July 12, 2010

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New State Laws Effective Today

Laws enacted during the Second Regular Session of the 124th Legislature take effect today, Monday, July 12, 2010, except for laws passed on an emergency basis and laws having a specific effective date later than 90 days after the adjourment of the session.  Several of these laws impact on health insurance and other aspects of health care financing and delivery.

The following bills are highlights from the Second Regular Session of the 124th Maine Legislature that took place from early January to mid-April of this year.  A comprehensive summary of all health care legislation tracked by the MMA for the two years of the 124th Legislature will be available later this summer.

·        Budget:  L.D. 1671, the State FY 2010-2011 supplemental budget (P.L. 2009, Chapter 571).  This bill closed a budget gap of approximately $310 million (on a $5.8 billion biennial budget).  It achieved a net savings of approximately $31.8 million in DHHS programs, down from $91.5 million as originally proposed by the Governor.  Again this year, federal stimulus funds softened the impact on State-funded programs.

·        Payment Reform/QI:  L.D. 1544, An Act to Amend the Laws Governing the Maine Health Data Processing Center and the Maine Health Data Organization (P.L. 2009, Chapter 613).  This bill establishes a working group “to resolve issues regarding submission of data concerning service and billing providers” and to develop a plan to provide such data to the MHDO.  A report is due to the HHS Committee on 11/15/10.

·        Licensing Board Issues:  L.D. 1608, Resolve, Directing the Commissioner of Professional & Financial Regulation to Study the Complaint Resolution Process (Resolves 2009, Chapter 191).  This bill directs the Commissioner to convene stakeholders to “study the need to establish protocols for the resolution of complaints made to occupational and professional licensing boards.  A report is due to the Business, Research & Economic Development (BRED) Committee on 2/15/11.

·        Substitution of AEDs:  L.D. 1672, Resolve, Regarding the Dispensing of Antiepileptic Drugs (Resolves 2009, Chapter 188).  This bill directs the Maine Board of Pharmacy, GOHPF, BOLIM, and DHHS to study patient safety issues in the substitution of antiepileptic drugs and to provide a report to the HHS Committee on 1/15/11.

·        Sexually-transmitted Disease:  L.D. 1617, An Act Enabling Expedited Partner Therapy (P.L. 2009, Chapter 533).  This bill permits “expedited partner therapy” for sexually-transmitted in accordance with ACOG guidelines.

·        Lyme Disease:  L.D. 1709, An Act to Enhance Public Awareness of Lyme Disease (P.L. 2009, Chapter 494).  This bill designates May as “Lyme Disease Awareness Month” and directs the Maine CDC to maintain a publicly accessible web site for Lyme disease awareness and education.

·        Immunizations:  L.D. 1408, An Act to Establish the Universal Childhood Immunization Program (P.L. 2009, Chapter 595).  This bill establishes the Universal Childhood Immunization Program and the Maine Vaccine Board to determine a uniform set of vaccines for children from birth until age 19.

·        Insurance Mandates

o       L.D. 20, An Act to Require Insurance Companies to Cover the Cost of Prosthetics Containing Microprocessors (P.L. 2009, Chapter 603).  This bill modifies an exclusion permitted under current law for prosthetics designed exclusively for athletics.

o       L.D. 425, An Act to Require Private Insurance Coverage for Certain Services for Children with Disabilities (P.L. 2009, Chapter 634).  This bill requires coverage from birth to 36 months up to a limit of $3200 per year or $9600 by the third birthday.

o        L.D. 1198, An Act to Reform Insurance Coverage to Include Diagnosis and Treatment of Autism Spectrum Disorders (P.L. 2009, Chapter 635).  This bill requires coverage within certain limits through age 5.                       

·        Insurance Reform:  L.D. 1620, An Act to Protect Health Care Consumers from Catastrophic Debt (P.L. 2009, Chapter 588).  This bill prohibits annual and lifetime caps in health insurance policies.

·        Physician Delegation:  L.D. 1702, An Act to Amend the Laws Governing Advanced Practice Registered Nurses (P.L. 2009, Chapter 512).  This bill eliminates reference to “delegated performance of services” in the nurse practice act.

·        Medical Marijuana:  L.D. 1811, An Act to Amend the Maine Medical Marijuana Act (P.L. 2009, Chapter 631).  This bill amends the law passed at referendum in November 2009 and addresses recommendations of the implementation committee.  The focus of the bill is on improving access for patients.

