April 12, 2010

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MMA Executive Committee Meets Wednesday, April 14th, Following Annual Corporate Affiliate Breakfast

More than 100 individuals are expected to attend the Association's Annual Corporate Affiliate Breakfast on this coming Wednesday, April 14th.  The breakfast begins at 7:30 a.m. and will be held at the Portland Country Club in Falmouth.  Best-selling author Kate Braestrup is the guest speaker.  Later in the day, at 2:00 p.m., MMA's Executive Committee meets in Manchester and considers several issues of importance to Maine's physicians.

MMA's 28-member Executive Committee meets this coming Wednesday at 2:00 p.m. at the Frank O. Stred Building in Manchester.   Priority topics for the meeting include MMA's activities regarding the new federal health reform law and the future of the Coding Center.  Members also will hear a presentation from Neil Korsen, M.D. who represents physicians as a member of the Maine Health Data Organization (MHDO).  The MHDO is a public agency with a board consisting of various stakeholders.  The agency controls the state's all-payer claims data base and has the authority to release physician-specific data to the public under certain circumstances. 

Relative to the Medicare payment formula and the need for a permanent fix, the Committee will consider a request to participate in a nationwide on-line petition drive aimed at gathering more than 1 million signatures to present to the Congress by the end of May.  The petition drive is being led by the Texas Medical Association.

Jo Linder, M.D., President-elect of MMA will present an update on the planning for the 157th Annual Session which will be held in Bar Harbor from September 10-12th, 2010.  Jackson Lab will again be a partner in the CME presentations.

As with all MMA committee meetings, any MMA member is welcome to attend, whether on the committee or not.


Health Care Reform Law Raises Geographic Payments from Medicare


Among the Medicare program changes made by the new health system reform law were revisions to the geographic adjustments made in calculating payments for physician services.  The AMA has developed preliminary estimates of the impact these provisions will have on average payment rates in each of the states, and concluded that physicians in 42 states and territories will benefit from these changes in 2010 and 2011.

The impact of the revised geographic adjustments on individual physicians will vary by state and by service.  But, starting at the beginning of the alphabet to illustrate, the AMA estimates the following increases for two services provided by physicians in Alabama (assuming no change in the fee schedule conversion factor):

  • Payment for a mid-level established patient office visit (CPT 99213) will increase by 4.6 percent, from $59.89 to $62.66.
  • Payment for a laparoscopic inguinal hernia repair (CPT 49650) will increase by 3.9 percent, from $355.03 to $368.93.

A regulation will need to be issued by the Centers for Medicare & Medicaid Services before the final numbers and details on the application of the 2010 adjustments will be known.  You can find a memo on the impact of these changes by state on the web at:  http://www.ama-assn.org/ama1/pub/upload/mm/399/gpci-impact-table.pdf. [return to top]

Congress Returns from Spring Recess Today; Faces Medicare SGR Deadline Immediately

Congress returns to Washington from its Spring Recess today.  One of the first tasks facing the Senate will be a cloture vote scheduled for 5:30 Monday evening on H.R. 4851, which extends a number of expiring programs, including a reprieve from the 21% Medicare physician payment cut that was originally scheduled to take effect on January 1.  Other expiring programs addressed by the bill include extended unemployment insurance benefits and COBRA subsidies for the unemployed.

As reported previously, the most recent reprieve from the 2010 payment cuts expired on April 1st.  Subsequently, the Centers for Medicare & Medicaid Services (CMS) instructed its carriers to refrain from processing any claims for services provided on or after April 1st for 10 working days, to minimize administrative complications and other disruptions that would result from calculating payments that reflect a rate reduction that Congress is expected to overturn.  That 10 day grace period expires on Wednesday, April 14th.  If Congress fails to pass H.R. 4851 or similar legislation by close of business on Wednesday, Medicare law will require carriers to begin processing claims for services provided in April with the 21% cut.

The controversy over passage of H.R. 4851 centered on disagreement over whether the legislation should be treated as an emergency measure that does not require budget offsets.  Senator Tom Coburn, MD (R-OK) is among the Senators who believe that the costs of the legislation must be offset by other spending reductions, and he blocked floor consideration of the bill prior to the Spring Recess. 

