March 15, 2010

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Let MMA Do Your Annual HIPAA Staff Training: April 2nd

Federal HIPAA regulations require staff to be trained annually in the law and regulations.  On Friday, April 2nd, MMA will present a three hour CME program on HIPAA, including emphasis on the new breach notification requirements which are enforced as of February 22nd.  The program will be available at the MMA office but is also available remotely through WebEx.  Registration is available on the MMA website at

Faculty for the program includes Kenneth Lehman, Esq., of Bernstein, Shur, Sawyer & Nelson in Portland, MMA attorneys Gordon Smith and Andrew MacLean, and John Coolong from Systems Engineering.  The program runs from 9:00 a.m. to noon.  The annual HIPAA update is the most popular FIrst Friday program we have so sign up now as there is limited space in the conference room and only 25 sites available through WebEx.  There is a $65 per person cost and three hours of category one CME are available to physicians and PAs.

For more information, call Maureen Elwell or Gail Begin at 622-3374 (extensions 219 and 210 respectively).

Democrats to Use Budget Reconciliation Process to Move Health Reform Bill this Week

House Democrats were mobilizing this past week for a full court press this coming week in an attempt to pass a health reform bill.  The process will begin with the House voting on the bill that was passed by the Senate on Christmas eve.  If passed, the bill would be signed into law by the President, but a second bill would be processed almost immediately that would make the changes in the Senate bill that House Democrats are insisting upon.  Because the process being used for the changes to the law requires only a majority vote, only provisions impacting upon the budget can be included.

The bill would provide coverage to more than 30 million people who are uninsured, would require most Americans to carry health insurance, and would prohibit insurers from denying coverage to people who are sick. 

While prospects for the bill appear more favorable than a week ago, there are still several unresolved issues that could prove fatal to the bill's passage, including the abortion issue.  Republicans appear unified in opposition to the bill.

Potential passage of a significant reform bill has put the interest groups back on the airwaves, with a coalition of business groups, including the United States Chamber of Commerce saying it would spend $4 million to $10 million on a round of commercials to try to stop the legislation.  America's Health Insurance Plans, the trade group for commercial carriers, also said it would buy more than $1 million of television time to explain its version of why premiums have been dramatically increasing.  Groups supporting the legislation also are spending on radio and television.

An initial vote in the House is likely to take place by Thursday or Friday.  President Obama has delayed an overseas trip until March 21st in order to be available to assist in passage of the bill.

According to an AMA update earlier today, this afternoon the House Budget Committee will begin consideration of a reconciliation bill that will carry refinements to H.R. 3590, the Senate-passed health system reform legislation.  The Budget Committee is scheduled to begin meeting at 3:00 p.m. and plans to stay in session until midnight.  

A 2300 page bill has been posted on the Budget Committee web site.  Importantly, this bill is NOT the vehicle that House leaders intend to bring to the floor.  The language contained in this "shell" vehicle will ultimately be stripped out and replaced with new language that is not yet available for review.  The AMA does not expect the true reconciliation bill language to be released before Tuesday.

Following the Budget Committee's action, the House Rules Committee will meet later this week and insert the final language into the bill before it is brought to the House floor for a vote. 
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Maine Awarded $6.6 Million Grant For Statewide HIT Plan

On February 12th, the State of Maine was awarded a $6.6 million grant from federal stimulus funds to develop and implement a statewide health information technology plan.  These funds are part of the HITECH Act and are the first stages of health care reform.  The Federal Government is making funds available to states to facilitate and expand the secure, electronic movement and use of health information among organizations according to nationally recognized standards.

Maine will receive $6,599,401 over four years to advance appropriate and secure health information exchange (HIE) across Maine’s health care system.  Two-thirds of the funds will be provided to expand the reach of Maine’s HIE (HealthInfoNet) to primary care providers and hospitals in all areas of the state.  This is a massive undertaking requiring a collaborative and coordinated effort.  One third of the funds will be used to create and support a new Office of the State Coordinator (OSC).

