December 7, 2009

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Maine Medical Marijuana Act Takes Center Stage

Maine voters have spoken and the Maine Medical Marijuana Act will become effective on February 21, 2010.  As noted in last week's Update, Governor Baldacci has established a fourteen-member committee to review the implementation of similar laws in other states, to make recommendations for changes in the law, and to advise DHHS in its development of proposed rules.  Physicians interested in the new law are invited to attend an evening meeting at MMA on Monday, December 14, 2009 during which the MMA staff hopes to hear from physicians of all points of view on the new law.

The meeting will be held from 6:30 pm to 8:30 pm at the association offices in the Frank O. Stred Building in Manchester.  Directions are available on the MMA website at  Dinner will be available beginning at 6:00 pm.  Any interested physician is welcome to attend but please RSVP to Maureen Elwell at 622-3374, ext. 219 or via e-mail to

The purpose of the meeting is two-fold:

  • to learn about the current status of medicinal use of marijuana from two physicians who have been working with patients qualified under the existing law; and

  • to learn about the new law and to provide input to members of the fourteen-member committee which is scheduled to meet for its third and last meeting on December 15th.

Gordon Smith, MMA's EVP, is the appointed representative of physicians on the Committee.  Given the wide variety of physician opinion regarding this topic, and the number of specialties from whom we need input, it is important to give any interested physician an opportunity to provide comment on the many issues currently before the Committee.  We hope that physicians representing primary care, addictionology, physiatry, psychiatry, pain specialists, and substance abuse specialties will be represented.

The session is intended to be very interactive.  While there will be brief presentations on the clinical side and on the new law, most of the evening will be spent receiving input from attendees on the issues pending before the Committee.  While there were many issues identified at the first Committee meeting on December 1st, those requiring physician input include the following (this list is not intended to be exclusive):

  • Whether the list of "Debilitating medical conditions" specified in the law needs to be amended by deletion or addition.

  • Whether a medical marijuana dispensary set up under the new law should be required to report to the state's Prescription Monitoring Program.

  • Whether the provision in the law restricting action by the Board of Licensure in Medicine is overly broad and in need of amendment.

  • What information a physician should present to an eligible patient in order to meet current standards of informed consent.

  • What education, if any, a physician should receive prior to providing an eligible patient with a medical certificate under the law.

MMA also wishes to receive input on how we can be helpful to those physicians who do not wish to provide medical certificates under the new law.  We already are receiving reports of patients insisting that they are entitled to a medical certificate now that the law has been passed.

The list of medical conditions making a patient eligible under the new law is significantly expanded from the 1999 law.  And in some cases, only a symptom is required, without a specified "medical condition."  Also, the role of the physician is enhanced in the new law.  Under the 1999 law, the physician role was limited to certifying that the patient had a qualifying disease.  Under the new law, the physician signs a written certification, "stating that in the physician's professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient's debilitating medical condition or symptoms associated with the debilitating medical condition.  A written certification may be made only in the course of a bona fide physician-patient relationship after the physician has completed a full assessment of the qualifying patient's medical history."

Physicians are not used to therapeutic options, particularly drugs, being made available by public vote rather than the FDA.  Working with the new law will require some tools that have not been required previously.  MMA invites input into how we can assist those physicians wishing to work with patients eligible under the new law, as well as assisting those physicians who need helping saying "no."  The Governor's Committee recognizes the difficulty in balancing the interests of those patients who may be assisted by the new law with the legitimate interest of law enforcement and public health and safety in preventing access to a drug currently in Schedule I by persons who do not have a "debilitating medical condition" as that term is defined in the law.

Health Systems Development Advisory Council to Hold Public Hearing on Payment Reform on Friday

The Advisory Council on Health Systems Development will hold a public hearing on Friday, December 11, 2009, beginning at 9:00 am at the offices of the Dirigo Health Agency at 211 Water Street in Augusta.   MMA representatives will be present to offer comments on the Proposed Report to the Legislature to Advance Payment Reform in Maine.  The five-page Proposed Report is the result of three public educational sessions, including one that featured presentations by MMA, the Maine Osteopathic Association, and Maine Medical Center.  The Report is required by L.D. 1444 that charged the Advisory Council to solicit input and develop recommendations on payment reform in Maine. 

