February 28, 2011

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Dora Anne Mills, M.D., M.P.H. Removed as MaineCare Medical Director

In a move that surprised many health professionals and policy wonks, the LePage Administration on Wednesday removed Dr. Dora Anne Mills from her position as Medical Director of MaineCare.  DHHS released a brief statement stating that as it continues to assemble a new leadership team, Dr. Mills had been relieved of her duties as Medical Director at the Office of MaineCare Services effective immediately.  Prior to accepting the new role at MaineCare, Dr. Mills had served for 14 years as Director of the Maine CDC.

The complete text of the DHHS statement reads as follows:

          As DHHS continues to assemble its new leadership team, Dr. Dora Anne Mills has been relieved of her duties as Medical Director at the Office of MaineCare Services immediately.  DHHS will continue to assess and evaluate the administrative responsibilities at OMS.  We wish Dr. Mills the best in future endeavors.

Dr. Mills was reported to be at Sugarloaf with her family enjoying the school vacation week when she received the phone call advising her of her removal.  She has declined to comment on the action.  The firing of Dr. Mills follows the earlier removal of the MaineCare Director Tony Marple.  Marple was replaced by an interim Director, Stephanie Nadeau, and he has taken an interim position at Mercy Hospital in the finance area.

In response to media inquiries following the announcement, MMA EVP Gordon Smith noted that he was both surprised and disappointed at the announcement as Dr. Mills was a dedicated public servant who, as a pediatrician, was especially committed to public health and prevention, including increasing immunization rates, tobacco control, and getting a handle on youth obesity. 

In 2007, Dr. Mills was recognized by the American Medical Association for her work in improving Maine's public health system with receipt of the prestigious Nathan Davis Award for Outstanding Government Service.  The award was presented at the annual National Advocacy Conference in Washington D.C.  Dr. Mills will also be honored at the Annual Go Red for Woman luncheon this coming Tuesday sponsored by the Maine Division of the American Heart Association.  She will receive the 2011 Crystal Heart Award "for her numerous contributions to making Maine a healthier place to live and work."  MMA is a co-sponsor of the event.

In a related development, Governor LePage this past week said that he was looking at the possibility of splitting up DHHS and separating the health programs from the social service programs.  The department currently has about 3600 employees and a two-year budget of $3.4 billion. The Governor's spokesman Dan Demeritt stated that the Governor, "thinks there may be opportunities to improve services and make the department more efficient if one agency focused on health and the other on welfare, helping move people from welfare to work."

Commissioner Mayhew has begun a comprehensive review of the department.


Topics Being Considered at MMA Executive Committee Meeting on this Wednesday (March 2)

The Association's 28-member Executive Committee will hold a regularly scheduled meeting this coming Wednesday.  Priority topics for discussion include:

  • A prioritization of legislative items of interest;
  • A first review of a new draft of bylaws drafted following the Executive Committee retreat in January;
  • An invitation to join a new coalition of Maine-based organizations focusing on expanding health care coverage in the state.

The proposed bylaws draft, if ultimately adopted by the membership at the Annual Meeting on September 10, 2011, would alter the make-up of the Executive Committee by moving away from strict geographical representation.  The recommendations also reduce the number of standing committees in favor of more ad hoc committees.  In terms of nomenclature, the Executive Committee would become a Board of Directors and the current 7-member Operations Committee would become the Executive Committee. 

Executive Committee minutes and agendas can be found on the MMA website (member's only section) at www.mainemed.com.   All MMA committee meetings are open to MMA members and their guests.

The Executive Committee is chaired by Kenneth Christian, M.D., an emergency medicine physician practicing at MaineCoast Hospital in Ellsworth.


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Learn the Latest in Employment Law at March 4 Educational Program at MMA

Two of the state's leading attorneys on employment law and health law will be participating in MMA's March 4th First Friday Webinar on the topic of Human Resources in the Medical Practice.  Attendees can participate by attending at the office in Manchester or via WebEx over  the internet ($60 fee is the same).

James Erwin, Esq., Chair of the Employment Law Group at Pierce Atwood and John Gleason, Esq., of the Health Law Section of Curtis Thaxter will bring attendees up to date on the latest trends in employment law and on current trouble spots.  MMA attorneys Andrew MacLean and Gordon Smith will also participate.  The program will close with a panel of experienced practice managers providing first hand advice and discussing difficult situations they have encountered.  These issues include the tricky use of social media.  What do you do, for instance, when an employee posts unfavorable comments about your worksite on their personal Facebook account?  Can a medical office policy adopt a policy to discourage such postings without violating free speech?  If you manage a medical practice in Maine or are responsible for human resources in a practice, this may be the most valuable seminar you attend this year.

Program materials were included in your issue of Maine Medicine which you should have received in the mail two weeks ago.  You may also register on the MMA website at www.mainemed.com.  There is a $60 per person cost for the three hour program which runs from 9:00 a.m. to noon at the MMA office or via Webex.

