March 10, 2008

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Political Pulse: New Dirigo Legislation, Budget "Change Package," & Other Highlights of the Week

The Legislature's Joint Standing Committee on Insurance & Financial Services will hold a public hearing this coming Thursday, March 13, 2008 on L.D. 2247, An Act to Continue Maine's Leadership in Covering the Uninsured, introduced this past week under the sponsorship of House Majority Leader Hannah Pingree (D-North Haven).  The bill contains the recommendations of the Baldacci Administration for the future funding of the Dirigo Health Agency and its programs and it includes an increase in the cigarette tax from $2.00 to $2.50 a pack and increases the tax on other tobacco taxes as well.  The other principal funding mechanism is a "health access surcharge" of 1.8% on paid health insurance claims.  MMA expects to be able to support most of the provisions in the legislation.

 1.  L.D. 2247, New Dirigo Legislation 

The hearing on L.D. 2247 will be held at 1:00 p.m. on Thursday afternoon in Room 427 of the State House.  In addition to the cigarette tax increase, the bill proposes to replace the existing "Savings Offset Payment" with a "health access surcharge" of 1.8% on paid claims.  The bill also establishes a reinsurance association for the individual health insurance market, in lieu of creating a high risk pool.  The bill would also allow health insurance companies to test new products designed for persons under the age of 30 in the individual market., subject to approval by the Insurance Superintendent.

Passage of the legislation could allow the DirigoChoice product to be offered, once again, to individuals.  Currently, enrollment is frozen for most categories.

Many of the provisions in the bill were recommended by a Blue Ribbon Commission which met during 2006 but whose recommendations were never presented during the first session of the current legislature.  The Commission had been chaired by former UNE President Sandra Featherman.  Robert McAfee, M.D., Peter Toussaint, M.D., and MMA EVP Gordon Smith all served on the Commission that  issued a series of unanimous recommendations.

Part D of the bill makes permanent the temporary voluntary cost containment targets on hospital consolidated operating margins and cost increases included as part of the original Dirigo legislation passed in 2003.

Most of the provisions in the bill appear consistent with existing MMA policy and MMA expects to support the bill, subject to a discussion with the MMA Legislative Committee which meets on its weekly conference call on Tuesday evening at 7:00 p.m.

You can see the text of the bill on the web at:  

 2.  Update on Legislation to License Direct-Entry Midwives

The Legislature's Joint Standing Committee on Business, Research & Economic Development (BRED) held a work session on the Sunrise Review Regarding the Practice of Licensed Midwiferyon Tuesday, March 4, 2008.  A bare majority of the 13-member committee voted to set aside the recommendation of the Department of Professional & Financial Regulation (DPFR) to reject licensing.  Six members of the Committee supported the report, thereby rejecting licensure, but supported an alternative proposal to make some medications and oxygen available to the so-called "lay" midwives. 

Because of the legislature's procedural rules, a new bill will be printed this week and will be the subject of a public hearing during the week of March 17, 2008.  While the language of the new bill will be the same as the original proposal, L.D. 1827,  the committee majority plans to recommend licensure by the current Board of Complementary Health Care Providers that now licenses naturopathic doctors and acupuncturists. 

The MMA,. the Maine Section of ACOG, the Maine Chapter of the American Academy of Pediatrics, and the Maine Academy of Family Physicians all strongly oppose licensing but are considering the alternative proposal to make limited medications available to them.  ACOG members discussed the proposal extensively at a meeting over the weekend.  The MMA will continue to solicit feedback from physicians through the next public hearing. 

Currently, there are 22 direct-entry midwives practicing in the state who are nationally certified.  An additional handful of practicing midwives are not nationally certified.

