February 23, 2009

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Update from MaineCare Provider's Advisory Group Meeting, February 19th

The MaineCare Provider Advisory Group (PAG) met on February 19, 2009 to review current MaineCare claims issues, the current status of the recovery of interim payments, and progress toward implementation of the new MIHMS (Maine Integrated Health Management System) on February 1, 2010.  Regarding interim payments, more than 96% of the $530+ million has now been repaid.

The Governor's Provider Advisory Group (PAG) and the related Technical Advisory Group (TAG) have met on a regular basis since early 2005 when the badly flawed MECMS system went live.  Certainly at that time, no one could have imagined that these groups would still be meeting during the fifth year of repairs, work-arounds, and patches that have all been result of the MECMS system.

A new claims management system is being built by the contractor Unisys, called MIHMS or the Maine Integrated Health Management System.  MaineCare, through the work of the PAG and TAG and through recent and on-going provider forums, appears to be avoiding the problems that led to the MECMS debacle and the resulting cost of more than $50 million.  Prior to turning on the MECMS system in 2005, there was no forum such as the PAG and TAG where MaineCare providers could provide input and be part of the development process.  With appropriate end -to-end testing, the February 2010 implementation is expected to go much smoother.  There is some work to be done by providers, of course, including re-enrollment that is taking place now.  But, it is a small price to pay for a claims and information system that is accurate, pays promptly, and is HIPAA compliant.  For physician offices, it will also be a relief to finally, after five years, have a payment system that is able to electronically process the Medicare Part B cross-over claims.

The group also received a briefing on the plan to eliminate all local codes by May 31, 2009. 

At the conclusion of the meeting, MaineCare Director Tony Marple provided an update on the status of provider-based reimbursement following the legislative action on the supplemental budget (L.D. 45).  The group had an opportunity to review a memo from the Commissioner that the Department released on Friday to providers.  The memo gave instructions to the provider-based entities regarding the change to billing the professional component on a CMS 1500 form.  Assuming that the agreements reached in the discussion on the supplemental budget hold through the biennial budget (L.D. 353), on July 1, 2009 all MaineCare professional fees will be paid to approximate 70% of the Medicare fee schedule, a significant increase from the 57% of Medicare paid currently.


Let MMA Do Your HIPAA Staff Training! April 3, 2009

The federal HIPAA privacy and security rules require your new staff to be trained in HIPAA and encourages annual HIPAA training for your existing staff.  On Friday, April 3, 2009 MMA will host its initial First Friday educational program, Annual HIPAA Update:  Privacy and Security.  The three hour program will begin at 9:00 a.m. and will feature three experts in on the HIPAA privacy and security regulations and state confidentiality laws.  The program is intended to meet the requirements for annual HIPAA training.  The program will be held at the Association offices in the Frank O. Stred Building in Manchester.

Gordon Smith, Esq., the Association's Executive Vice President and a frequent lecturer to medical groups, Kenneth Lehman, Esq., of the Portland law firm of Berstein, Shur, Sawyer & Nelson, and John Coolong, of Systems Engineering make up the faculty for this program.

The program will also update attendees on the changes in the HIPAA regulations that were included in the recent stimulus package.  These changes deal primarily with accounting for inadvertant disclosures and other aspects of enforcement. 

To register, call 622-3374, ext. 219 or go to the MMA website at www.mainemed.com.  There is a $60 fee which covers breakfast and all course materials.  For physicians attending, three hours of category one credit are available. [return to top]

Welcome to Newest Group Member: New Horizons and Inland Medical Associates

MMA welcomes today its newest group member, the employed physicians at Inland Hospital in Waterville.  New Horizons Health Care and Inland Medical Associates, both affiliated with Inland Hospital, include sixteen primary care physicians. 

