July 26, 2010

 
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MMA Group Health Plan to Terminate Feb. 1, 2011

After more than fifty years of offering a group health insurance plan to association members, their spouses and staffs, the Maine Medical Association's Group Health Plan, offered through Anthem Blue Cross Blue Shield of Maine, will terminate effective Feb. 1, 2011.  Following an increase in premium of 29% last February and with a similar increase anticipated at the next renewal, the Association's Committee on Membership and Member Benefits and the Executive Committee have voted to terminate the plan.  All contract holders have been notified and have been offered assistance in finding alternatives.  There are currently only 63 practices or individual members participating in the plan, including sixteen retirees using the plan for coverage supplementing Medicare.

The decision was made jointly by MMA and Anthem.  "Unfortunately, the future of association health plans is not good," noted MMA EVP Gordon H. Smith, Esq.  "Despite our aggressively watching the expenses in the plan and negotiating annually with Anthem,  the number of participants continues to decline.  Given the limited number of participants and the increasing cost of premiums, we no longer believe the plan is a cost effective member benefit."

The following letter has been sent to each participant in the plan.  A similar letter was sent to retirees who use the plan as a supplement to Medicare coverage.  Termination of the plan, effective Feb. 1, 2011, will have no impact on the group dental plan, which is offered to MMA members through a subsidiary of Anthem/Wellpoint.

It is with regret that I write to inform you of the decision of the Association to terminate the current MMA Group Health Plan, effective Feb. 1, 2011.

Given the 29% increase in premium charged by Anthem Blue Cross and Blue Shield of Maine, effective last February, and with a similar or greater increase anticipated in February 2011, the Association's Committee on Membership and Member Benefits and the Executive Committee did not believe the Plan would be a cost-effective benefit to you.  The number of Plan participants is decreasing each year and by 2011, we expect fewer than fifty members would find our association health plan to be the most cost-effective option for them.

I want to offer you all of the resources of MMA and of our insurance brokers, Willis of Northern New England, as you review other options.  Judy Conley or Zoie Smith at Willis will be contacting you in the next few days to discuss your options and whether or not it will be in your best interest to replace coverage prior to February 1, 2011.  Enclosed is Judy's business care if you prefer to call her at your convenience.  Don't hesitate to contact me at 207-622-3374, ext. 212, if I can be of assistance to you.

Sincerely,

 

Gordon Smith, Esq.

Executive Vice President

Maine Medical Association

 

MMA One of Ten Recipients of MeHAF Grant To Inform Mainers About Health Reform

The Maine Medical Association, through the Maine Medical Education Trust, is one of ten Maine non-profit organizations to receive a grant to support accurate, direct and effective outreach about how federal health care reform will impact people in Maine who are uninsured and medically underserved.  In addition to providing the facts about the new law, the organizations will explain how Mainers can take advantage of new benefits.  The award to the MMET was approximately $38,000 for one year.

Working together, the ten organizations will share straight-forward information with their constituents about opportunities and changes that the new PPACA brings to public and private health insurance programs.  The MMET submitted a proposal to help educate consumers of the PPACA opportunities working through the primary care offices in the state.

"We want to ensure that Maine people are fully equipped with information to make informed choices about new programs and benefits," said MeHAF President and CEO Wendy Wolfe, M.D.  "These ten organizations were selected because they have demonstrated an eagerness to work together to identify appropriate messages and outreach strategies, and because each has a history of service and influence among particular populations and communities in Maine in order to get the job done quickly."

In addition to the monetary grants, MeHAF will provide consulting assistance to help the organizations plan and implement a coordinated outreach process to educate Maine's young adults, seniors, low-income, immigrant and other groups who tend to be among those without insurance or access to quality care.

Other organizations, in addition to the MMET, receiving grants, totaling $344,492, include:

  • Consumers for Affordable Health Care Foundation
  • Legal Services for the Elderly
  • Maine Equal Justice Partners
  • Maine Primary Care Association
  • Maine People's Resource Center
  • Eastern Agency on Aging
  • Western Maine Community Action
  • Healthy Community Coalition
  • Maine Health

The Maine Health Access Foundation, founded in 2000, is Maine's largest health care foundation.  Each year MeHAF provides approximately $5 million in grants and program funding across the state to expand access to health care.  With an initial endowment of $81.7 million, MeHAF was established as a result of the sale of the not-for-profit Blue Cross & Blue Shield of Maine to the for-profit Anthem Blue Cross & Blue Shield of Maine (www.mehaf.org)

This grant to the MMET is the first grant that an MMA related organization has received from MeHAF (also the first one ever applied for).