The OSC will be created and temporarily positioned in the Governor's Office of Health Policy & Finance.  A multi-stakeholder group was identified and convened by the Governor’s Office of Health Policy & Finance (GOHPF).  This committee has been brought together to collaboratively develop a statewide strategic plan for HIE and health Information Technology (HIT).  Six sub-committees are being created to advise and oversee the health information exchange, the committees are: governance, finance and sustainability, technical infrastructure, business and technical operations, and legal/policy and quality improvement.

Maine’s DRAFT HIT plan can be viewed at:



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Senate Passes Bill to Delay Medicare SGR Cut Until October 1st

On March 10th, the Senate voted 62-36 in favor of the American Workers, State, & Business Relief Act of 2010 (H.R. 4213), a tax extenders package (the "jobs" bill) that, among other things, delays until October 1st a Medicare physician payment cut of more than 21% set to be implemented on April 1st.  The bill now awaits action in the House.

The bill includes provisions affecting most health care providers.  In particular, passage of the bill is important for the current state supplemental budget because it extends for 6 months enhanced Medicaid funding for the states included in the original stimulus bill, the ARRA.  The ARRA provided each state with a 6.2% increase in its federal medical assistance percentage (FMAP) plus an additional increase based upon the state's unemployment rate, but the provision expires at the end of December.  For Maine, this means approximately $81 million towards reducing the budget deficit.  The bill also includes additional COBRA aid for workers who have been laid off.  Finally, it clarifies the eligibility of some hospital-based physicians for the ARRA's financial incentives for implementing and using electronic health records. [return to top]

Connecticut AG Blumenthal Pursues Antitrust Investigation of Anthem

On March 8, 2010, Connecticut Attorney General Richard Blumenthal wrote to US DHHS Secretary Kathleen Sebelius bringing to her attention his office's investigation of Anthem Blue Cross Blue Shield of Connecticut's use of "most favored nation" ("MFN") clauses to dampen reimbursement for hospitals while at the same time requesting substantial premium increases from insurance regulators.

You can find a copy of the AG's letter on the web at: [return to top]

Author Kate Braestrup to Keynote Annual Corporate Affiliate Breakfast April 14, 2010

New York Times best-selling author Kate Braestrup will be the keynote speaker at MMA's Annual Corporate Affiliate Breakfast being held this year on April 14th at the Portland Country Club in Falmouth.  The event will begin at 7:30 a.m. with breakfast and will conclude by 9:30 a.m.  There is no charge for MMA Corporate Affiliates and members of the Executive Committee and Membership & Member Benefits Committee.  Invitations have been sent and those affiliates and members attending should RSVP to Lisa Martin at

Reverend Breastrup will be available to sign books following the breakfast and her books will also be available for sale.  Her first book,  Here if You Need Me, received widespread acclaim and was on the New York Times best selling list.  Her new book, Marriage and Other Acts of Charity, was recently published.

Since 2001, Rev. Braestrup has served as chaplain to the Maine Warden Service, joining the wardens as they search Maine's woods for those who have lost their way, and offering comfort to those who wait for the ones they love to be rescued, or for their bodies to be recovered.

MMA appreciates the support annually of nearly 100 Corporate Affiliates and the annual breakfast presents an opportunity to thank these firms and their representatives for their support of MMA throughout the year.


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Survey Opportunity: Preventive Medicine Education Needs Assessment

The Division of Community & Preventive Medicine at the Maine Medical Center is organized to promote population-based research, education, and community service throughout Maine.  It is conducting a survey to help plan educational activities and develop educational resources for Maine physicians and other health care providers.  All responses are anonymous and only aggregated results will be reported. 

Please help with this process by taking their brief (less than 5 minutes) survey:

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Legislative Committee Conference Call Information

The MMA Legislative Committee's next weekly conference call will take place this Thursday, March 18th at 8:00 p.m. using the following toll free number and access code:  1-877-669-3239; access code 23045263.  The MMA staff will provide an update on the week's activities at the legislature.  As usual, the MMA encourages any interested physician or physician staff member to participate. [return to top]

POLITICAL PULSE: Work Session on Medical Marijuana Tomorrow


Following last week's public hearing, the Legislature's Committee on Health & Human Services will hold a work session tomorrow, Tuesday, March 16th on L.D. 1811, An Act to Amend the Maine Medical Marijuana Act.  The work session will begin at 1:00 p.m. in room 209 of the Cross State Office Building in Augusta.