The Council educated itself about payment reform through a Primer developed by the Governor's Office of Health Policy and Finance.  As stated in the Proposed Report, " . . . . the Council has found unprecedented agreement among policymakers, payers, purchasers, providers, and consumers that fundamental reform is needed to support safe, effective and efficient patient-centered care."

In addition to providing information on the status of payment reform initiatives in Maine, the Proposed Report recommends that the Legislature adopt a set of principles to guide payment reform efforts toward a common vision.  While concluding that no one payment reform strategy will fulfill all principles, collectively the efforts should:

  • Support integrated, efficient, and effective systems of care delivery and payment;

  • Promote a patient-centered approach to service payment and delivery;

  • Encourage and reward the prevention and management of disease;

  • Promote the value of care over volume to measurably lower costs; and

  • Support payments and processes that are transparent, easy to understand, and simple to administer for patients, providers, purchasers, and other stakeholders.

A full copy of the Proposed Report is on the website of the Governor's Office of Health Policy and Finance at  and will be placed on the MMA website at

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CME Home Study Course on Prescribing for Chronic Pain Now Available on MMW Web Site

With funding provided by the Board of Licensure in Medicine, MMA last year developed a home study course on the subject of prescribing for chronic pain.  The course was accredited for two hours of CME.  The course has now been updated and can be completed on-line.  There is no cost.  A physician interested in taking the course should go to the MMA website at  The links to access the course and the post-test are under "Resources for Management of Pain," then "CME."

The materials were assembled by Noel Genova, PA-C, who is also available for in-office consultations.  These consultations also are funded by the Board of Licensure in Medicine.  The consultations are confidential.  To request an in-office consultation, call Noel directly at 671-9076.

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President Goes to Capitol Hill on Sunday to Advocate for Health Reform Bill

Yesterday (December 6th), President Obama went to Capitol Hill to meet with Senate Democrats and encourage efforts to set differences aside and enact a comprehensive health reform bill.  The message from the President was that not since the enactment of social security has the Congress had an opportunity to help so many people. 

Peter Orszag, the Director of the Office of Management & Budget, continues to identify four critical pillars of health care reform from the perspective of the Obama Administration:

  1. deficit neutrality;
  2. an excise tax on high-cost plans;
  3. a Medicare commission; and
  4. delivery system reforms.

But, there are still difficult issues for the Democrats to work out amongst themselves, as it looks increasingly unlikely that any Republicans will support the bill (although Senators Snowe and Collins remain the most likely supporters if any Republican does cross over).  The two issues proving to be the most difficult to resolve are funding for abortion and the so-called "public option."

Three moderate Senators, including Senator Susan Collins, released on Friday a package of amendments that would reward Medicare patients for choosing physicians judged to be efficient, require insurance companies to make public more information about claims denials, and speed up payment reform programs.  The amendments would also double the existing penalties for hospitals with high infection rates.  Hospitals have expressed concern over some aspects of the amendments.

The House has already enacted its bill.  If the Senate passes its bill, the two bills would be reconciled in a conference committee with a final vote then taking place in each body before a bill could be sent to the President.  Senate Majority Leader Harry Reid (D-NV) is still hoping to have a bill on the President's desk by Christmas, but that is looking increasingly unlikely. 

On this coming Thursday, MMA representatives will be meeting with Senators Snowe and Collins.  Our message will be to keep working, look for areas of common interest, and try to improve on the status quo.  The MMA also will emphasize the need to permanently repeal the sustainable growth rate formula , as without some change, Medicare payment rates for physicians will be reduced by 21% on January 1, 2010.

The AMA has many health system reform resources on its web site at: . 

You may be particularly interested in the AMA's letter to Senate Majority Leader Reid dated December 1, 2009 pointing out provisions of the Senate bill supported and those opposed by the AMA.  Also, please note a document entitled, H.R. 3962 and H.R. 3590, Health System Reform Legislative Summary Chart of Major Provisions dated December 2, 2009.

