April 14, 2008

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Political Pulse: State Senate Defeats Lay-Midwifery Licensing Proposal!

The Maine State Senate on Friday defeated the majority report on L.D. 2253 that would have licensed lay-midwives in the state and given them a scope of practice determined principally by their national certifying organization.  On a vote of 24 to 11, the Senate rejected the majority report of the Committee on Business, Research & Economic Development and then proceeded to adopt the minority report by the same margin.  Later in the day, the House of Representatives, which had previously adopted the majority report by a 30 vote margin, receded and concurred with the Senate action, all but ensuring that the minority report will be enacted and signed into law this coming week.

The minority report rejects licensing but does allow midwives to have access to a limited list of medications to use during home births.  MMA and many other medical organizations had opposed licensing, believing that licensing would lead to confusion with certified nurse midwives (CNM's) and would falsely imply that the state had ensured the safety of home births attended by lay midwives.

The legislature is expected to adjourn by the end of the coming week, but must first deal with the Dirigo Health legislation (L.D. 2247) and approximately 150 other bills.

1.  Direct entry or "lay" midwife licensing

The legislative action on L.D. 2253 ends at least temporarily the effort by midwives to seek increased stature in the state through licensing.  The effort in Maine was also a continuation of a national effort which has seen the midwives gain licensure in 24 states, including both New Hampshire and Vermont.  Despite the Department of Professional & Financial Regulation recommending against licensure in its "Sunrise Review" report, a bare majority of the Business, Research & Economic Development Committee voted to proceed with licensing through the existing Board of Complementary Health Care Providers.  That  Board currently licenses naturopathic doctors and acupuncturists.

The grassroots lobbying associated with the midwives effort was intense with several Senators reporting dozens of calls and contacts by midwives and women who had give birth at home attended by midwives.  MMA's efforts were complemented by the work of the Maine chapter of ACOG, the Maine Academy of Family Physicians, the Maine Chapter of the American Academy of Pediatrics, the Maine Chapter of the American College of Emergency Physicians, the Maine Association of Psychiatric Physicians, and the Maine Osteopathic Association.  In the later weeks, the Maine Association of Nurse Practitioners also assisted in the effort to oppose licensing.  MMA also received addition funds to assist in the lobbying effort from both the Maine Chapter of ACOG and the AMA's Scope of Practice Partnership.

The following is a list of the 24 State Senators who voted to reject licensing.  Please take the time to thank them for their effort at protecting the mothers and infants of Maine.  If your Senator is not on this list, he or she supported the midwives:  Senators Benoit, Brannigan, Bryant, Courtney, Diamond, Dow, Gooley, Hastings, Hobbins, Marrache, McCormick, Mills, Nass, Nutting, Perry, Plowman, Raye, Rosen, Savage, Sherman, Smith, Snowe-Mellow, Turner, and Weston.

In an article in the Bangor Daily News this weekend, a spokesperson for the midwives vows to continue in Maine the effort to become licensed, presumably in the next session of the legislature which convenes in December of 2008.

You can find the legislative history of L.D. 2253, An Act to License Certified Professional Midwives, including the roll call votes, on the web at:  http://janus.state.me.us/legis/LawMakerWeb/summary.asp?ID=280028293.

2.  Toxics Bill Now in Senate After Passing House Without Debate

The majority "ought to pass as amended report" (9-4) on L.D. 2048, An Act to Protect Children's Health & the Environment from Toxic Chemicals in Toys and Children's Products passed the House without debate last Wednesday, April 9, 2008.  The bill is awating Senate action this week.

The majority report authorizes the DEP  to include on a list of chemicals of high concern chemicals identified by specific entities.  Prior to designating priority chemicals, the DEP is required to consult with affected industries, independent experts, and other interested parties and with the Maine CDC.  It authorizes the BEP to adopt rules restricting the sale of children's products  containing priority chemicals if safer alternatives are available.  It authorizes DEP to designate mercury or a mercury compound as a priority chemical for the purpose of adopting rules to prohibit the sale of a mercury-added product that is not currently regulated. 

The minority report recommends a Resolve directing the DEP to work with the Maine CDC to develop a list of chemicals of high concern and to convene a stakeholder group to gather recommendations on the list.  It also requires the 2 state agencies to consult with various federal agencies to help identify areas where state action is practical and necessary.  Finally, it requires the 2 agencies to report back to the legislature on their efforts.

The MMA Public Health Committee has been actively engaged in supporting this bill.

3.  Dirigo Health Bill Remains Tabled in the House

L.D. 2247, An Act to Continue Maine's Leadership in Covering the Uninsured is tabled as unfinished business in the House.  With all House Democrats on the IFS Committee supporting the majority report, including the replacement of the "savings offset payment" (SOP) with a 1.8% health access surcharge, likely will pass the House.  The bill also includes a $0.50 per pack increase in the cigarette excise tax as part of the funding package.  These proposals will be much more controversial in the Senate where members of the Democratic caucus are looking for alternative funding mechanisms, including new soda and snack taxes, alcohol taxes, or money from the Fund for a Healthy Maine.  The MMA and other members of Health Policy Partners of Maine (including the Maine Coalition on Smoking or Health) oppose taking money from the Fund for a Healthy Maine for Dirigo funding.  Senators Bill Diamond (D-Windham) and Barry Hobbins (D-Saco) seem to be the leading proponents of this effort.  The MMA urges physicians concerned about the potential further diversion of funds from the FHM's prevention priority to call members of the Senate on the toll free line this week:  1-800-423-6900.  You also can find their contact information on the web at:  http://www.maine.gov/legis/senate/senators/index.htm.