At the public hearing, MMA Executive Vice President Gordon Smith testified in favor of the bill which was crafted by a 14 member committee appointed by the Governor charged with clarifying provisions in the publicly initiated law approved by the citizens of Maine last November.  Mr. Smith was a member of the committee.

While supporting the bill, MMA also presented proposed amendments to it.  The amendments, if enacted, would accomplish the following:

1.  Would prohibit children 12 years of age and under from becoming qualifying patients under the law.

2.  Would establish a review process for a qualifying patient ages 13 through 17 inclusive.

3.  Would add the medical specialties of pediatrics and addictionology to the advisory board established in the legislation.

 4.  Would provide the advisory board with the authority to recommend the deletion of any medical condition from the list that current medical and scientific literature no longer supports as benefiting from the medical use of marijuana.

In addition to speaking on behalf of MMA, Mr. Smith provided comments on behalf of the Maine Association of Psychiatric Physicians and the Maine Gastroenterology Society.

MMA's testimony and the language of the proposed amendment to L.D 1811 are available on the MMA website at


The Governor's Commissioner of Administration & Finance, Ryan Low, briefed both the Appropriations and HHS Committees on the Governor's proposed restorations to the supplemental budget (L.D. 1671) based upon the 6-month enhanced Medicaid match extension in the "jobs" bill (see related article above).  Assuming passage of the jobs bill in the House, considered likely, the State of Maine will receive $81 million in additional federal Medicaid revenue rather than the $35 million the Governor included as a placeholder in the original FY 2010-2011 supplemental budget.  The Governor's proposal restores approximately $58 million in cuts, most of it in the health and social services area and in aid to local government.  Some of the highlights include:

  • $17.9 million to eliminate a provider pay cycle delay;
  • $1.5 million to reduce the critical access hospital (CAH) cut from 109% of costs to 107% of costs rather than to 101% of costs as originally proposed (for a 10% cut in the biennium);
  • $5.6 million in circuit breaker restoration;
  • $5 million in restoration of municipal revenue sharing in FY 2011; and
  • $5 million in restoration of general purpose aid to local education in FY 2011.

The Appropriations Committee worked yesterday afternoon, mostly in closed door caucuses, and work sessions will continue this week.  The MMA continues to work with other members of Health Policy Partners to advocate for a dollar increase in the cigarette tax to reduce smoking and to further offset the cuts in health and human services.


Following a Senate Democratic caucus on the bill last Tuesday, Assistant Senate Majority Leader Lisa Marrache, M.D. and the bill's sponsor, Senator Peter Bowman, sought a compromise that could achieve the support of the entire Senate.  Their approach would be to ask the Maine Board of Pharmacy to consider the issues and develop recommendations.  Following negotiation among the interested parties, the following proposed floor amendment appears to be able to win the support of the Senate and presumably the House as well.

New Title: Resolve, Regarding the Dispensing of Anti-epileptic Drugs

RESOLVE : The Maine Board of Pharmacy, the Governor's Office of Health
Care Policy and Finance, the Board of Licensure in Medicine and the
Department of Health and Human Services, Office of MaineCare Services
shall each designate one or more officials or members to conduct a study
for the purpose of examining substitution within the anti-epileptic
class of medications, current state laws governing substitutions
generally, the powers available to prescribers under current
substitution laws and whether there is a need to grant any additional
powers to Maine prescribers for any one class of drugs. This analysis
shall take into account the findings and opinions on this topic by the
Food and Drug Administration, the American Medical Association and any
statistically valid peer reviewed research in this area. The study group
shall publish its findings in a report to the legislature to be
delivered no later than January 15, 2011.  





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