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On December 9th, MMA Public Health Committee Presents "Our Public's Health"

The MMA Public Health Committee is hosting a two-hour panel presentation on Our Public's Health - Climate Change, Energy Efficient Hospitals/MESHnet and Environmental Toxins on Wednesday, December 9th, from 4:00 pm to 6:00 pm at the MMA office in Manchester.  It also will be broadcast via video-conference link to the MMC Dana Health Education Center, Classroom 10.  Educational Credits are pending.  This is the December meeting of the Public Health Committee and, if time permits, the Committee will address some business items after the panel presentation.

Norma Dreyfus, MD, Chair of the MMA Public Health Committee will serve as moderator and panelists include:

  • Lani Graham, MD, MPH providing an overview of health care and environmental toxins, which will include findings from the Hazardous Chemicals in HealthCare report, (detailing the first investigations ever of chemicals found in the bodies of health care professionals, including MMA Past President Stephanie Lash, MD).
  • Paul Santomenna, Executive Director of Physicians for Social Responsibility, will talk about hospitals' contribution to greenhouse gas emission and the work of the Hospital Network.
  • Matt Prindiville of the Natural Resources Council of Maine, will provide an update on federal and state legislation including TSCA reform.
  • Syd Sewall, MD, MPH will provide information on the use of the Pediatric Environmental Toolkit in clinicians' offices.

An application for two hours of educational credits is pending.  For more information and to pre-register for this free educational offering for all members and nonmembers, contact MMA at 207-622-3374, ext. 219 or via email to Maureen Elwell at .  Members and nonmembers are welcome to attend. 

In case of inclement weather, please contact the MMA office at the above number for information about the status of the program. [return to top]

Maine CDC H1N1 Vaccine and Treatment Update

Below is the text of the health advisory that went out late Friday afternoon.  Because of a substantial increase in the H1N1 vaccine supply, we are able to expand the priority groups to include most of those in the US CDC’s high priority groups.  Virtually all primary and specialty health care providers who ordered vaccine from us should have at least some vaccine delivered by the end of this coming week.  The exceptions include employers, some institutions, and pharmacies, though we are eager to provide them vaccine when we are able to.  H1N1 disease activity continues to decline, though we fully expect it to circulate for months and possibly years to come, so vaccination will be an ongoing strategy.  One should see an increasing number of public clinics posted on our website,, and this information is also available through 211.  And, I’d like to remind those organizing such clinics that it is required by us and US CDC that all such publicly available clinics be posted on this website, and with enough notice to assure the information is available sufficiently ahead of time.  We will also be using media outlets to promote the website and 211 as an information source for these clinics.  So, all in all, things are looking up!  Thank you for your ongoing work on H1N1 – it truly takes a village to vaccinate!  Dora

Maine CDC H1N1 Vaccine and Treatment Update – December 4, 2009

Vaccine Distribution
The vaccine supply continues to increase, and more substantially this week and into next week.  By Monday we expect to have about 390,000 doses in Maine, which is enough for a little more than 1 dose per 2 people in the high priority groups and 1 dose per 3 people in the general population.  Our distribution this past two weeks has focused on getting vaccine to many more health care facilities and practices, who now number into the hundreds.  If you are a health care provider and have not received vaccine yet, there is a good chance you will this coming week.  However, we still need to be vigilant about the vaccine supply since there still are over 300,000 people in high priority groups in Maine who have not had any access to vaccine. 

With the vaccine supply increasing, H1N1 vaccine efforts should gradually start looking like seasonal flu vaccine efforts (in a non-shortage year), with the vaccine available in many different venues and offered by many different organizations. 

Although there continues to be a seasonal flu vaccine shortage, there have also been some recent increases in the supply, allowing Maine CDC to fulfill our orders for nursing homes, many primary care health care providers, and most schools.

Vaccine Administration – Priority Groups Expanded
Because of the expansion of H1N1 vaccine availability in many places in the state and the expected continued expansion throughout all of Maine, the priority groups for H1N1 vaccine administration is expanded now to include the following: 

  • Pregnant women and recently pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated. Note that pregnant women should not receive the nasal-spray flu vaccine LAIV. 

  • Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus.