Physician practices of ten or more physicians may take advantage of MMA's Group Membership Program if all the physicians belong and if the discounted dues are paid in one check.  If your practice is not currently taking advantage of this arrangement, please contact Gordon Smith, Esq., MMA Executive Vice President, at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com. [return to top]

Political Pulse: Legislative Highlights of the Week

During the week of February 16, 2009, the Appropriations & Financial Affairs Committee heard public hearings on the health and human services portions of the Governor's FY 2010-2011 biennial budget, L.D. 353.  As usual, the Health & Human Services Committtee joined the Appropriations Committee for these hearings.  On Tuesday, February 17, 2009, the MMA joined representatives of the Maine Hospital Association in opposing cuts to hospital-based physicians and to Critical Access Hospitals (CAH) that were carried forward from the Governor's supplemental budget proposal.  The proposed cut to hospital-based physicians is approximately $20 million per year in state and federal funds.  The proposed cut in reimbursement to critical access hospitals is approximately $6 million per year in state and federal funds.  Speakers opposing the cuts at the public hearing were:

  • Mary Mayhew, MHA
  • John Simko, Town Manager, Town of Greenville
  • Gino Murray, CEO, C.A. Dean Memorial Hospital
  • Dan Coffey, CFO, Eastern Maine Healthcare
  • Larry Hopperstead, M.D., CMO, Central Maine Healthcare
  • David McDermott, M.D., M.P.H., Emergency Department Director, Mayo Regional Hospital & President-elect, MMA

Dr. McDermott's testimony is or shortly will be posted on the MMA web site, www.mainemed.com.  As during the supplemental budget deliberations, the MMA expects extensive discussions of these two proposals in HHS and AFA work sessions in the weeks to come.  The HHS Committee has work sessions on the biennial budget scheduled for this week. 

Your legislative contacts on these issues this week should be focused on the HHS Committee and your own legislators.  

You can find your own legislators on the web at:  http://www.maine.gov/legis/house/townlist.htm.

You can find members of the HHS Committee and their contact information on the web at:  http://www.maine.gov/legis/house/jt_com/hum.htm.

You can call toll-free and leave a message at the State House for any legislator as follows:

  • Senators:  1-800-423-6900
  • Representatives:  1-800-439-2900

In other action last week, the Insurance & Financial Services Committee voted to table L.D. 257, An Act to Establish the Health Technology Clinical Committee, a bill sponsored by Rep. Charles Priest (D-Brunswick) that would set up a state level process for comparative effectiveness research.  Based upon Rep. Priest's suggestion, the Committee decided to table the bill until more is known about the health information technology and comparative effectivenss provisions of the federal stimulus bill. [return to top]

AMA Offers Physicians' Action Kit on Health System Reform

To help physicians prepare for active participation in current and future discussions on health system reform, the AMA has prepared an action kit outlining the organization's perspective on many of the key issues involved.  You can find this material on the AMA web site at:  http://www.ama-assn.org/ama/pub/legislation-advocacy/current-topics-advocacy/health-system-reform-action-kit.shtml.

The AMA will update the site as the national health care reform debate evolves. [return to top]

AMA Provides Summary of H.R. 1, the American Recovery & Reinvestment Act of 2009

The AMA has posted a summary of the stimulus conference agreement signed by President Obama in Denver last Tuesday, February 17, 2009.  At the end of the summary are links to 3 other documents summarizing provisions of the comparative effectiveness research, health information technology, and privacy provisions of the American Recovery & Reinvestment Act of 2009.  You can find the summaries here:  http://www.ama-assn.org/ama/pub/legislation-advocacy/current-topics-advocacy/hr1-stimulus-summary.shtm. [return to top]

Anthem Blue Cross And Blue Shield Wants To Raise Premiums

Maine's Bureau of Insurance has scheduled three public hearings next month on a request by Anthem Blue Cross and Blue Shield for approval of rate revisions to take effect May 1. The hearings are scheduled for March 3 in Orono, March 10 in Portland, and March 12 in Gardiner.

If the rate revisions take effect, premiums would rise 7.7 percent for its HealthChoice Standard and Basic, 17.2 percent for Anthem's HealthChoice product, and 34.1 percent for Lumenos Consumer Directed Health Plan. [return to top]

HIT Gets $19 Billion Boost, Comparative Effectiveness Research Gets $1 Billion

As part of the stimulus package signed into law by President Obama earlier this week, $19 billion is now dedicated to transforming the patient record into an electronic format. Health information technology (HIT) standards must be developed by Jan. 1, 2010, and physicians will be eligible for up to $44,000 worth of incentive payments for the use of an electronic record. The incentive payments will be spread over a four- to five-year period beginning in 2011.

In order to qualify for the financial assistance, a physician must meet all of the following requirements:

  • Use certified electronic health record (EHR) technology in a meaningful manner, including the use of e-prescribing;
  • Demonstrate that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information; and
  • Submit information on clinical quality measures and other measures, as required by the Department of Health and Human Services (HHS). 