It is uncertain whether the cloture vote will succeed on Monday evening.  Even if that vote is successful, the subsequent debate on the Senate floor could continue beyond the April 14th deadline for the current Medicare claims hold.

This represents the second time in two months that Congress has allowed short-term reprieves from the 2010 Medicare payment cuts to expire before taking action, illustrating all-too-well the urgency of resolving this problem once and for all by repealing the fatally flawed sustainable growth rate (SGR) formula. 

The AMA has urged patient and physician grassroots to continue pressuring their Senators to support a permanent repeal of the SGR (http://www.ama-assn.org/ama/pub/health-system-reform/repeal-medicare-sgr.shtml).  The AMA also is working with state medical and national specialty societies on very focused engagements with key Democratic and Republican Senators.  In addition, the AMA is coordinating efforts with our long-standing allies such as AARP. 

At the MMA Executive Committee meeting this coming Wednesday, a request that MMA join a Texas Medical Association petition drive aimed at showing more public support for reform of the Medicare payment formula will be considered.  Signatures of physicians and patients would be collectected on line until the end of May and then the signatures would be presented to Congress.  The original goal of 1 million signatures across the country will likely be increased as nearly all fifty state medical societies have joined the petition drive. 

The MMA will keep you informed on further developments on this matter.

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Major Medicare Savings Under Health System Reform Legislation

During the debate over health system reform, many physicians expressed concerns about Medicare program savings being used to offset the costs of the legislation.  The following are brief descriptions of the major provisions affecting Medicare spending and the 10-year budget savings that the Congressional Budget Office attributed to each.  Importantly, the new law also makes some significant Medicare payment improvements that are not covered in this document. Brief descriptions of those affecting physicians can be found in the document, titled "How the Passage of Federal Health System Reform Legislation Impacts Your Practice."

Physicians—$3 billion savings over 10 years
Utilization assumption for high-cost imaging equipment will be increased to 75 percent effective January 1, 2011 (net savings $2.3 billion over 10 years).  New physician-owned hospitals will be banned from participating in Medicare and limits are placed on growth of existing physician-owned facilities (net savings $500 million over 10 years).

Bonus payments under the Physician Quality Reporting Initiative will continue for an additional four years, followed by penalties beginning in 2015.  Because these provisions will produce a net increase of $300 million in Medicare spending over 10 years, the budget impact is not reflected in the total savings figure above.

Medicare Advantage—$136 billion savings over 10 years
Medicare Advantage plan payment benchmark variances, currently ranging from 95 percent of traditional Medicare program spending in high-costs areas to 115 percent of Medicare spending in low-cost areas, will be reduced.

Medicare DSH payments to hospitals—$22 billion savings over 10 years
As the number of uninsured Americans grows smaller, Medicare disproportionate share (DSH) payments to hospitals will be reduced.  These reductions will be based on a new formula that takes into account factors such as the decreasing number of uninsured and the decreasing amount of uncompensated care hospitals will need to provide.

Home health care—$40 billion savings over 10 years
Beginning in 2014, the Secretary of Health and Human Services will rebase home health payments to reflect case mix, the cost of providing care, the type of agency and resource costs.  Payments for outliers would be limited to 10 percent of cases.

Medicare Part D—$11 billion savings over 10 years
The premium subsidy for higher income beneficiaries is reduced.

Market basket adjustments for facilities and suppliers—$157 billion savings over 10 years
Most Medicare providers, other than physicians, receive annual market basket payment updates based on growth in the costs of goods and services or on the Consumer Price Index (CPI).  Also unlike physicians, these updates are not subject to an annual adjustment to reflect increased productivity.  The legislation addresses this inequity by providing for annual productivity adjustments for each market basket or CPI update for the various provider categories.  Additional provisions for the following providers, include:

