November 16, 2009

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AMA House of Delegates Reaffirms Commitment to Health System Reform at Interim Meeting

The AMA House of Delegates debated health system reform at the AMA interim meeting from November 7-10, 2009 in Houston, Texas.  Despite resolutions from some state and national specialty societies in opposition to the AMA's support of H.R. 3200 and H.R. 3962, the AMA House reaffirmed its position in support of health system reform through a vehicle known as "Substitute Resolution 203."

At last week's meeting in Houston, the AMA reaffirmed its endorsement of H.R. 3962, the Affordable Health Care for America Act and H.R. 3961, the Medicare Physicians Payment Reform Act.  The following state and national medical societies submitted a resolution seeking to withdraw the AMA's support of these bills including  Alabama, Arkansas, Delaware, D.C., Georgia, Kansas, Louisiana, New Jersey, South Carolina, the American Academy of Facial Plastic & Reconstructive Surgery, the American Association of Neurological Surgeons, and the American Society of General Surgeons.

AMA President J. James Rohack, M.D. told the delegates, "H.R. 3962 is not the perfect bill, and we will continue to advocate for changes that help make the system better for patients and physicians as the legislative process continues."  "We must pass H.R. 3961 as an essential element of health reform and to fulfill Congress' obligations to current and future Medicare patients," said Dr. Rohack.

You can find more information about the AMA's actions on health system reform in Houston last week, including the text of Substitute Resolution 203, on the web at:

Senate Majority Leader Harry Reid (D-NV) has stated that he may bring health care reform up for debate in the Senate as early as this week.

In the House, a vote is expected this week on H.R. 3961, the "Medicare Physician Payment Reform Act of 2009".  This critical piece of legislation would permanently repeal the Sustainable Growth Rate (SGR) formula that calls for annual cuts in Medicare physician payments and replace it with a new, more rational payment system. Without a fix to the formula, Medicare payments will be reduced by more than 21 percent on Jan 1, 2010.  It is important that physicians call the offices of Congressman Mike Michaud and Congresswoman Chellie Pingree and ask for their vote on H.R. 3961.  You may call 800-833-6354, the AMA Physician Grassroots Hotline, to be directly connected with either office. 

2009 First Friday Educational Programs Close with Successful Program on Delegation and Supervision

Over fifty persons attended the Nov. 6th CME program at MMA on the topic of delegating to and supervising medical assistants and mid-level practitioners.  In addition to MMA attorneys Gordon Smith and Andrew MacLean, the faculty included Sheri Oldham, M.D., chair of the Board of Licensure in Medicine, Cheryl Peaslee, R.N., MBA, Senior Vice President of Rick Management at Medical Mutual Insurance Company of Maine and Erich Fogg, PA, who formerly directed the physician assistant program at UNE. 

Mr. Smith opened the program with an overview of the scope of practice in Maine for medical assistants who remain unlicensed in the state but who are permitted to perform medical acts under the delegation of a physician if the physician in on the premises and the act is one which has, by custom and usage, been delegated to MA's.  It was noted also that some MA's are nationally certified and can use the term Certified Medical Assistant but that aside from national certification, any person could use the term if it fit the type of work they were performing.

Dr. Oldham addressed the topics of delegation and supervision from the point of view of the licensing board.  Most of the focus of her talk was the need to take seriously the supervising function.  Similarly, Ms. Peaslee focused on the risk assumed by physicians when they delegate or supervise.  Finally, Mr. Fogg provided attendees with an update on the effort of the PA Advisory Committee to produce new templates for supervision agreements.

The November program closed out a successful year for MMA's First Fridays educational programming.  Watch your November-December issue of Maine Medicine for a list of the programs scheduled for 2010.  Generally, the programs are offered at the MMA offices in Manchester during the first Friday morning of each month, from 9:00am to noon.  However, we generally don't schedule programs in January and February and during the summer months.  The topics are selected from suggestions from the membership and their practice managers.  A modest fee is charged for the programs which includes breakfast and materials.  In 2010, we will try at least one or two webinars which will allow persons to participate from their own office rather than driving to Augusta. Upcoming programs are also always listed on the MMA website at You may also register on-line for any program.