  • All people from 6 months through 24 years of age

Children from 6 months through 18 years of age because there have been many cases of H1N1 flu in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread.  Children 6 months – 10 years of age should receive a booster dose.  Some schools will be hosting clinics for the second doses soon. 

Young adults 19 through 24 years of age because there have been many cases of H1N1 flu in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population.

  • Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.  Chronic medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).

  • Healthcare personnel working in inpatient and outpatient settings with frequent direct contact with high priority patients and infectious materials.  This includes, for instance, all EMS as well as nurses and doctors working in outpatient primary care practices, specialty practices, and schools.  This is because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients.

The one caveat to these priority groups is that since many people at high risk for hospitalization and death from H1N1 have not had adequate access to the vaccine (due to the shortage), we would like to make sure that the expansion to the above mentioned health care workers (assuming they themselves are not high-risk) doesn’t mean that a community or health care facility cannot offer vaccine to those who are at highest risk of dying or being hospitalized from H1N1 – pregnant women, children and young adults, and adults with high-risk conditions.  The main reason why healthy non-pregnant health care workers should be vaccinated is to protect the patients they serve, who more likely fall into high risk categories.  The best way to protect these patients is to vaccinate them.  However, we are receiving quite a bit of nasal spray, which is licensed for otherwise healthy non-pregnant 2 – 49 year olds.  This is a very appropriate formulation for many health care workers.  Therefore, we ask that the nasal spray be given to health care workers whenever possible so that their vaccination is not taking away from those who are at highest risk of being hospitalized or dying from H1N1. 

It is our strong desire that all people in Maine be offered vaccine soon, and we hope that time will be here shortly. 

Reporting Vaccine Administration
Maine CDC asks all H1N1 vaccine providers and/or administrators to submit the vaccine administration data into the Maine CDC’s weekly vaccine reporting system. This may start impacting the flow of vaccine, since it indicates low uptake of the vaccine.  We believe at this point in time these data are an indication of under-reporting and how busy health care providers are taking care of people sick with H1N1 as well as administering vaccine. 

Maine CDC’s Immunization Program is compiling a database that matches the vaccine distribution database with the vaccine administration database by provider so we can tell which providers are not reporting on vaccine administration (or not using their vaccine).  We will then use this to help guide our vaccine distribution decision-making. 

The weekly vaccine reporting form can be found at:  The vaccine reporting periods on the form are the same timeframe as the dates for the vaccine clinics.  This form is then compiled by us and submitted, as required, to US CDC. 

Prioritizing H1N1 Vaccine for Household Members of Infants
Infants younger than six months old cannot receive H1N1 vaccine and are vulnerable to serious complications if infected. Household members of infants are a prioritized group for vaccine.Maine CDC encourages obstetricians and pediatricians and other health care providers to vaccinate parents of infants younger than six months old, even if these individuals are not currently their patients. The PREP Act established liability protections for physicians who administer vaccine to patients not normally under their care (

Second Doses
Children nine and younger require a second dose of vaccine at least 21 days after the initial dose for full immunity; US CDC recommends a period of 28 days between doses. There is no maximum number of days between doses. Although it is preferable to receive the same type of vaccine (nasal spray or injection) for both doses, it is not required.

Due to the formulation of vaccine currently coming into the state, we are now able to begin offering second doses for children nine and younger in some areas. Vaccinators should follow the vaccine screening form to determine if sufficient time has passed between doses. Documentation of the first dose should not be required before administering a second dose. If a second dose is inadvertently administered early, it will not cause harm. In settings where supply is limited, first doses should still be prioritized.

Spacing of Second Doses of H1N1 and Seasonal Flu Vaccine Table:

Pneumococcal Illness and Vaccine
Increases in pneumococcal disease were seen during all three of the flu pandemics that occurred in the twentieth century. A report released in September showed that bacterial pneumonia is contributing to fatalities in people with H1N1 flu, similar to previous pandemics (

All children less than 5 years of age should receive the pneumococcal conjugate vaccine. The polysaccharide vaccine should be administered to all persons 2-64 years of age with high risk conditions and everyone 65 years and older.

Although there is no evidence that this vaccine is harmful to either a pregnant woman or to her fetus, it is not recommended during pregnancy. Women who have underlying conditions known to put them at risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible.