Practitioners who do not adopt HIT will face a reduction in Medicare payments, starting with a 1 percent cut in 2015. Hardship exceptions from these penalties can be granted by HHS. ASCs are eligible for HIT grants and loans under the stimulus bill.

The stimulus package also includes $1 billion in initial funding for comparative effectiveness research that will focus on the clinical outcomes, effectiveness, risks and benefits of two or more medical treatments and services that address a particular medical condition. In addition, the final bill includes $10 billion for NIH for new research grants and renovations and construction at NIH facilities.

Other public health investments in the bill include:

  • $1 billion for prevention and wellness programs
  • $500 million for the National Health Service Corps and health professions education programs
  • $500 million to modernize aging Indian Health Service facilities
  • $2 billion for operations and capital needs at community health centers
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New Bills for Your Review & Comment/Legislative Committee Conference Call Schedule

The following are bills of interest to the physician community printed and referred to committees last week for your review and consideration.  Please note that clicking on the highlighted "LD XXX" will take you to a PDF version of the bill.

LD 502, An Act To Require Additional Information in the Annual Reports of Nonprofit Corporations (monitor)

LD 518, An Act To Authorize a General Fund Bond Issue To Enhance Funding for Stem Cell Research in Maine (monitor)

LD 519, An Act To Expand the Diagnostic Function of Denturists (radiologists; oppose)

LD 523, Resolve, Directing the Department of Health and Human Services and Department of Education To Enter into a Memorandum of Understanding Regarding Early Childhood Intervention (pediatricians; monitor)

LD 524, An Act To Provide Assistance to Family Members, Friends and Neighbors Who Provide Home Health Care for Senior Citizens (monitor or oppose)

LD 549, An Act To Amend the Employment Practices Law Regarding Substance Abuse Testing (monitor)

LD 550, An Act To Protect Maine Residents from Home Fires and Carbon Monoxide (support)

LD 552, Resolve, Authorizing Coverage of Enteral Formula under the MaineCare Program (pediatricians; support)

LD 563, An Act To Pay a State Share into the HealthInfoNet System (support)

LD 565, An Act To Define "Edentulous Arch" in the Laws Governing Denturists (monitor)

LD 572, An Act To Expand the Membership of the Maine Elder Death Analysis Review Team (monitor or support)

LD 574, Resolve, To Increase the Blood Supply (monitor)

LD 578, An Act Regarding Repayment of Subrogation or Lien Claims in Workers' Compensation Actions (monitor)

LD 579, An Act To Provide Wraparound Medical Coverage in the Workers' Compensation System (monitor)

LD 590, An Act To Establish a Wellness Tax Credit (monitor or support)

LD 599, An Act To Allow Noninvasive Testing of Infants for the Presence of Drugs without a Parent's Consent (pediatricians; monitor)

LD 600, Resolve, To Encourage Physicians To Administer the Injectable Painkiller Toradol in Lieu of Other Opioids (monitor)

LD 609,  An Act To Amend the Laws Governing Involuntary Hospitalization Procedures When Both Commitment and Involuntary Treatment Are Sought (psychiatrists; monitor)

LD 610, An Act To Add 10 Days to the School Year and To Require Daily Physical Exercise for All School Children (pediatricians; Public Health Committee; monitor or support)

LD 611, An Act To Provide Reimbursement in the MaineCare Program for Board-certified Behavior Analysts (psychiatrists; monitor)

LD 617, An Act To Amend the Maine Workers' Compensation Act of 1992 To Remove Independent Medical Examiners (physiatrists; monitor)

LD 623, An Act To Provide the Office of Chief Medical Examiner Access to Controlled Substances Prescription Monitoring Program Data for the Purpose of Conducting Cause of Death Investigations (monitor or support)

LD 624, Resolve, To Implement Certain Recommendations of the Report of the Governor's Task Force on Expanding Access to Oral Health Care for Maine People (pediatricians; Public Health Committee; support)

LD 625, Resolve, To Ensure All Children Covered by MaineCare Receive Early and Periodic Screening, Diagnosis and Treatment Services (pediatricians; monitor)

The next MMA Legislative Committeeconference call is scheduled for 8:30 p.m. on Thursday, February 26, 2009.  The conference call number is 800-989-2842 and the access code is 6223374#.  Everyone should join as "participants."  Any MMA member or specialty society representative is welcome to join the discussion of bills listed above and other legislative highlights.



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