For further information, contact Gail Begin or Maureen Elwell at the MMA office (622-3374) or via e-mail to gbegin@mainemed.com or melwell@mainemed.com. [return to top]

POLITICAL PULSE: Legislative Highlights of the Week

There was relatively little activity at the State House last week of interest to the MMA because of the school vacation week.  The legislature had no sessions scheduled and the principal health committees had no meetings scheduled.


The Joint Standing Committee on Appropriations & Financial Affairs opens public hearings on Governor LePage's proposed FY 2012-2013 biennial budget today.  Hearings for most health and social service budget lines will take place during the week of March 7th.

You can find an overview of the Governor's budget proposal along with the budget documents on the web at:  http://maine.gov/budget/budgetinfo/2012biennial.htm.

The following are some highlights of the budget noted during a MMA staff review of the documents:

  • General Fund (GF) savings of nearly $200 M in each year of the biennium from changes to the state employees pension program
  • GF savings of approximately $8 M in the first year and $19 M in the second year in the Dirigo Health Fund from reduced access payments
  • GF savings of $2.5 M in the second year from anticipated changes in the role and/or structure of the Dorothea Dix Center in Bangor
  • GF savings of $5.5 M in each year of the biennium from a "redistribution of funds" and reductions in the Fund for a Healthy Maine
  • GF savings of $420,000 in each year of the biennium from limiting benefits to legal non-citizens who have been in the state for less than 5 years
  • GF savings of approximately $100,000 in each year of the biennium from elimination of the Maine Rx Plus program
  • GF expenditures of approximately $74 M in the first year and $71 M in the second year for MaineCare spending on hospitals "to reflect enrollment growth and the conversion of payments to hospitals from a prospective interim payment methodology to payments based on diagnosis-related groupings and ambulatory patient classifications"
  • GF expenditures of approximately $6.8 M in the first year and $5.6 M in the second year to offset the loss of supplemental rebates because of the ACA
  • GF expenditures of $611,797 in the first year and $646,920 in the second year to continue the Patient Centered Medical Home Pilot project
  • GF expenditures of approximately $17 M in the first year and $18.5 M in the second year to offset a reduction in the state's Medicaid matching percentage (FMAP)
  • GF savings of approximately $2.6 M in the first year and $5.9 M in the second year "by freezing enrollment in the MaineCare program to parents of children whose income levels exceed 133% of the FPL
  • GF savings of approximately $17.7 M in the first year and $17.6 M in the second year of the biennium "as a result of a redistribution of resources within the Fund for a Healthy Maine"
  • GF savings of approximately $8.8 M in each year of the biennium "by limiting benefits provided to legal non-citizens who have been in the United States for less than 5 years"
  • GF savings of $1.25 M in the first year and $2.5 M in the second year in TANF "by implementing a full-family sanction for violation of program rules"
  • GF savings of $1.25 M in the first year of the biennium "by implementing a strict 5-year time limit for recipients of assistance under the Temporary Assistance for Needy Families Program"
  • Part NN of the budget language establishes a working group on the future of the Dorothea Dix Psychiatric Center
  • Part OO of the budget language directs DHHS to work with the AG's office on fraud detection
  • Part QQ of the budget language authorizes the transfer of up to $25 M from the GF unappropriated surplus to pay hospital settlements
  • Part SS of the budget language eliminates the Maine Rx Plus program
  • Part WW of the budget language requires health care practitioners to participate in the Controlled Substances Prescription Monitoring Program by providing information on dispensed controlled substances (MMA believes this may have been a drafting error, but nonetheless will be opposing a requirement that physicians report to the PMP)
  • Part XX of the budget language changes "MaineCare" back to "Medicaid" throughout the Maine statutes
  • Part BBB of the budget language reduces and then eliminates the Dirigo Heath Program access payments by 7/1/13
  • Part KKK of the budget language establishes the Streamlining and Prioritize Core Government Services Task Force to undertake a comprehensive analysis of state government to achieve GF savings of $25 M throughout departments and agencies statewide


This morning, the Joint Standing Committee on Criminal Justice & Public Safety held its first work session on L.D. 83, An Act to Legalize the Sale, Possession & Use of Fireworks.  Following a lengthy discussion among committee members, the Governor's Chief Legal Counsel Dan Billings, Public Safety Commissioner John Morris, and Fire Marshall John Dean, a consensus emerged (about half the committee seemed to favor) to ask the Executive Branch representatives to develop a compromise proposal that would allow some increased public access to fireworks.  Rep. Anne Haskell (D-Portland) asked that bill opponents Maine Medical Association, Maine Society of Eye Physicians & Surgeons, and Maine Municipal Association be included in the discussion.  The MMA will keep you posted on further work session activity. [return to top]

Legislative Committee Conference Call This Tuesday; New Bills for Review

The MMA's Legislative Committee will hold its next weekly conference call this Tuesday, March 1st at 8:00 p.m.  Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-669-3239

Passcode:  23045263

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.