4.  Legislative Committee Conference Call 
The next Legislative Committee conference call is scheduled for tomorrow evening, April 15th at 7 p.m.  The conference call number is 1-800-989-2842 and the access code is 6223374#.

5.  Legislative Schedule and Other Resources  
The Legislature's statutory adjournment deadline is Wednesday, April 16, 2008, but it is likely to take most of this week for legislators to complete their work.

You can find more legislative information on the Maine State Legislature's web site:  http://janus.state.me.us/legis.   

Daniel Corcoran named President of Anthem BCBS in Maine

Anthem BCBS in Maine this past week announced that Daniel P. Corcoran has been named president of the company.  He replaces Erin Hoeflinger, who earlier this year was appointed president of Anthem Blue Cross and Blue Shield in Ohio.

In his new position, Corcoran will be responsible for the management of all employer health insurance business in Maine including sales, account service, marketing, underwriting and product delivery, as well as for maintaining customer relationships.  In addition, he will lead strategy, planning and execution, and serve as the primary contact for state regulators to ensure compliance and manage any state-related matters.  He will be based at the company's South Portland headquarters.

Corcoran joined BCBS of New Hampshire in 2002.  He most recently had experience for financial planning and analysis for Anthem Blue Cross and Blue Shield plans in Maine, New Hampshire and Connecticut.  Previously, he served as senior finance associate for the New Hampshire market.

Corcoran is a graduate of the University of New Hampshire, Whittemore School of Business and Economics, and holds a Masters of Business Administration and a Masters of Science, Management Information Systems, from Boston University's Graduate School of Management.

"Dan has a proven record of business and community leadership and accomplishment and he is a great fit for Anthem Blue Cross and Blue Shield in Maine," said Erin Hoeflinger, president, Anthem Blue Cross and Blue Shield in Ohio, and Corcoran's predecessor in Maine.

"I am truly honored to be appointed the president of Anthem in Maine.  As Maine's largest health benefits company, we have a special role and obligation in providing both service and solutions for our members and Maine citizens," Corcoran said. [return to top]

Next "First Friday" Program Features 2008 Physician's Guide to Maine Law

The MMA's popular publication, The Physician's Guide to Maine Law was last published in 2002.  It has now been updated through the end of the 122nd Legislature (2006) and will be brought up to date through the end of the current legislative session and published on line this summer.  As we have had a lot of requests for the publication, we have scheduled a First Friday presentation for Friday, May 2nd to distribute three-ring binders with the material to be published and to discuss the materials.  MMA attorneys Andrew B. MacLean and Gordon H. Smith will present the material, emphasizing the changes since the last edition.  All the First Friday presentations are held at the MMA offices in Manchester and run from 9:00am to noon with breakfast being available during registration.

Among the topics to be discussed are the following:

  • Recent changes in the law regarding testing for HIV
  • Advanced Directives
  • Minor's Consent to Care
  • Confidentiality
  • Disclosure of practice charges
  • Prescribing for Pain
  • Medical-Legal Code of Cooperation
  • Mandatory Reporting

Watch your mail for flyers announcing the program or you may register online at www.mainemed.com.  There is a $60 registration fee which includes the cost for the binder. [return to top]

Voluntary Practice Assessment Initiative (VPAI) Available to Primary Care Private Practices

The Voluntary Practice Assessment Initiative, funded by the Maine Quality Forum, is still offering assessments at no cost to primary care practices which are privately owned.  While the target of the project is private practices which are not supported by a hospital or by a PHO, requests by such a practice will be considered on a case by case basis. 

So far, 67 physicians in over twenty practices have been assessed.  Practices with adult patients may choose to be assessed for their care of diabetic patients or patients with cardiovascular disease and pediatric practices may choose to be measured regarding their care of patients with asthma or their record of immunizations.  In addition to a chart review performed by an MMA reviewer, a patient satisfaction survey is also included as part of the assessment. 

In some cases, the assessment can be expanded to include enough charts to qualify for reporting to Pathways to Excellence, thus potentially enabling the practice to participate in pay for performance initiatives.

Practices interested in an assessment should call Gordon Smith at 622-3374 ext. 212 (gsmith@mainemed.com) or Nancy Morris at 799-1090 (nmtmha@aol.com).   [return to top]

MMA Executive Committee to Meet on Wednesday

The MMA Executive Committee will meet this coming Wednesday, April 16, at 2:00pm at the offices of the Association at the Frank O. Stred Building in Manchester.  The committee is chaired by David McDermott, M.D., a family physician from Dover-Foxcroft.