If you have a topic that you would like considered for an educational program, please contact MMA's CME coordinator Gail Begin at   [return to top]

MPHP Seeks Case Manager, Administrative Assistant

The Medical Professionals Health Program is seeking to fill two positions:

Case Manager

Job Description
Seeking an Case Manager for a quality healthcare related organization.  This position will require discretion and sensitivity to confidential information.  The position of Case Manager is critical to ensure the ongoing oversight of active participants in the Maine Medical Professionals Health Program.  It is the primary responsibility of the Case Manager to oversee and monitor participants’ compliance with the care and reporting requirements of their treatment plan contracts.  This position reports to the appropriate directors of the Maine Medical Professionals Health Program.

Primary Responsibilities:

  • Communicating with MPHP participants regularly
  • Monitoring MPHP participants’ progress in program
  • Evaluating and assessing participants’ recovery programs
  • Overseeing compliance with MPHP monitoring agreements including compliance with Treatment Plan Contract.

Secondary Responsibilities:

  • Gathering and entering participant information in the MPHP files; and
  • Tracking contract compliance regarding meeting attendance and drug screen results; and
  • Responding to any administrative issues with compliance (ie. missed calls, tests, monitoring reports)
  • Keeping MPHP informed of all participants’ progress.


  • Bachelors Degree/Masters preferred;
  • Formalized behavioral health training with specific emphasis on substance abuse;
  • Experience with substance abusing clients;
  • Working understanding of behavioral impairments.
  • Advanced computer skills.
  • Excellent written, verbal, and interpersonal skills
  • Ability to work independently and as part of a team

Salary commensurate with education, training  and experience.  Primary office located in Manchester, Maine.  Full-time (40 hours per week) position with full benefits.

Administrative Assistant
Job Description
Seeking an experienced full time Administrative Assistant for a quality healthcare related organization.  This position will require discretion and sensitivity to confidential information.   Therefore, the ideal candidate should possess excellent written, verbal, and interpersonal skills with the ability to work independently and as part of a team.  The person selected for this position will report to multiple program directors, so this candidate should also be able to multi-task, be flexible, positive and have a strong work ethic.

Duties include :

  • answering phones,
  • scheduling meetings,
  • database management and coordination of data,
  • teleconferences and event planning,
  • attending and providing support to project meetings;
  • project report preparation.

Position requires:

  • High school graduate with some college strongly preferred.
  • Proficiency in Word, Excel and Power Point. 
  • Familiarity with Quickbooks, preferred

Other Info:
Categories:  Administrative / Clerical / Office Support
Full Time
Hourly Wage ($12.00 - $15.00 per hour depending on education, training and experience)
Full benefits

To apply please submit a cover letter and a resume.

Contact Info: 
Diane McMahon                                      
Office Manager                                        
Maine Medical Association                    
PO Box 190                                               
Manchester, ME 04351                           
Phone: 207-622-3374                                                     
Fax:  207-622-3332
Email: [return to top]

HHS Announces Funding to Reduce HAIs at Ambulatory Surgical Centers

On November 10, 2009, HHS Secretary Kathleen Sebelius announced that her agency will release approximately $9 million to state survey agencies in 43 states to help prevent health care-associated infections (HAIs) in ambulatory surgical centers.  The funding comes from the ARRA and will be used to fund the survey of approximately 1300 ASCs with a tool developed by CMS and CDC.

 The HHS Action Plan is available on the web at: [return to top]

H1N1 invokes HHS to waiver authority under Section 1135 of the Social Security Act.

The Secretary of Health and Human Services has invoked her waiver authority under Section 1135 of the Social Security Act.  This allows for the waiver or modification of certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and for the time periods covered by the 1135 authority. 

Requests by providers to operate under the flexibilities afforded by the waiver should be sent to the state survey agency or CMS regional office.  Please visit the CMS website for a detailed paper outlining the 1135 waiver process (  (This is also pasted in below.)