  • Acute care hospitals, long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities and outpatient hospitals—additional reductions in market basket of between 0.1 percent and 0.75 percent annually through 2019 and productivity adjustment starts in 2012.
  • Skilled nursing facilities—productivity adjustments start in 2012.
  • Home health agencies—productivity factor starts in 2013 and additional market basket reduction of 1 percent scheduled for 2011-2013.
  • Hospice care—productivity adjustment begins in 2013 and additional market basket reductions of 0.3 percent contingent upon level of uninsured may be imposed annually through 2019.
  • Dialysis—eliminates 1 percent reduction scheduled for 2012 and begins productivity adjustments in 2012.
  • Ambulance services—productivity adjustment begins in 2011.
  • Ambulatory surgical services—productivity adjustment applied beginning in 2011.
  • Laboratory services—1.75 percent reductions for 2011-2015 (negative updates allowed) and productivity adjustment begins in 2011, but would not be allowed to take update below zero.
  • Certain durable medical equipment (DME)—productivity adjustment applied beginning in 2011 and increase scheduled for 2014 is eliminated.
  • Prosthetic devices, orthotics and prosthetics—productivity adjustment factor begins in 2011.
  • Other DME items—productivity adjustment factor begins in 2011.

Calculation of Part B premiums—$25 billion savings over 10 years
Current income thresholds for higher Medicare Part B premiums are linked to the CPI.  The new law freezes those income thresholds at current levels from 2011-2019.

Independent Payment Advisory Board—$16 billion savings over 10 years
An Independent Payment Advisory Board will be established to recommend savings in the Medicare program with fast track congressional approval procedures.  Most hospitals and hospice would be exempt from any savings proposals until 2020; clinical labs would be exempt until 2015.

New payment models—$13 billion savings over 10 years
A new Center for Medicare and Medicaid Innovation will be created and various demonstration programs and pilot projects involving physician and facility payments will be extended or established, including a national pilot program on bundled payments, hospital readmissions reduction program, gainsharing demonstrations, and a community-based care transition program.
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Your Participation in Upcoming MaineCare Survey Critical to HIT Incentives

The ARRA Health Information Technology Act (HITECH) provides Medicaid incentive funding for providers adopting, implementing, or updating electronic health records and health information technology.

Physicians, physician organizations, and qualified professionals may be eligible for funding up to $63,750 per professional over a five year period.  Ongoing funding requires that providers demonstrate “meaningful use” of HIT as defined by CMS.  Physicians may be eligible for either Medicare or Medicaid funding but may not participate in both.  Hospitals are also eligible for Medicaid HIT funding but hospital employed physicians are not.  The pertinent CMS rulemaking can be found at http://www.cms.hhs.gov/Recovery/Downloads/CMS-2009-0117-0002.pdf.  Physician practice organizations are eligible for funding for up to ten providers.

Similar incentives will be administered by Medicare.  Hospitals are eligible to receive both Medicare and Medicaid funding, while physicians eligible for both Medicare and Medicaid funding must choose which program to participate in. 

MaineCare is in the planning phase of HIT incentives.  CMS requires Medicaid agencies to assess the current state of technology development in the provider community and to create a vision for the future (2015) state of HIT/HIE in Maine.  The State will use an electronic survey tool administered by the Muskie Institute to compile the assessment of current technology.

It is very important that every physician, whether eligible or not, participates in the survey.  The survey is not an application for funding, but a tool to assess the “as is” state as required by CMS. 

Funding to providers will begin in January of 2011.  The implementation phase of the project including provider funding applications begins next fall.

You will be receiving an email shortly containing the survey link.

We look forward to working with you on the HITECH funding.

If you have any questions, please contact Dawn Gallagher by phone at (207)287-9366 or by email at dawn.r.gallagher@maine.gov.

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Sebelius Names Christie Hager CMS Region I Director

On April 6th, US DHHS Secretary Kathleen Sebelius announced the appointment of five new CMS Regional Directors, including Christie Hager as the Region I Director based in Boston.  Region I includes Maine.  From 2004 to 2009, Hager served as the chief health counsel in the Speaker's Office of the Massachusetts House of Representatives.  She currently is an adjunct lecturer on health policy at the Harvard School of Public Health.  Hager holds a master's degree in public health from the Boston University School of Public Health and a law degree from the University of Connecticut. [return to top]

AMA Announces New Tool to Help Physicians with Managed Care Contracting

On March 16th, the AMA announced the launch of its National Managed Care Contract database to help physicians analyze and negotiate health insurance participation agreements.  The AMA calls the searchable database "the first comprehensive managed care contracting resource geared specifically to the needs of physicians."  It is an effort to create model contract language that complies with the insurance laws of all 50 states and the District of Columbia and that addresses the range of physician concerns with these contracts.