You can research the legislative history of L.D. 1827 on the web at:

You can find the DPFR report on the web at:

3.  The FY 2008-2009 Supplemental Budget "Change Package" 

The legislature received the Governor's proposed "change package" to L.D. 2173, the supplemental budget, on Wednesday, March 5, 2008.  The new proposal addresses a budget gap that has grown to more than $200 million.  The new proposal includes more cuts in health and social services in addition to the $20 million cut in hospital-based physician reimbursement.  New savings include:

  • elimination of the pharmacy benefit for the "non-categorical" population to save approximately $20 million;
  • elimination of coverage for podiatric services to save $1.3 million;
  • reducing MaineCare hospice reimbursement rates to Medicare rates to save $230,000; and
  • restructuring of DHHS to save approximately $1.5 million.

You can find the "change package" materials on the web at:

The Appropriations Committee has scheduled two days of hearings this week on the "change package."  The DHHS provisions are scheduled to be heard beginning at 9:30 a.m. on Wednesday, March 12, 2008 in Room 228 of the State House.

4.  HHS Committee Recommends Passage of Amended Version of Bill on Non-payment for "Never Events" 

At a work session on Tuesday, March 4, 2008, the HHS Committee voted 11-2 in favor of L.D. 2044, An Act to Prohibit Payment to Health Care Facilities for Treatment to Correct Mistakes or Preventable Adverse Events as amended through negotiations by the Maine Hospital Association and the prime sponsor, Rep. Patsy Crockett (D-Augusta)The two physician members of the Committee, Sen. Lisa Marrache, M.D. (D-Kennebec) and Rep. Bob Walker, M.D. (R-Lincolnville), voted against the bill because of concern about the scope of the list of "never" events.  The MMA will coordinate any further action on the bill with the MHA.

5.  Colorectal Screening Insurance Mandate Close to Enactment 

On Tuesday, March 4, 2008, the House voted 140-0 in favor of L.D. 2109, An Act Relating to Insurance Coverage for Colorectal Cancer Early Detection, a 12-1 "ought to pass as amended" report from the Insurance & Financial Services Committee.  The Senate accepted the report today.  The bill would require health insurance coverage for colorectal screening recommended by a physician in accordance with the guidelines of the American Cancer Society.  Brunswick gastroenterologist John "Jay" Bosco, M.D. was instrumental in achieving this positive result.

You can see the legislative history of the bill on the web at:

6.  HHS Committee Takes Further Action on Lead Threat to Children 

In a work session last Friday, the HHS Committee unanimously recommended passage of two bills dealing with lead poisoning.  L.D. 2053, An Act to Ensure that Children's Toys and Products are Free of Lead would restrict the sale or distribution of a lead-containing children's product in this state, including a toy, child care article, lunch box or children's jewelry.  A lead-containing product is defined as a product or product component containing more than 0.004% lead by weight (40 part per million).  Reacting to concerns raised by the Maine CDC and the MMA, Rep. Gary Connor (D-Kennebunk) revised L.D. 2172, An Act to Protect Children from Lead Poisoning to be a Resolve.  The Resolve will do the following:

  • Require Maine CDC to identify areas of the State that are of high risk for children with elevated blood lead levels based on analysis of blood lead surveillance data;
  • Require Maine CDC to attempt to achieve universal blood screening in high risk areas for children age 12 and 24 months, and for any child age 25 to 72 months that has either never previously been tested or has had a change in risk of exposure to lead (e.g., moved into a pre-1950 dwelling or live in a pre-1950 dwelling that has had recent renovations or remodeling);
  • Require Maine CDC to report back to the HHS Committee annually, beginning January 2009 on identifying high risk areas, progress made in achieving universal screening in designated high risk areas, lessons learned in attempting to achieve universal screening, and any further recommendations for screening; and
  • Require DHHS and the Department of Education to report back to the HHS Committee on the feasibility of and possible procedure for getting lead screening information on children into school records.

7.  HHS Committee Recommends Resolve on Screening for Autism

At a work session on Thursday, March 6, 2008, the HHS Committee unanimously recommended passage of an amended version of L.D. 1977, Resolve, to Establish a Statewide Protocol for the Early Detection and Treatment of Autism. The amended Resolve includes Section 1 of the bill addressing the establishment of a uniform statewide screening protocol, but deletes Section 2 mandating intervention.  You can review the bill text on the web at:

8.  Legislative Committee Conference Call

The next Legislative Committee conference call will be Tuesday, March 11, 2008 at 7 p.m.  The conference call number is 1-800-989-2842 and the access code is 6223374#.

