician education known as "academic detailing."  It is hoped that a collaborative academic detailing program could be established in Maine, New Hampshire and Vermont.

Both Maine and Vermont have passed legislation supporting academic detailing and New Hampshire is considering similar legislation at this time. 

A follow-up meeting is being scheduled for March. [return to top]

MECMS Provider Advisory Group to Meet Thursday

The Governor's Provider Advisory Group organized to provide input on the MaineCare MECMS problem will hold its monthly meeting on this Thursday, Feb. 21, 2008 at the offices of MaineCare on Civic Center Drive in Augusta.  MMA representatives will attend the meeting.

On the agenda is a presentation by representatives of the new vendor, Unisys, which has been hired to build a new claims management system, to be operational by Jan. 1, 2010.  The plans for the new system will be presented.

MMA has also asked that reports of alleged harsh collection practices employed by the Department  in the case of physicians owing interim payments but owed funds for unpaid claims be discussed. [return to top]

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