You can find more information on the new database on the web at:  http://www.ama-assn.org/ama/pub/news/news/managed-care-contract-tool.shtml. You must be an AMA member to access this particular content. [return to top]

MMA Participates in Governor's Signing Ceremony for Bill Prohibiting Annual, Lifetime Caps in Health Insurance Policies

Recently, MMA representatives joined other advocates at Governor Baldacci's signing ceremony for L.D. 1620, An Act to Protect Health Care Consumers from Catastrophic Debt (P.L. 2009, Chapter 588), a first-in-the-nation bill to prohibit health insurers from setting annual or lifetime caps on benefits.  The recently enacted federal health care reform law will prohibit lifetime caps in 6 months, but it does not prohibit caps on annual benefits until 2014.  At the signing ceremony on April 6th, Governor Baldacci called it "an important piece of consumer protection legislation."  During his visit to Maine on April 1st, President Obama mentioned the Maine man who went deeply in debt because his cancer treatment exceeded his policy cap.  A strong advocate for this legislation, the man died before enactment, but his wife participated in the ceremony.  L.D. 1620 was sponsored by House Democratic Whip Seth Berry (D-Bowdoinham) on behalf of Consumers for Affordable Health Care.  Various consumer and provider organizations provided strong support for the bill.  MMA member Dr. Paul Liebow testified in favor of the bill and participated in the signing ceremony. [return to top]

Latest AMA Therapeutic Insights Addresses Alzheimer's Disease

The American Medical Association announces the release of Management of Alzheimer’s Disease, the latest AMA Therapeutic Insights newsletter
Take a quick look! Viewan overview of the Alzheimer’s Disease newsletter.

Maine physicians can access their Personal Prescribing Profile showing their individual prescribing patterns for Alzheimer’s Disease alongside state, national and specialty prescribing patterns for the condition. Just select the Maine newsletter and click Personal Prescribing Profile
AMA Therapeutic Insights
□  is free and online
□  highlights one disease condition per issue
□  features individual, state, national prescribing data* and evidence-based treatment guidelines
□  is written by top disease experts in collaboration with the AMA
□  offers AMA PRA Category 1 CreditTM
While most treatment-oriented CME programs focus solely on disease management, AMA Therapeutic Insights takes it one step further. This program delivers the actual prescribing patterns for the disease.
Visit AMA Therapeutic Insights to read this issue, as well as previous newsletters covering Hypertension, Type 2 Diabetes and Insomnia.
*The prescribing data in AMA Therapeutic Insights are provided by IMS Health. The AMA does not collect or have access to physician prescribing data in any form.
The AMA is accredited by the ACCME to provide continuing medical education for physicians.

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First Fridays Program on May 7th Features Risk Management

The next MMA First Fridays seminar on Friday, May 7th from 9:00 a.m. to noon features two experienced risk managers from Medical Mutual Insurance Company of Maine speaking about two important aspects of risk management in the physician office. 

  • Sue Boisvert, B.S.N., M.H.S.A., Senior Risk Manager will offer a presentation entitled, Workplace Violence:  Are You Prepared? 
  • Nancy Brandow, M.S., Senior Risk Manager will follow with a presentation entitled, Telephone Triage Tips to Reduce Risk and Improve Patient Safety.

Registration is available on the MMA web site at:  http://www.mainemed.com/.

You also may participate by WebEx.

For more information, please contact Maureen Elwell at MMA by phone at 622-3374, ext. 219 or by email at melwell@mainemed.com. [return to top]

MMA Public Health Committee to Meet on Monday, April 26th

The MMA Public Health Committee meeting is scheduled for  Monday, April 26, 2010 from 4:00 p.m. - 6:00 p.m. at the Maine Medical Association office.  All members and interested non-members are welcome to attend.  This meeting is now accessible by Webinar via your laptop for your convenience.  Please follow the instructions below.  It would be best for you to connect in via the instructions below for "the On-line Meeting."  The Dana Center (Maine Medical Center) will no longer be used for video-conferencing of the Public Health Committee meetings because of the new Webinar capabilities.  You will still be able to connect in via conference call as well.