Among the items of business to be considered at the meeting are the following.

  • An update of Association activities funded by the state including the Voluntary Practice Assessment Initiative and the Prescribing for Pain Initiative.
  • A review of programming for the 155th Annual Session being held at the Samoset Resort Sept. 4-7.
  • Review financial performance for the 1st quarter, 2008
  • Review staffing changes and finances for the Physician Health Program, now to be known as the Medical Professionals' Health Program.
  • Review end of session legislative and political activities.

MMA meetings are open to any MMA member. [return to top]

SAVE THE DATE: 1st Congressional District Candidate Forum on Tuesday, May 13, 2008

The MMA Legislative Committee and the Trustees of the Maine Physicians Action Fund (MPAF) have scheduled the second forum of the year for Tuesday, May 13, 2008 from 5:30 to 8:00 p.m. at the MMA office in Manchester.  This event will be a candidate forum with the Republican and Democratic candidates for Maine's First Congressional District.  While we have not yet heard from all the candidates, we do expect Steve Meister, M.D., Adam Cote, Senator Ethan Strimling, former state Senator Mike Brennan, and Dean Scontras. 

Legislative Committee Chair Katherine Pope, M.D., Vice Chair Sam Solish, M.D., and PAC Chair John Makin, Jr., M.D. invite any interested member to join us for this event.  Please RSVP to Lisa Dennison at ldennison@mainemed.com or 622-3374. [return to top]

U.S. House Panel Recommends Moratorium on Controversial Medicaid Rules

Last Wednesday, April 9, 2008, the House Energy & Commerce Subcommittee on Health voted in favor of the Protecting the Medicaid Safety Net Act of 2008 (H.R. 5613).  The bill would impose a moratorium on 7 controversial proposed Medicaid regulations until April 1, 2009.  The moratorium would apply to CMS rules that would reduce or prohibit Medicaid reimbursements 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.

Four of the rules already are under moratorium.  The Senate has a companion bill (S. 2819) that also would extend the moratoriums until April 1, 2009 and would impose a moratorium on an August 2007 CMS directive regarding SCHIP eligibility.  The AAP spoke in favor of these actions at the subcommittee hearing. [return to top]

Senator Baucus Says Medicare Physician Fee Bill to be Considered by Mid-May

On Tuesday, April 8, 2008, Senate Finance Committee Chairman Max Baucus (D-MT) said that Medicare legislation including an 18-month fix for the physician fee schedule problem (the "SGR" methodology) likely will be considered by the full Senate by mid-May.  The Senate Finance Committee remains at work trying to determine how to pay for the package that probably will reduce reimbursement for some other Medicare providers.  The cost of this approach, however, may be prohibitive.  The AMA is supporting a bill (S. 2785) introduced by Finance Committee member Senator Debbie Stabenow (D-MI) that would replace the scheduled cut with a 0.5% increase for the remainder of 2008 and a 1.8% increase in 2009.

In related action, the Medicare Payment Advisory Commission (MedPAC) on April 9, 2008 voted to recommend that Congress increase reimbursement for primary care physicians and to fund a "medical home pilot project." [return to top]

Maine AAP Spring Conference, April 26-27, Sunday River

This year’s topic of Bright Futures, Foster Care, and Child Abuse Prevention has brought together a diverse slate of presenters and topics. On Saturday we will explore implications for clinical pediatric practice around child abuse prevention, the impact of abuse and neglect on child health and development, and strategies for the state and medical providers to improve care (and outcomes) for these children. Sunday will be entirely focused on a special program, the 6 G’s of substance use prevention.

For more information, click here [pdf] [return to top]

MPCA Holds Site Development Conference, April 30

HRSA recently announced proposed changes in the way the federal government designates areas as “underserved”. The Maine Primary Care Association Care Association and the Maine State Office of Rural Health and Primary Care will hold a Site Development conference to discuss these new rule changes and their potentially profound implications for Maine’s underserved communities and providers. The event will be held on Wed., April 30th, at the Lucerne Inn. 

For more information or to register, click here [pdf] [return to top]

Reminder: MMA's Annual Corporate Affiliate Breakfast this Wednesday, April 16, Portland Country Club

Nearly one hundred members and guests are expected to attend this week's corporate affiliate breakfast at the Portland Country Club.  The event will be held beginning at 7:30am and is expected to be concluded by 9:30am.  The speaker at this year's breakfast will be Joshua Daniel Sparling, M.D., currently on active duty in the military, who will speak of his experiences in Iraq in 2007 in support of Operation Iraqi Freedom.

Dr. Sparling is currently sole staff dermatologist responsible for all active duty and dependent patients in the 10th Mountain Division at Fort Drum.

Dr. Sparling received his medical training at Dartmouth Medical School and is an honors graduate of the University of Maine.

If you would like to attend this event, for which there is no cost to attend, please call Lisa Martin at MMA at 622-3374 ext. 221 or via e-mail to lmartin@mainemed.com. [return to top]

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