9.  Other Resources

You can find more legislative information on the Maine State Legislature web site:

You can leave a message for Senators at the State House by calling 1-800-423-6900.

You can leave a message for Representatives at the State House by calling 1-800-423-2900. 





Report on MMA Executive Committee Meeting this Past Wednesday

Despite Wednesday's storm, 17 members of MMA's Executive Committee participated in its regularly scheduled meeting last Wednesday, March 5, 2008.  Action taken at the meeting included the following:

  • Amendments were made to the 2008 budget previously voted at the Annual Meeting in September.  The adjustments were based largely upon the final financial results for calender year 2007.

  • Approved a group membership proposal for members of the Maine Academy of Family Physicians.

  • Approved an amended budget for the Physician Health Program, including funds for an administrative assistant and part time case manager.

  • Heard an update on the Voluntary Practice Assessment Initiative, funded by the Maine Quality Forum.

  • Approved a proposal to blend the existing Professionalism Initiative into existing MMA committee activities.

The Committee is chaired by David McDermott, M.D., a family physician and emergency room director in Dover-Foxcroft. [return to top]

MMA Receives Board of Licensure Support to Provide Consultations in Pain Management

The Maine Medical Association, through a contract with the Board of Licensure in Medicine, is now offering a consultation service to medical practices on the subject of pain management.  At no cost to the practice, Noel Genova, PA-C will visit any practice that requests the assistance and conduct an audit for existing narcotics prescribing.  The audit will review items such as:

  • Use of the Prescription Monitoring Program;

  • Use of a modern narcotics contract and compliance with its terms;

  • Use of a registry of narcotics users;

  • Compliance with BOLM Guidelines for Prescribing for Pain (1999); and

  • Review of the chart for appropriate consultations, periodic office examinations, and use of evidence-based guidelines.

The consultations will be strictly confidential with the results being provided only to the practice.

To schedule a consultation, call Noel at 671-9076 or Gordon Smith, EVP at 622-3374, ext. 212. [return to top]

Central Maine HealthCare Announces Affiliation, Future Purchase of Parkview Adventist Hospital

Last Monday, March 3, 2008, Central Maine Healthcare, the parent company of Central Maine Medical Center, Rumford Community Hospital, and Bridgton Hospital, announced its plans to acquire Parkview Adventist Medical Center in Brunswick.  The sale is expected to be completed by the end of the summer.

Representatives of the two health systems said at the announcement that Parkview, the smaller hospital, will benefit from increased purchasing power, better access to capital, and improved recruitment of physicians.  Parview is a 55-bed hospital with nearly 500 employees and 137 on its medical staff.

The previous Friday, Parkview closed its obstetrical service, citing the loss of business associated with the pending closure of Brunswick Naval Air Station and the loss of patients who followed three obstetricians who moved to the larger MidCoast Hospital last year.

Parkview will continue to be governed by its own Board of Trustees with final decisions being subject to approval of the CMHC Board. [return to top]

Massachusetts Leads In E-Prescribing

During a press briefing for the Sate-Rx Awards on Tuesday, March 4, 2008, Massachusetts was recognized as the national leader in transmitting prescriptions electronically rather than by fax or paper.  In 2007, prescribers sent more than 4 million prescriptions electronically.  This is 13.4% of "eligible" prescriptions and more than 6 times the national average.  In addition to Massachusetts, the other "top ten" e-prescribing states are Rhode Island, Nevada, Delaware, Michigan, Maryland, North Carolina, Arizona, Connecticut, and Washington.  At the briefing, the American Academy of Family Physicians, the Medical Group Management Association, the American Academy of Pediatrics, the American College of Cardiology, and the American College of Obstetricians & Gynecologists announced that they are rolling out a new web site to assist physicians in acquiring and using e-prescribing technology. [return to top]

Waxman Report Says States Will Lose $50 B Under New CMS Regulations - Maine Sues Feds

According to a report released on March 3, 2008 by Henry Waxman (D-CA), Chairman of the House Committee on Oversight and Government Reform, states would lose nearly $50 billion over 5 years as a result of 7 new CMS regulations.  The OMB had estimated the reductions to be $15 billion over 5 years and CMS disputed the report.  