Further information on the 1135 Waiver process can be found at:

Requesting an 1135 Waiver

Definition of an 1135 Waiver

When the President declares a disaster or emergency under the Stafford Act or National Emergencies Act and the HHS Secretary declares a public health emergency under Section 319 of the Public Health Service Act, the Secretary is authorized to take certain actions in addition to her regular authorities. For example, under section 1135 of the Social Security Act, she may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods and that providers who provide such services in good faith can be reimbursed and exempted from sanctions (absent any determination of fraud or abuse). Examples of these 1135 waivers or modifications include:

  • Conditions of participation or other certification requirements
  • Program participation and similar requirements
  • Preapproval requirements
  • Requirements that physicians and other health care professionals be licensed in the State in which they are providing services, so long as they have equivalent licensing in another State (this waiver is for purposes of Medicare, Medicaid, and CHIP reimbursement only – state law governs whether a non-Federal provider is authorized to provide services in the state without state licensure)
  • Emergency Medical Treatment and Labor Act (EMTALA) sanctions for direction or relocation or of an individual to receive a medical screening examination in an alternative location pursuant to an appropriate state emergency preparedness plan (or in the case of a public health emergency involving pandemic infectious disease, a state pandemic preparedness plan) or transfer of an individual who has not been stabilized if the transfer is necessitated by the circumstances of the declared emergency. A waiver of EMTALA requirements is effective only if actions under the waiver do not discriminate on the basis of a patient’s source of payment or ability to pay.
  • Stark self-referral sanctions
  • Performance deadlines and timetables may be adjusted (but not waived).
  • Limitations on payment for health care items and services furnished to Medicare Advantage enrollees by non-network providers

These waivers under section 1135 of the Social Security Act typically end no later than the termination of the emergency period, or 60 days from the date the waiver or modification is first published unless the Secretary of HHS extends the waiver by notice for additional periods of up to 60 days, up to the end of the emergency period. Waivers for EMTALA (for public health emergencies that do not involve a pandemic disease) and HIPAA requirements are limited to a 72-hour period beginning upon implementation of a hospital disaster protocol. Waiver of EMTALA requirements for emergencies that involve a pandemic disease last until the termination of the pandemic-related public health emergency. The 1135 waiver authority applies only to Federal requirements and does not apply to State requirements for licensure or conditions of participation.

Other Flexibilities

In addition to the 1135 waiver authority, Section 1812(f) of the Social Security Act (the Act) authorizes the Secretary to provide for skilled nursing facility (SNF) coverage in the absence of a qualifying hospital stay, as long as this action does not increase overall program payments and does not alter the SNF benefit’s “acute care nature” (that is, its orientation toward relatively short-term and intensive care).

Determining if Waivers Are Necessary

In determining whether to invoke an 1135 waiver (once the conditions precedent to the authority’s exercise have been met), the Assistant Secretary for Preparedness and Response (ASPR) with input from relevant OPDIVS determine the need and scope for such modifications. Information considered includes requests from Governor’s offices, feedback from individual healthcare providers and associations, and requests to regional or field offices for assistance.

How States or Individual Healthcare Providers Can Ask for Assistance or a Waiver 

Once an 1135 Waiver is authorized, health care providers can submit requests to operate under that authority or for other relief that may be possible outside the authority to the CMS Regional Office with a copy to the State Survey Agency. Request can be made by sending an email to the CMS Regional Office in their service area. Email addresses are listed below. Information on your facility and justification for requesting the waiver will be required.

Review of 1135 Waiver requests

CMS will review and validate the 1135 waiver requests utilizing a cross-regional Waiver Validation Team. The cross-regional Waiver Validation Team will review waiver requests to ensure they are justified and supportable.

Implementation of 1135 Waiver Authority

Providers must resume compliance with normal rules and regulations as soon as they are able to do so, and in any event the waivers or modifications a provider was operating under are no longer available after the termination of the emergency period.