If you have any questions about the conference calls, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

The following bills of interest to the physician community have been printed since last week's call and will be discussed on Tuesday.  For each bill, MMA Deputy EVP Andrew MacLean has proposed a staff recommendation for the MMA's position (support, oppose, monitor) and any specialty society or MMA committee that may be particularly interested in the bill.  Clicking on the "L.D. XX" will take you to the summary page on the legislature's web site showing you the procedural status of the bill.  To find the bill text for review, click on the "Bill Text and Other Docs" tab on the left side of the page.

Priority bills for discussion:

L.D. 678, Resolve, to Improve Health Outcomes for MaineCare Members in Managed Care (monitor)

L.D. 683, An Act to Enhance Long-term Care Services for Maine Citizens (monitor)

L.D. 702, An Act to Prevent HIV Transmission from a Pregnant Mother to a Child (support; ob-gyns, Public Health Committee)

L.D. 711, An Act to Regulate Noise from Wind Turbines in Residential Developments (monitor; Public Health Committee)

L.D. 712, An Act to Expand Access to Clinical Trials (support; MMA/American Cancer Society bill)

L.D. 717, An Act to Increase the Penalties for Possessing and Displaying a Firearm on School Property (monitor or support; pediatricians, Public Health Committee)

L.D. 719, An Act to Make Certain Prescription Drug Disclosure Laws Consistent with Federal Law (oppose Section 5 provision eliminating manufacturer fees that, in part, fund the academic detailing program)

We also will discuss aspects of the Governor's proposed FY 2012-2013 biennial budget outlined in the Political Pulse article just before this article in the newsletter.


Consent bills for discussion only if raised by call participant:

L.D. 676, An Act to Enact Requirements Concerning Veterinary Prescriptions (monitor)

L.D. 694, An Act to Encourage Transparency in Disclosing the Ingredients in Vaccinations for Children to Parents and Guardians (oppose; pediatricians, Public Health Committee)

L.D. 716, An Act to Improve the Recycling Rate of Mercury-added Motor Vehicle Components (monitor; Public Health Committee)

L.D. 720, An Act to Mandate Insurance Coverage for Infertility Treatment (monitor; ob-gyns)

L.D. 724, Resolve, to Create an Evidence-based Study and Comprehensive Plan for HIV and AIDS Services in Maine (support; Public Health Committee)

L.D. 736, An Act to Prohibit Texting While Driving (support; Public Health Committee)

L.D. 739, Resolve, to Amend the Rules Concerning Long-term Care Services to Better Support Family Caregivers (monitor)


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Register Now for 2011 AMPAC Campaign School

On April 13-17, 2011, AMPAC will conduct its annual Campaign School, in Pentagon City, Virginia, for AMA members who wish to become involved in the political process as advocates and volunteers for medicine-friendly candidates. The School is organized around asimulated congressional campaign, where participants are put on campaign "staff" teams and attend daily lectures on campaign strategy, media advertising and political fundraising.  Each team participates in nightly exercises such as creating a campaign strategy, taping a radio commercial, and writing a political fundraising letter.  Graduates have gone to become advisers and strategists for political campaigns across the country.

All costs for AMA members, except transportation to the Washington, DC metro area, are borne by AMPAC.  For more information on the Campaign School or an application, please contact Jim Wilson, Political Education Programs Manager, at 202-789-7465 or jim.wilson@ama-assn.org.     [return to top]

Efforts to Eliminate Form 1099 Reporting Requirements Advance

On February 17th, the House Ways & Means Committee considered legislation (H.R. 4 and H.R. 705) to eliminate a provision in the Affordable Care Act (ACA) that requires businesses to file an IRS form 1099 for all goods and services they receive that are valued over $600.  

H.R. 4, introduced by Rep. Dan Lungren (R-CA), eliminates the requirement without a financial offset, and the committee passed it on a voice vote.  H.R. 705, similar legislation introduced by Ways and Means Committee Chair Dave Camp (RMI), would: 1) eliminate the 1099 reporting requirement for goods and services; 2) repeal a similar 1099 requirement for individuals owning rental property; and 3) offset these two changes in the law by amending an ACA provision regarding the health insurance premium subsidy for certain individuals and families.  The Committee passed H.R. 705 by a party-line vote of 21-15.  The House Rules Committee must now consider both H.R. 4 and H.R. 705 before a proposal will be brought to the House floor.   