If you plan to attend the meeting, please email Kellie Slate Miller, Director of Public Health Policy at kmiller@mainemed.com.  Thank you, and we look forward to your involvement.  The upcoming meeting will focus on our work in Climate Change, the National Children's Study, an update on the State Health Plan, the Gubernatorial Candidate Forum focusing on public health issues held in conjunction with the MMA Annual Session, and our legislative successes and next steps.

The PHC meeting packet (agenda and supporting materials)  can be accessed one week prior to the meeting at the Maine Medical Association's website at http://www.mainemed.com/calendar/programs/2010/021010_PHCAgendaMaterials.pdf.

To join via webex, please follow the instructions below:

Topic: Public Health Committee
Date: Monday, April 26, 2010
Time: 4:00 pm, Eastern Daylight Time (New York, GMT-04:00)
Meeting Number: 738 855 359
Meeting Password: 1234

To join the online meeting (Now from iPhones too!)
1. Go to https://mainemed.webex.com/mainemed/j.php?ED=132014882&UID=914381577&PW=NNjdkNmVjMjVk&RT=MiMxMQ%3D%3D
2. Enter your name and email address.
3. Enter the meeting password: 1234
4. Click "Join Now".

To view in other time zones or languages, please click the link:

To join the audio conference only
To receive a call back, provide your phone number when you join the meeting, or call the number below and enter the access code.
Call-in toll-free number (US/Canada): 1-877-669-3239
Call-in toll number (US/Canada): +1-408-600-3600
Global call-in numbers: https://mainemed.webex.com/mainemed/globalcallin.php?serviceType=MC&ED=132014882&tollFree=1
Toll-free dialing restrictions: http://www.webex.com/pdf/tollfree_restrictions.pdf

Access code:738 855 359

For assistance
1. Go to https://mainemed.webex.com/mainemed/mc
2. On the left navigation bar, click "Support".

You can contact me at:

To update this meeting to your calendar program (for example Microsoft Outlook), click this link:

WebEx will automatically setup Meeting Manager for Windows the first time you join a meeting. To save time, you can setup prior to the meeting by clicking this link:

The playback of UCF (Universal Communications Format) rich media files requires appropriate players. To view this type of rich media files in the meeting, please check whether you have the players installed on your computer by going to https://mainemed.webex.com/mainemed/systemdiagnosis.php

Sign up for a free trial of WebEx


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AMA and MMA Collaborate on Climate Change and Human Health for Clinicians on May 20th

Public Health Forum on Climate Change and Human Health For Clinicians

May 20th                                                                                                                                                                                   8:30am-11:30am                                                                                                                                                                   Holiday Inn by the Bay, Portland, Maine                                                                                                                         Limited to 50 attendees  (There is no registration fee)                             

The earth's climate is in the midst of significant change and with it comes the impact upon human health.  Increased respiratory allergies, asthma attacks, days lost from work due to respiratory disease, emergency room visits, hospitalization rates, and mortality are all symptoms of climate changes.

Physicians, Physician Assistants, Nurse Practitioners and Nurses are being called upon to increase their involvement in educational efforts on the impending health problems due to climate change and the adaptive and mitigating actions that can be taken in the public health policy arena. 

A limited number of seats (50) are available for clinicians to attend this forum that will address the scientific underpinnings of climate change and identify human health effects and implications for public health.

Expert Faculty to include:

Paul R. Epstein, MD, MPH, Associate Director Harvard Center for Global Health and the Environment.  Dr. Epstein received recognition for his contributions on the work of the Intergovernmental Panel on Climate Change (IPCC), awarded the Nobel Peace Prize in 2007.

Paul A. Mayewski, PhD, Explorer and Scientist Director & Professor, The Climate Change Institute, University of Maine.  Dr. Mayewski has developed integrated understanding of multiple controls on climate and unique role of human impact, demonstrated associations between climate and disruptions to civilization.

The program will conclude with a reactor panel of experts to facilitate an in-depth discussion with attendees.

To register, email kmiller@mainemed.com and indicate in the subject line that you would like to register for the Climate Change Forum on May 20th.  When your registration is received, a detailed agenda with directions will be sent to you via email prior to the forum.