Federally certified/approved providers must operate under normal rules and regulations, unless they have sought and have been granted modifications under the waiver authority from specific requirements.

Frequently Asked Questions

Further information on the 1135 Waiver process can be found at: 

 Questions regarding 1135 that are not addressed at the above website can be sent to the following mailbox:

Email Addresses for CMS Regional Offices

(Northeast Consortium): Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, New York, New Jersey, Puerto Rico, Virgin Islands, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

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"Bundled Payment" is Key to Cost Containment According to NEJM Article

According to an article published recently in the New England Journal of Medicine, using a "bundled payment" approach is one of the best ways to contain costs in our health care system.  The article is entitled, Controlling U.S. Health Care Spending - Separating Promising from Unpromising Approaches and is authored by Peter. S. Hussey, Christine Eibner, M. Susan Ridgely, and Elizabeth A. McGlynn of Rand Health.  The authors argue that bundled payments for six chronic conditions and four acute conditions or procedures requiring hospitalization could reduce national health care spending by 5.4% between 2010 and 2019.

You can find the article on the web at: [return to top]

MaineCare Announces New Restrictions on Prescribing Narcotics for Chronic Pain

Due to increasing concerns regarding the appropriate, safe use of long-term narcotics, the Pharmacy Unit of the Office of MaineCare Services will expand the scope of its chronic narcotic prescription monitoring efforts starting January 1, 2010.  The specific goal is to promote the widespread adoption of key elements of the existing standards of care (most notably the joint Rule 11 of the Boards of Licensure in Medicine and Osteopathy) as they pertain to “new” chronic narcotic patients.  This effort will require a prior authorization (PA) for any member who has had 90 days of narcotics in the past 100 days (and no chronic, sustained narcotic prescriptions in the previous nine months; chronic starters). A PA will not be required for hospice patients or for those members being actively treated for a life threatening illness such as AIDS or cancer. It is expected that 100 to 130 MaineCare members per month would meet the criteria requiring such a PA. Providers will be given thirty days to complete the Prior Authorization. Pharmacies will be granted overrides to continue dispensing narcotics during this time period for all affected patients.

The PA will concentrate on determining how thoroughly the following principles of pain management have been addressed:

  • Confirming an appropriate indication for chronic narcotics
  • Reviewing non-pharmacologic and non-opioid drug treatments considered and/or tried
  • Verification that a narcotic/controlled substance contract exists
  • Reviewing the intended monitoring plan (such as whether Urine Screens and Random Pill Counts may be appropriate).
  • Verification that Prescription Monitoring Program reports are used routinely and not misinterpreted

It is anticipated that only a handful (minimum of 1 to maximum of 5) of Chronic Narcotic Use Prior Authorizations will be required of each provider. Some patients will require a follow-up PA 3 to 12 months later to see how well actual monitoring results and contract violations are handled. Exemptions will be granted quickly once it is clear that appropriate selection and reevaluation/monitoring of chronic narcotic patients is occurring.

Providers may wish to take advantage of a consultation program for chronic pain jointly sponsored and supported by the Maine Medical Association and the Maine Board of Licensure in Medicine. This program provides free, professional consultations. To schedule a visit to your practice contact Noel Genova directly at or 207-671-9076, or Kellie Miller at or 622-3372 ext. 229.

We will soon publish a list of Narcotics that will be included in the monitoring program.   Questions can be emailed to, Pharmacy Unit Manager, Office of MaineCare Services.

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PMP Introductory Webinar Offered December 9

There will be an introductory Webinar on Maine’s Prescription Monitoring Program (PMP) at noon on Wednesday, December 9. If you are interested in finding out how to register as a data requester on the PMP web site, generate and print patient history reports, and learn about helping people find substance abuse treatment services, email Daniel Eccher, PMP Project Coordinator, at the Office of Substance Abuse, with “December 9 Webinar” in the subject line:


The emphasis is on providers who have yet to register, but those who’ve already registered but are not yet familiar with the new web site would find the session useful as well.