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Veterans Seeking Care at VA Clinics No Longer Having to Choose Between VA Medication and Medicinal Marijuana

A directive from the Veterans Affairs Department this week is expected to change current policy which provides that veterans who receive medication from the VA can not use marijuana, even in those states which allow for medicinal use.  Maine and 13 other states were impacted by the previous policy.  While the new guidance does not authorize VA physicians to complete a medical certificate for marijuana for a patient, VA clinics generally will allow the use of medical marijuana where consistent with state law for veterans already taking it under the authorization of another physician. 

Dr. Robert A. Petzel, the VA Undersecretary for Health, said the guidelines would be distributed to the VA's 900 healthcare facilities around the country this week.  He also made clear that a VAA physician could continue to refuse to prescribe medications if there was a concern about the interaction of prescription medication and marijuana. 

"If a veteran obtains and uses medical marijuana in a manner consistent with state law, testing positive for marijuana would not preclude the veteran from receiving opioids for pain management" in a VA facility, Petzel wrote.  "The discretion to prescribe or not prescribe, opioids in conjunction with medical marijuana, should be determined on clinical grounds."

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Advisory Council on Health Systems Development Focuses on Federal Health Care Reform

The Advisory Council on Health Systems Development met in Augusta on July 23, 2010.  Following a brief discussion regarding how the recently released State House Plan would be distributed, the remainder of the meeting consisted of a presentation on health care exchanges to be established as part of the federal Affordable Care Act (ACA).  The presentation was made by Amy Lischko, Assistant Professor, Tufts University School of Medicine and Beth Waldman, Senior Consultant, Bailit Health Purchasing, LLC.

The presenters provided an overview of the exchange provisions in the ACA, including the American Health Benefit Exchange and the Small Business Health Option Program (SHOP).  Comparison of the ACA Exchange was made to other models, and the requirements of an exchange was discussed.  Under the law, states must establish exchanges by 1/1/2014.  The Exchanges may be administered by a governmental agency or a non-profit agency and they may be organized at a multi-State, State or a regional level.  States must decide on the structure of their Exchange(s) by 1/1/2013 and the federal HHS Secretary will decide whether significant progress has been made by 1/1/2013.

Federal grants are available to states for planning the exchange and for technical assistance for the small business health options program.  Any state exchange must be financially self-sustaining by 2015 and states must consult with relevant stakeholders in establishing the Exchange.  If a state does not establish an exchange, HHS willl establish one itself.  In 2017, states may apply for waiver of many of the Exchange features (and many other overall reforms).

Exchanges are intended to be a one-stop portal for health insurance eligibility and purchase, a place where low-income individuals and businesses can attain subsidies and tax credits to assist in paying for coverage.  One element of an exchange would be a website where purchasers could compare the cost and quality of health plans.  There would also be a pooling mechanism for more broadly distributing risk across a greater number of covered lives.  An entity would be established or selected to educate and inform the public about ACA and health insurance.

Goals of the Exchange would include the following:

  • Increase transparency of insurance coverage
  • Standardize and simplify insurance purchase
  • Increase competition among insurance plans
  • Increase portability and choice
  • Improve outreach and education
  • Reduce costs and improve quality of health care

A copy of the 40 slide power point presentation is available from MMA by calling 622-3374 (Press O for assistance).

 

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Donations Needed for MMA's Silent Auction at 157th Annual Session

Your July-August issue of Maine Medicine will contain an insert promoting a silent auction taking place on Sept. 11, 2010 at the MMA Annual Session.  The insert includes a donation form where members, corporate affiliates and friends may donate items for the auction, which will benefit the Maine Medical Education Trust (MMET).  The MMET supports a variety of educational programming for Maine physicians and is MMA's primary conduit for supporting various non-profit partners such as Quality Counts, the Hanley Center for Health Leadership and Health Policy Partners. 

Donations must be received by Sept. 1, 2010 in order to be listed by donor name in the program guide being prepared for the event.

Questions concerning the silent auction of the MMET may be directed to Dee Kerry deHaas, MMA Development Director at 207-622-3374 ext. 215.  [return to top]

MMA Executive Committee Meets on Wednesday, July 28

The 28 member MMA Executive Committee will hold its regularly scheduled summer meeting this coming Wednesday, July 28, at the home of MMA President David McDermott, M.D., MPH and his wife Ellen in Dover-Foxcroft.  Priority items for the meeting include presentation of the proposed budget for 2011 and a discussion of the need for an overall strategy for the Association's communications.  Redesign of the MMA website (www.mainemed.com) will be a part of the discussion.  Other items on the agenda include final planning for the 157th Annual Session being held Sept. 10-12, 2010 at the Harborside Hotel and Marina in Bar Harbor.  The draft report of the Nominations Committee will be reviewed for presentation in September.