Medical Professionals Health Committee Meets Tonight at MMA

The Medical Professionals Health Committee meets tonight, Monday, July 12, 2010 at the offices of MMA in the Frank O. Stred Building in Manchester.  The meeting begins at 6:00 p.m. and dinner will be available beginning at 5:30 p.m.  This Committee, chaired by Guy Raymond, M.D., of Fort Kent, advises the work of the Medical Professionals Health Program, a program that has assisted physicians in recovery for more than 25 years.  In addition to physicians, the program also now works with dentists, pharmacists, physician assistants, and nurses.  A staff of six full-time and part-time professionals work in the program and are assisted by others on the MMA staff from time to time.

A Powerpoint presentation on the work of the committee is available and can be presented by one of several different staff.  This presentation is eligible for category one CME credit for physicians and PAs and would be particularly appropriate for a medical staff meeting or grand rounds presentation.  If you or your organization are interested in having this program presented at your facility, please contact Catherine Stratton, MPHP Administrative Director at 623-9266.  Lani Graham, M.D., M.P.H. serves the program as part-time Medical Director and Margaret Palmer, Ph.D., serves as Clinical Director.  Mindy Armstrong, R.N. is a full-time case manager and the program is also assisted by John Murray, Pharm.D., and Barbara Farrell, Administrative Assistant.  Gordon Smith, Esq., serves as legal counsel to the program, assisted by Andrew MacLean, Esq.

If you know of medical professionals who need the services of the program, you may make a confidential referral by calling 623-9266.

  [return to top]

Medical Care Development Seeks Director of Operations

Medical Care Development, Inc. (MCD), a Maine non-profit health services, non-governmental organization, provides programs in the U.S. and 14 African countries.  MCD's mission is to improve the health and well-being of people both nationally and internationally.  MCD has 600 U.S.-based employees and annual revenue of greater than $40 million.  MCD currently seeks candidates for a new, high-level executive management position, Director of Operations.  You can find more information about the position on the web at:  http://mcd.org/empopp.asp.

Please note that the deadline for applications is July 16, 2010. [return to top]

Television Series Based on Tess Gerritsen's Rizzoli & Isles Debuts Tonight

Camden novelist Tess Gerritsen, M.D., spouse of MMA Past President Jacob Gerritsen, M.D., achieves another milestone tonight, Monday, July 12, 2010 with the debut of a new television series on the TNT cable network.  The mystery series, featuring two characters featured in previous Gerritsen best selling novels, is called Rizzoli & Isles and is on at 10:00 p.m.  The series features actresses Angie Harmon (who plays Rizzoli) and Sasha Alexander (who plays Medical Examiner Isles).  In the novels, Rizzoli is a tough Boston-based detective and Maura Isles, M.D. is a state Medical Examiner based in Boston.  The series also features Lorraine Bracco as Rizzoli's mother.

Tess (known to us here at MMA as Terri) was a practicing internist before she began writing fiction while on maternity leave and while raising, with Jacob, their two boys.  Her books have now sold more than 20 million copies and she is regularly on The New York Times best-seller list.  Her latest novel, Ice Cold, has just been published and is the eighth book in this particular series that began with The Surgeon and The Apprentice

Tonight Terri will be hosting a public event at the Camden Opera House preceeding a public showing of the TV show at 10:00 p.m.  Advance reservations were required and, unfortunately, the event is full.  But, you can catch her tomorrow night, Tuesday, July 13th at Border's in South Portland where she will have a book signing and will be reading from her new book at 7:00 p.m. Call 775-6110 for more information on that event.

Congratulations Terri on another milestone!  [return to top]

Jessa Barnard, J.D. Named MMA Director of Public Health Policy

Jessa Barnard, J.D., currently of Palo Alto, California but moving across the country this week, has been named Director of Public Health Policy for MMA.  Kellie Slate Miller, MS previously held this position but begins a new position this week as Director of Continuing Medical Education at the University of New England School of Osteopathic Medicine. 

Jessa is a 2008 graduate of Stanford Law School and a 2002 graduate of Dartmouth College.  From 2002 until beginning law school in 2005, Jessa worked at the Vermont Medical Society and directed a variety of projects, many of them in the field of public health.  For the last two years, she has worked as a staff attorney and Equality Rights Fellow  at the Law Foundation of Silicon Valley.  As part of that work, she established the first medical-legal partnership in the nation to assist patients with diabetes. 

"We are extremely fortunate to find Jessa at this critical time for MMA and for public health," said Gordon Smith, Esq., MMA Executive Vice President. "I recall her work in Vermont and her background is ideally suited for our public health work and a number of other projects, contracts, and grants we have currently underway." 