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MaineCare Rendering Provider Reenrollment Notice

MaineCare is aware that some providers are not able to re-enroll certain rendering providers (RP).  In these instances, the following error message is received: 



This is due to the fact that a RP employed by another pay-to provider cannot be in process for re-enrollment at the same time.  This design is intentional to ensure that there are no data conflicts with pending re-enrollments in the system.


Please do not delay the submission of your re-enrollment application

as indicated in the error message above.


A.    In order to assist you in completing and submitting your electronic applications for re-enrollment promptly, we ask that you follow these instructions when this error occurs:


1.      Complete your application for re-enrollment with as many rendering providers as you are able to re-enroll. 

2.      Keep a list on the attached spreadsheet of all rendering providers for whom you receive the error message above.  

3.      Complete the remaining application screens and submit your electronic application.

4.      Then, complete the additional data required in the spreadsheet for each rendering provider you could not re-enroll.

5.      E-mail the fully completed rendering provider spreadsheet to

6.      Once your initial application for re-enrollment is approved, a provider enrollment specialist will enter your additional rendering providers for you from the completed spreadsheet.  You may be contacted and asked to return to the portal to sign off on additional attestations, if needed.  

7.      You will receive notification as your rendering providers are approved in the system.

8.      Please contact Provider Enrollment at (800) 321-5557, option 6 for assistance if you have any questions.


B.     A similar situation may be encountered by independent practitioners who are also providing services for a group or organization.  That individual may receive the same error when attempting to re-enroll.  If this should happen, please contact Provider Relations at (800) 321-5557, option 8 for assistance.

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Free athenahealth Webinar: Cracking the Code of Successful EHR Design

This coming Thursday, November 19, 2009, 12:00 PM ET

With all the buzz in Washington these days around the HITECH Act and the federal stimulus dollars available to doctors, one could get the impression that electronic health record (EHR) adoption is a no-brainer. It’s not.

The truth is that traditional EHRs consistently fail to help physicians make more money, do less work, or deliver better care. Cost is one factor: traditional EHRs have high up-front fees and revenue-draining maintenance and upgrade costs.

But the greatest problem with traditional EHRs is that they are designed without an understanding of the fundamental economics of a patient encounter.

There Is a Better Way. Join us for this live Webinar to learn more about:

  • The key economic drivers of a typical clinical encounter
  • The five critical failures of traditional EHRs
  • How a well-designed EHR can reduce costs where they are highest – client document management, patient orders, and results follow-up
  • How an informed EHR approach leverages all phases of the patient encounter for increased revenue and improved staff efficiency

Please join us for this presentation, and bring your own questions — we’ve set aside plenty of time for Q&As. Learn more and register now.

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Pain Management CME Program Offered in Farmington on Friday, Nov. 20 (Free!)

This Friday, November 20th, physicians and others who prescribe will have a unique opportunity to receive, at no cost, four hours of category one CME and to learn of Maine's efforts to prevent diversion of narcotics and at the same time, receive information on state of the art treatment for pain.

Comprehensive Management of Patients with Acute & Chronic Pain While Preventing Diversion is being offered by Franklin Memorial Hospital and Medical Rehabilitation Associates, with financial support from the Maine Office of Substance Abuse.  The program is accredited by the Maine Medical Education Trust and the MMA staff is providing content on the medical-legal aspects of the issue.

The program runs from 12:30 pm to 5:00 pm at the Franklin Memorial Hospital Ben Franklin Center in Farmington.  A complementary lunch will be available at noon.

The faculty for the programs includes Daniel Eccher of the Maine Office of Substance Abuse, John Guernelli, M.D. of Medical Rehabilitation Associates (MRA), Gene Guinti, D.O. also of MRA, Gordon Smith, Esq. of MMA, and Douglas Pavlak, M.D. of MRA.

Anyone  interested in the program may RSVP by fax to Karen Rogers at Franklin Memorial Hospital (Fax is 779-2496) or via e-mail to Karen at

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