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: http://janus.state.me.us/legis/LawMakerWeb/externalsiteframe.asp?ID=280028222&LD=2247&Type=1&SessionID=7
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: http://janus.state.me.us/legis/LawMakerWeb/summary.asp?ID=280024886.
You can find the DPFR report on the web at: http://mainegov-images.informe.org/pfr/legislative/documents/MidwivesSunriseReviewReport.pdf.
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: http://www.maine.gov/legis/ofpr/08_09_Supplemental_Budget/budget_materials.htm.
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: http://janus.state.me.us/legis/LawMakerWeb/summary.asp?ID=280027656.
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: http://janus.state.me.us/legis/LawMakerWeb/externalsiteframe.asp?ID=280027469&LD=1977&Type=1&SessionID=7
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: http://janus.state.me.us/legis.
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.