Jessa will begin her position at MMA on August 23rd, but she will attend the MMA Executive Committee meeting on July 28th. [return to top]

Quality Counts Board Meeting, July 7, 2010

The Board of Quality Counts (QC) held its bi-monthly meeting at the offices of MMA in the Frank O. Stred Building in Manchester this past Wednesday, July 7th.  The Board is chaired by MMA EVP Gordon Smith and the Executive Director is Lisa Letourneau, M.D., M.P.H. of Scarborough.

The most significant item of business was the election of a new member of the Board, Sharron Sieleman, R.N., M.S.N. who was nominated by Central Maine Healthcare.  Sharron is the Vice President for Nursing at Central Maine Medical Center and serves as Chair of the Quality Counts/AF4Q Nurse Leaders group.  Sharron was elected from a group of four individuals nominated for an open position on the board.

During the Enviromental Scan portion of the meeting, the role of Quality Counts in the work of the Maine Regional Extension Center (REC) was discussed.  QC is a subcontractor on the federal grant that funds the work of the Extension Center which is intended to promote the adoption of electronic health record systems and their "meaningful use."

During the Strategic Issues part of the meeting, Ted Rooney, RN, MPH introduced Board members to the AF4Q 3.0 grant proposal to Robert Wood Johnson Foundation.  The application for the new proposal to achieve two more years funding of AF4Q is due in August.  Proposals must include plans to continue support for current priorities and to expand to several new areas including HIT, payment reform, and alignment with national health reform priorities.

Other updates included the work of the Patient Centered Medical Home pilot and the possible linkage with the CMS Advanced Primary Care Demonstration and reports from the Membership & Marketing Committee and the Finance Committee.  The membership recruitment campaign for the coming year will begin immediately.  The current budget is on track for the year.

The next Board meeting will be held at 2:00 p.m. on Wednesday, September 1, 2010, again at the MMA offices.  For more information, go to www.mainequalitycounts.org.  [return to top]

AMA Provides Overview of New Web Portal to Help Uninsured Get Insurance

This is another briefing from the AMA's Health System Reform Insights series.  On July 1, Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the government's new website aimed at helping uninsured consumers find and buy insurance. The Patient Protection and Affordable Care Act required HHS to set up HealthCare.gov. Sebelius called the site a "one-stop, easy-to-use resource where American consumers can see all their health care options in one place." The site also includes information about the health system reform law.

Info about public programs, private insurance plans

HealthCare.govis the first central database of health coverage options, and includes information about public programs, such as Medicare, Medicaid, the Children's Health Insurance Plan, and high-risk pool coverage provided through the new Pre-Existing Conditions Insurance Plan. In addition, it includes information from more than 1,000 private insurance plans. Consumers can see a list of all private health plans that are accepting new customers by state and zip code.

Coverage options for small businesses

The site also provides coverage options for small businesses, including information about the tax credits available in the health system reform law. While consumers cannot enroll directly through the federal site, they are provided with health plans' Web links and phone numbers. The website also links to a summary of health plans' benefits and the provider networks, as well as the drug coverage offered by the plans.

A list of local individual health coverage plans

The website walks individuals through a checklist where they are asked to indicate their state, age range, and whether they are disabled, healthy, or have a medical condition. They are also asked whether they have any health insurance coverage. The site then provides options to learn about private health plans, public options, COBRA coverage, and the new high-risk insurance pools for people who have not been able to obtain coverage due to pre-existing medical conditions. Once they enter their zip code, a list of plans in their area is provided.

Benefit information, price estimates and performance data

Beginning in October, the website will expand to include benefit information and price estimates, including premiums, deductibles, and coverage limitations. The site eventually will provide additional information such as performance data on plans, including the percentage of claims rejected, medical loss ratios, and how often patients appeal coverage decisions, as well as information on preventing disease and illness and improving health care quality. The website will serve as an information bridge until 2014 when the state health insurance exchanges are operational; at that point, most of the website's functions will be taken over by individual state exchange websites. [return to top]

Update on 2010 PQRI

It is not too late to start participating in the 2010 PQRI program and potentially qualify for incentive payments.  The new six-month reporting period began on July 1st and extends through December 31, 2010.  Eligible professionals who satisfactorily report PQRI measures for the six-month reporting period will become eligible to receive a PQRI incentive payment equal to 2% of their total Medicare Part B allowed charges for services performed during that time.