This forum will provide 2.0 hours of CME and CEU credits.

The American Medical Association is sponsoring only three Climate Change forums across the country on Climate Change and this program is one of the three. [return to top]

Psychiatry Update April 30th - Registration Open

Maine Association of Psychiatric Physicians 2010 Update

Psychiatry: On the Street and In Your Genes

What: MAPP Annual Educational Sessions

When:  Friday, April 30, 2010

Where: Holiday Inn by the Bay, Portland, ME

Who Should Attend:  Psychiatrist, Primary Care Physicians, Physician Assistants, Nurse Practitioners, Psychiatric Nurses, those that want to broaden their knowledge of mental health care

Sample Topics:

Genetics of Addiction

Medical Marijuana: Risks and Benefits, What Literature Says, Understanding the Law

Treatment of Addiction

Risks of Anti-psychotic Medicine in Dementia

Treatment of Adults with Psychotic Disorders

Prevention of Schizophrenia

And More

For more information please call or email Warene Eldridge, 207. 622 .7743 or weldridge@mainemed.com

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POLITICAL PULSE: 124th Maine Legislature Passes Smaller Bond Package; Anticipates Adjournment Today

Early this afternoon, the House passed an amended bond package that received Senate approval this morning and thereby removed one more obstacle to adjournment.  The MMA expects the 124th Legislature to adjourn sine die some time this afternoon or this evening more than a week earlier than its April 21st statutory adjournment deadline.

The version of L.D. 1826, An Act To Authorize Bond Issues for Ratification by the Voters for the June 2010 Election approved by both chambers includes Appropriations Committee amendment "A" as amended by Senate amendment "J" thereto.  It reduces the original $85 million proposal by $40.7 million.  You can find the legislative history of this bill on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280036085.

Last week, both chambers enacted L.D. 1360, An Act To Allow Law Enforcement and Family Members To Petition the District Court To Initiate Assisted Outpatient TreatmentThe roll call vote in the House was 123-26.  You can find the legislative history of this bill on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280032509.

Also last week, both chambers enacted L.D. 1811, An Act To Amend the Maine Medical Marijuana Act .  You can find the legislative history of this bill on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280035810.

Finally, last week, both chambers enacted an amended version of L.D. 1611, An Act To Ensure Humane Treatment for Special Management Prisoners .  You can find the legislative history of this bill on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280035042 .   The amended version of the bill provides as follows: 

‘Resolve, Directing the Department of Corrections To Coordinate Review of Due Process Procedures and To Ensure Transparency in Policies Regarding the Placement of Special Management Prisoners’

Amend the bill by striking out everything after the title and before the summary and inserting the following:

Sec. 1 Commissioner of Corrections's review of due process and other policies related to placement of the special management prisoners at the Maine State Prison. Resolved: That the Commissioner of Corrections shall, in consultation with the mental health and substance abuse focus group of the State Board of Corrections, review due process procedures and other policies related to the placement of special management prisoners. In its review of due process procedures and placement policies, the commissioner shall also consider and propose an appropriate timeline for regular reporting to the joint standing committee of the Legislature having jurisdiction over corrections matters; and be it further

Sec. 2 Reporting date established. Resolved: That the Commissioner of Corrections shall report findings and recommendations pursuant to the report under section 1, including any suggested policy or legislative changes, to the joint standing committee of the Legislature having jurisdiction over corrections matters by January 15, 2011. Upon receiving that report, the committee may report out a bill to the 125th Legislature.’


This amendment is one of 2 committee minority amendments. The amendment replaces the title and the bill and creates a resolve directing the Commissioner of Corrections, in consultation with the mental health and substance abuse focus group of the State Board of Corrections, to review due process procedures and other policies related to the placement of special management prisoners. The amendment also requires the commissioner to consider an appropriate timeline for regular reporting to the joint standing committee of the Legislature having jurisdiction over corrections matters and to report all recommendations, including any suggested policy or legislative changes, to that committee by January 15, 2011. Upon receiving that report, the committee may report out a bill to the 125th Legislature.

The MMA's biennial summary of health care legislation from the two years of the current legislature will be available later this summer.


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