The formation of an ad hoc committee on Governance will be discussed, intended to review a number of issues including the selection and make-up of the Executive Committee, the timing and frequency of Executive Committee meetings, and the role of all MMA committees.  The Committee will be chaired by in-coming President Jo Linder, M.D.

The Executive Committee is chaired Nancy Cummings, M.D., of Farmington.

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First Fridays Educational Presentations Resume Oct. 1, 2010 with Compliance Program

MMA's popular First Fridays educational programs will resume on Oct. 1 following a summer break with a three hour program entitled, Compliance in the Medical Practice.  Faculty for the program include John Gleason, Esq. of the Portland law firm of Curtis Thaxter Stevens Broder & Micoleau and Laurie Desjardins, CPC, Senior Manager in the Healthcare Management Consulting Division of Baker Newman & Noyes. 

The program is intended to assist physicians and their practice and compliance managers in understanding the issues surrounding the design and implementation of an effective compliance plan.  Given the increased level of scrutiny and enforcement at the federal and state level established as part of the PPACA, this program offers a timely opportunity to discuss the range of issues affecting medical practice compliance efforts, from the general development of the overall plan to the specific issues that may arise in a coding and billing audit.

The program is available at the MMA offices in Manchester or via WebEx.  A $65 fee covers all the materials and breakfast (if the registrant attends in persons).

Registration is available on the MMA website at www.mainemed.com or by calling Maureen Elwell or Gail Begin at MMA at 622-3374. 

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MaineCare Managed Care Advisory Group Holds First Meeting

At the first meeting of the MaineCare Managed Care Stakeholder Advisory Group, DHHS officials and representatives from the Muskie School of Public Service provided background information and an overview of Maine's proposed overhaul of the MaineCare program in the context of national Medicaid trends and the national health care reform law.

The Legislature established the group, which includes MMA, to "provide guidance to the department regarding the transition to manged care for the MaineCare program."

DHHS is planning to change the MaineCare program and its relationship to members, providers, and other stakeholders.  The initiative will move MaineCare away from its traditional role of approving and paying for individual services, toward a role of holding contractors accountable for the delivery of high-quality health services to members.

The stated goals of the initiative are:

  • Enhance the quality of MaineCare services; and
  • Reduce the growth rate in per person spending.

The Department aims to achieve these goals by forging a new partnership with members, providers, and health plans.  The primary objectives of this new approach are to align the incentives of members, providers, contractors, and MaineCare and to measure and reward quality.

The Department has proposed a timeline that includes the first RFP being issued in Apirl 2011 with the first enrollment to take place in January 2012.

A section of the DHHS, Office of MaineCare Services web site has been dedicated to information about the MaineCare Managed Care Initiative (MMI):  http://www.maine.gov/dhhs/oms/mgd_care/mgd_care_index.html.

Thanks to David Winslow of the Maine Hospital Association for preparing this summary as reported in the MHA Friday Report, July 23. [return to top]

Maine Insurance Superintendent Mila Kofman Requests Federal Waiver of Medical Loss Ratio Provision in ACA

Maine Insurance Superintendent Mila Kofman on July 1, 2010 filed a request with the federal Department of Health and Human Services asking for a waiver of that portion of the new health reform law that requires 80% of health insurance premiums to be spent on patient care as opposed to marketing, administrative costs and profits.  Current Maine law establishes a 65% threshold for what is called a medical loss ratio, but which we at MMA prefer to call a medical expense ratio.  We do not feel that it is appropriate to refer to insurance payments for medical expenses as a "loss" when, in fact, the whole purpose of paying premium is to have such expenses paid for.

Superintendent Kofman filed the waiver request in order to preserve what she believes is a competitive individual market in the state.  The current carriers are Anthem, HealthMarkets (associated with MegaLife) and Harvard Pilgrim through its partnership with the Dirigo Health Agency.  She expressed concern, based upon MegaLife filings with the SEC, that it might pull out of the individual market if the minimum expense ratio was increased. 

In the letter to HHS, Ms. Kofman states that Maine's 65% standard is not substantially lower than the new federal standard because the state law does not allow taxes and other expenses such as quality improvement initiatives to be part of the costs included in medical expenses. Federal regulations regarding what costs can be considered in determining the formula are not expected for a couple years, as the provision is not fully effective until 2014. 

There has not been any response from HHS since the letter requesting the waiver was received.    [return to top]

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