Those who have not participated in the PQRI program can begin by reporting data using:

  • claims-based reporting of individual measures;
  • claims-based reporting of one measures group;
  • registry-based reporting for individual PQRI measures; or
  • registry-based reporting for a measures group (with a minimum of 8 patients).

Although there is no requirement to register prior to submitting data, there are some preparatory steps that physicians should take prior to undertaking PQRI reporting. 

You can find more information about the Physician Quality Reporting Initiative (PQRI) on the CMS web site at:  https://www.cms.gov/pqri/.

  [return to top]

Proposal Affecting Implementation of Health Reform Quality Provisions

On May 18th, the National Quality Forum (NQF) released for public comment a proposal for establishing a Partnership for Applying Measures to Improve Quality (PAMIQ).  This draft proposal responds to Sec. 3014 of the health system reform law, now known as PPACA, which directs a consensus-based entity (NQF) to convene multi-stakeholder groups to provide input on the selection of quality measures and on national priorities for improvement in population health and the delivery of health care services.  The establishment of the PAMIQ provides a unique and long desired opportunity to align a fragmented quality enterprise.  Submitted on June 15th, the AMA's comment letter urges the new Partnership to eliminate duplication of effort on the selection and use of quality measures in both public and private health programs, and to do so by merging new and existing quality entities within the proposed multi-stakeholder structure.  Furthermore, composition of the Partnership must result in appropriate representation of all affected stakeholders, and support inclusion of widely representative organizations with experience in health care delivery and quality improvement.  You can find more information about the development of this Partnership on the web at:  http://www.qualityforum.org/Setting_Priorities/Partnership_for_Applying_Measures.aspx. [return to top]

Maine Concussion Management Conference Scheduled for July 19th

The Maine Concussion Management Initiative (MCMI) is hosting a Maine Concussion Management Conference from 8:30 a.m. to 4:00 p.m. on Monday, July 19th at Colby College in Waterville.  You can find the agenda for the day and registration information on the web at:  http://wiki.colby.edu/display/GCMGrant/July+19th+Conference.

About MCMI

The Maine Concussion Initiative (MCMI) was founded in 2009, through a generous grant from the Goldfarb Center for Public Affairs and Civic Engagement at Colby College. The goal of our program is to enhance the health and safety of Maine high school athletes by educating medical practitioners and school administrators about the dangers of traumatic brain injury and the importance of consistent concussion management.  We are a group of physicians, parents, athletic trainers, neuropsychologists, teachers, and other professionals dedicated to minimizing the effects of concussion on Maine youth.

The Maine Concussion Management Initiative is committed to making computerized cognitive testing available to all high schools in Maine.  We will begin rolling out this program with 25 high schools in the first year.  We are approximating that this initial roll-out will affect 7,500 athletes.  
However, we would like to eventually expand to include 150 schools.  It is our hope to partner to make change that you can see.
[return to top]

US DHHS Announces New HIPAA Rules

On July 8th, the federal Department of Health & Human Services announced a proposed rule amending the current HIPAA privacy, security, and enforcement rules as required by the HITECH Act, a provision of the ARRA.  In addition to the so-called "breach notification" requirements, the HITECH Act required the HIPAA rules to apply to business associates in much the same way as they do to covered entities.  The proposed rule is scheduled for publication in the Federal Register on July 14th and DHHS will accept public comments for 60 days.  The Department has said it intends to set a compliance deadline of 180 days after publication of the final rule.  While many provisions of the HITECH Act took effect in February, the Department acknowledged the need for further guidance through rulemaking. [return to top]

Dirigo Board Hears Overview of New Program Developments Providing Coverage Available in August

The Dirigo Health Agency Board of Directors, chaired by Portland Attorney Jonathan Beal, held its regular meeting from 9:00 to 11:00 a.m. at its offices at 211 Water Street in Augusta.  Governor's Office of Health Policy & Finance Director gave an update on the State's work to comply with the federal health care reform initiative.  DHA Director Karynlee Harrington and her staff provided an extensive agency update, including strong financial statements for June 2010 and a description of the following aspects of Dirigo coverage:

  • DirigoChoice
  • Pre-existing Condition Plan
  • Health Care Tax Credit (HCTC)
  • Part-time Worker Coverage Voucher
  • Parent Expansion

You can find more information about these coverage categories on the DHA web site at:  http://dirigohealth.maine.gov/.  Several of these categories will be open to new enrollment effective August 2010. 

Maine Quality Forum Director Josh Cutler, M.D. also presented an update on the MQF's recent activities. [return to top]

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