US CDC issued a letter to health care providers urging them to make sure all their adult patients with indications have received the pneumococcal polysaccharide vaccine. (

CDC has also issued a Q&A on influenza and invasive pneumococcal disease (

Infection Control and Use of N95
Successfully Preventing transmission of influenza in the health care setting requires a comprehensive approach, beginning with plans that are flexible and adaptable should changes occur in the severity of illness or other aspects of 2009 H1N1 and seasonal influenza.  Facilities should use a hierarchy of controls approach to prevent exposure of healthcare personnel and patients and prevent influenza transmission within healthcare settings.

Maine CDC has posted the US CDC guidance on Infection Control Measures, a Summary of the October 2009 Infection Control Guidance, OSHA’s position on compliance and enforcement, and the procedures for hospitals requesting N95 respirators from the Strategic National Stockpile at this site:


Antiviral Treatment
The groups at risk for complications from the flu are slightly different from the groups prioritized to receive H1N1 vaccine. Those at highest risk for complications from the flu include:

    • Children younger than 2 years-old

    • Pregnant women

    • Adults age 65 and older

    • People with underlying medical conditions (such as asthma, heart failure, chronic lung disease, diabetes, HIV)

People who fall into one or more of these groups and you have signs of the flu, should contact their health care providers as soon as possible to get a prescription for antiviral medications (such as Tamiflu®). People who fall into one of more of these groups, have not gotten an H1N1 vaccination yet, and live with someone who has the flu, should contact their health care providers. In some cases, the health care provider may want to prescribe antiviral medications before the person exhibits symptoms. These medicines can significantly reduce severity (including hospitalization and death) as well as duration of illness.

Maine CDC encourages physicians to prescribe antiviral medications as appropriate. In an effort to minimize financial barriers, Maine CDC has mobilized a significant portion of the state-purchased stockpile of antiviral medications for outpatient use by those who cannot afford them. For more information:

Pediatric Suspension:
The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions:

MaineCare has promulgated emergency rules increasing the reimbursement for compounding pediatric suspension from $4.35 to $10.  Pharmacies can put through paper claims and they will be back dated to October 1 to receive the $10 co-pay. The full stockpile of pre-prepared pediatric suspension in the stockpile has been fully deployed to hospitals, health centers, and Hannaford’s pharmacies and other willing pharmacies.  Additional syrup used to compound the pediatric suspension has also been deployed.

Mixing Tamiflu® with Sweet Liquids, a short video that demonstrates how to prepare a sweet liquid mixture for children who cannot swallow capsules, is now available at

Intravenous Treatment for Hospitalized Patients with Antiviral Medicines – Peramivir:



  • Health Care Providers’ Clinic Consultation Line:  1-800-821-5821, available 24 hours per day

  • Public Information and Referral Line:  211, available now 8 am – 8 pm 7 days per week (note that this has changed from a Maine CDC phone number)

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Letter from Congresswoman Pingree to MMA Members

Dear Maine Medical Association Members,

Thank you for your interest in health care reform, and even more importantly, for the critical work you do to provide quality care to Mainers.

As you know, we are on the verge of achieving landmark health reform. H.R. 3962, the Affordable Health Care for America Act, passed the House with my support on November 7.  This historic health reform legislation will lower the cost of health care for those who are already insured, improve the quality of care in this country, and provide guaranteed access to a choice of affordable coverage for every American family.

We know that lasting health reform cannot be achieved unless we address the needs of our country's physicians and enable them to serve their Medicare patients.  That is why I was proud to vote in favor of H.R. 2961, the Medicare Physician Payment Reform Act of 2009, which passed the House on November 19.

This critical legislation will permanently reform the way Medicare pays physicians by repealing the Sustainable Growth Rate (SGR) formula that would otherwise result in a 21 percent fee reduction scheduled for January 2010.  This bill will replace the SGR with a stable system that ends the cycle of threats of ever-larger fee cuts followed by short-term patches. Permanent Medicare physician payment reform will guarantee that Medicare beneficiaries can continue to have access to the doctor of their choice, an essential cornerstone of care for our seniors.