The 7 regulations would:

  • reduce Medicaid reimbursement for public and teaching hospitals;
  • narrow Medicaid coverage for outpatient hospital services, rehabilitation services, school-based administrative and transportation services, and case management services; and
  • restrict how states raise funds for Medicaid.

On February 29, 2008, 4 state Medicaid agencies, led by Maine, filed suit in the U.S. District Court for the District of Columbia to strike down the new rule on reimbursement for case management services.  Maine is joined in the suit by Maryland, New Jersey, and Oklahoma.  The Maine AG's office has said that the rule would cost Maine $16 million during the next 2 fiscal years.  The suit alleges that the rule fails to comply with the Deficit Reduction Act of 2005 because it excludes the delivery of foster care services, restricts the states' right to direct the delivery of underlying services, limits the scope of underlying administrative activities, and removes the ability of the state to require assessments for affected populations. [return to top]

State Appeals Order Striking Down Prescriber Data Restriction Law

On February 25, 2008, the State of Maine filed a notice of appeal of Judge John A. Woodcock, Jr.'s order late last year finding that Maine's prescription data privacy law, L.D. 4, inappropriately restricted free speech.  On February 15, 2008, Judge Woodcock amended his order to permit certain non-enforcement aspects of the law to move forward.  The amended order allows the State to:

  • continue to permit prescribers to register and provide information so they can be listed as having opted out of disclosure of their prescribing practices;
  • to compile for public information the identities of those prescribers; and
  • to collect fees due by statute from drug manufacturers.

The New Hampshire law pre-dating Maine's also was struck down on First Amendment grounds and the State's appeal is pending before the Court of Appeals for the First Circuit.  Oral argument in the matter took place on January 9, 2008.   Vermont has agreed not to implement its law until a decision comes down on the New Hampshire law.  [return to top]

Public Hearing Scheduled Next Week on Latest State Health Plan

The 2008/2009 State Health Plan has been published and will be the subject of a public hearing before the Governor's Office of Health Policy & Finance and the Advisory Council on Health Systems Development on Tuesday, March 18, 2008 from 9:00 a.m. to noon in the Augusta Room of the Augusta Civic Center.  Written comments may be submitted to Jude Walsh, Governor's Office of Health Policy & Finance, State House Station 15, Augusta, Maine 04333-0015 until 5 p.m. on March 28, 2008.

You may find the new State Health Plan and related documents on the web at: [return to top]

New Bills for Your Review and Comment

The MMA has identified the following new bills of interest to the physician community.  By clicking on the "LD xxxx," you can go to the text of the proposal on the legislature's web site.  For each bill, MMA Deputy EVP Andrew MacLean has suggested a proposed position and any specialty or MMA Committee that may be specifically interested in the bill.

If you have comments about the bill or the proposed MMA position, or if you or your specialty society would like to participate in the public hearing on a bill, please contact Andrew MacLean at or 622-3374, ext. 214.

LD 2218,  An Act To Protect Children from Hazardous Lead-based Paint (monitor or support) (pediatricians, Public Health Committee)

LD 2224, An Act To Require Legislators and Their Dependents To Be Enrolled in Dirigo Health (monitor)

LD 2231An Act To Reduce the Cost of Prescription Drugs Purchased by the State and Counties by Using Section 340B of the Federal Public Health Service Act (monitor)

LD 2242An Act To Fund the Universal Childhood Immunization Program (support) (pediatricians, Public Health Committee)

LD 2243An Act To Increase the Number of Mandated Reporters of Abuse, Neglect or Exploitation (monitor) (pediatricians)

LD 2247, An Act To Continue Maine's Leadership in Covering the Uninsured  (support) [return to top]

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