I firmly believe that there is nothing we can do for Maine and this country that is more important than fixing our health care system, and passing H.R. 3961 and H.R. 3962 were big steps in doing that.  This legislation is now awaiting further action in the Senate, and I will work to ensure that we continue to protect doctor-patient access as these bills continue to move through the legislative process.

I sincerely hope my office can serve as a resource for you during this time.  If you have any questions or concerns about how this bill would affect the work that you do, or if you need any additional information that you can share with your colleagues or patients, please don't hesitate to contact Jennifer Taylor in my Washington, D.C. office at (202) 225-6116.

Again, thank you again for your dedicated service to Maine seniors.  I hope to see you in Maine soon.

Chellie Pingree
Member of Congress

For a pdf of the original letter, click here [pdf]. [return to top]

David Himmelstein, M.D. Scheduled to Speak at Bowdoin College Tomorrow Evening

David U. Himmelstein, M.D., an expert on the cost of U.S. health care and an advocate for a national health care system, will deliver Bowdoin College's Arnold D. Kates Lecture at 7:30 p.m. on Tuesday, December 8, 2009, in Pickard Theater, Memorial Hall.

Himmelstein's talk, entitled, Why We Need Single-Payer National Health Insurance, is open to the public and admission is free.

David Himmelstein graduated from Columbia University's College of Physicians and Surgeons and completed a medical residency at Highland Hospital in Oakland, California, and a fellowship in general internal medicine at Harvard University.

He has authored or co-authored more than 100 journal articles and three books, including widely cited studies of medical bankruptcy and the high administrative costs of the health care system in the United States.  His 1984 study of "patient dumping" led to the enactment of the Emergency Medical Treatment & Active Labor Act (EMTALA), the law that banned the practice.

In 1987, Himmelstein co-founded Physicians for a National Health Program (PNHP), a single-issue organization advocating a universal, comprehensive single-payer national health program.  PNHP has more than 17,000 members and chapters across the United States and educates physicians and other health professionals about the benefits of a single-payer system. 
For more information call 207-725-3257. [return to top]

HHS Publishes FY 2011 Medicaid Matching Rates for States

On November 27, 2009, the U.S. DHHS published the "federal medical assistance percentages" (FMAP) determining the federal government's contributions to state Medicaid programs.  Depending on the state's per capita income, the percentages range from 50% to almost 75%.  HHS also published enhanced FMAP rates that determine the federal contribution to the Children's Health Insurance Program (CHIP) and some Medicaid expenditures on behalf of children.  

These percentages will be effective from October 1, 2010 through September 30, 2011.

Maine's FMAP will be 63.80% and our enhanced FMAP will be 74.66%.

You can find the provision of the Federal Register including this announcement at: [return to top]

MMA Legislative Committee Schedules Weekly Conference Calls Beginning January 14th

The MMA Legislative Committee held its organizational meeting for the Second Regular Session of the 124th Maine Legislature on Tuesday evening, December 1, 2009.  Among the administrative decisions of the group is the selection of Thursday evenings at 8 p.m. for the weekly conference calls of the Committee.  The first call will take place on Thursday, January 14, 2010 at 8 p.m.  The MMA staff will include directions to access the call in a future Weekly Update.  Members of the Committee, specialty society representatives, and other interested physicians and guests discussed the new Maine Medical Marijuana Act, key bills carried over from the First Regular Session of the 124th Maine Legislature, bills of interest accepted for consideration during the Second Regular Session, the state budget situation, and the Advisory Council on Health System Development's Proposed Report to Legislature to Advance Payment Reform in Maine.

The Committee expects to conduct two in-person legislative forums during the coming session - one likely in February and one in March.

Lisa D. Ryan, D.O., a pediatrician in Bridgton, chairs the Committee.  Andrew MacLean, Deputy EVP, and Maureen Elwell, Legislative Assistant, are the Committee's staff.  If you are interested in participating in the MMA's advocacy work and/or if you would like to participate in the Doctor of the Day Program, please contact Maureen Elwell at or 622-3374, ext. 214.

The 124th Maine Legislature will convene for its Second Regular Session on Wednesday, January 6, 2010.


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