Previously, the Senate approved an amendment on Feb. 2 offered by Sen. Debbie Stabenow (D-MI) to eliminate the 1099 requirement on a bipartisan vote of 81-17.  The amendment was offset through a rescission of unobligated, discretionary funds.  The amendment was offered successfully to S. 223, a bill to reauthorize the Federal Aviation Administration, which later passed by the Senate on February 17th.  Additionally, on February 16th, Sen. Mike Johanns introduced companion legislation to the Camp bill as S. 359.   The pathway for final passage of legislation to eliminate the 1099 reporting requirement is not yet clear.   

The AMA has urged the IRS to exempt physician practices from the 1099 reporting requirement, and there were several attempts in the 111th Congress to eliminate this section of the ACA.  Those efforts were unsuccessful largely due to the need to find a politically viable budgetary offset.  During his State of the Union Address, President Obama also cited this provision as one he wanted addressed.  [return to top]

House Judiciary Committee Approves Medical Liability Bill

The House Judiciary Committee completed its two-day mark-up of H.R. 5, the “Help Efficient, Accessible, Low-cost Timely Health Care Act” (HEALTH Act), on February 16th.  H.R. 5, as introduced, would institute a $250,000 cap on non-economic damages in states without caps.  However, state laws that provide for higher or lower damage caps on non-economic damages would not be preempted.  

Votes on amendments were along party lines, with Democrats offering amendments to weaken the $250,000 cap on non-economic damage awards that were defeated.  The mark-up became contentious when a minority of Republicans agreed with Democrats that medical malpractice reform is traditionally regulated by the states and that the federal government should not pass a bill that allows for the preemption of state law.  Chairman Lamar Smith (R-TX) said he is working on an amendment to empower states that will be available for review three days before House floor action.  

 The bill was approved by the Committee by a vote of 18 to 15, and now awaits consideration by the Energy & Commerce Committee before it will be sent to the House floor.   [return to top]

MPHA Seeks Nominations for Access to Healthcare Award

The Maine Public Health Association is seeking nominations for its annual Phoebe Conrey King Access to Healthcare Award.  Nominations are due Friday, March 18th - details are available through this link: http://www.mainepublichealth.org/news.php.

The Phoebe Conrey King Access to Healthcare Award recognizes an individual or individuals who have made a significant contribution to improving access to healthcare in Maine.  The individual will have demonstrated leadership abilities in promoting increased access to healthcare by all Maine residents.  He or she will have made a significant contribution toward meeting the needs of the uninsured and medically underserved.  The nominee need not be a member of the Maine Public Health Association.  Programs are not eligible as MPHA has previously established an award to recognize exemplary programs.  To nominate someone, please go to http://www.mainepublichealth.org/news.php [return to top]

Call for Abstracts: Public Health Challenges

The Maine Public Health Association is pleased to announce its Call for Abstracts for breakout sessions at the 2011 Fall Conference.  The theme of the conference is Facing Public Health Challenges Today for a Healthier Tomorrow and will be held October 18th.  We encourage abstracts in all areas of public health, but are specifically interested in climate change, global health, policy change and health disparities.  Students are also encouraged to apply.  Abstracts should be no more than 500 words and must include learning objectives.

Authors must provide complete and accurate contact information in order to be notified of abstract status.  You do not have to be a member of MPHA to submit an abstract, however, if your abstract is accepted, presenting authors must register for the Annual Meeting at a discounted rate.

All abstracts must be submitted via e-mail or fax by April 1st at 5 p.m. by email to MPHAabstracts@gmail.com or by fax to 207.622.3616.

You can link directly to the abstract submission form through the MPHA website at http://www.mainepublichealth.org/news.php.

As we enter a new decade of incredible changes in the health care arena, public health practitioners are more valuable than ever before.  Please help us showcase the incredible research, programs and policies and work taking place across Maine by submitting an abstract for our Annual Meeting.  Until then, we wish you success in your efforts to promote health in your communities. [return to top]

SAVE THE DATE: Legislative Committee Forum Planned for Tuesday, March 15th

The MMA Legislative Committee plans one of its periodic issue oriented meetings in the near future.  The details are:

  • Date:  Tuesday, March 15th

  • Time:  6:00 - 6:30 p.m.  Social/networking opportunity; heavy hors d'oeuvres available; 6:30 - 8:30 p.m.  Remarks by guest(s), roundtable discussion

  • Location:  MMA headquarters, Frank O. Stred Building, Manchester

  • Topic:  Health care reform/insurance reform bills before the 125th Maine Legislature (insurance sales across state lines, Rule Chapter 850 geographic access standards, mandated benefits, insurance regulation, including portability provisions and community rating, etc.)

  • Guests:  Maine Insurance Superintendent Mila Kofman and perhaps 1 or 2 others

  • RSVP:  All Legislative Committee members, specialty society legislative liaisons, and any interested member or staff are welcome, but please RSVP to Maureen Elwell, Legislative Assistant so that we may get a head count for food (melwell@mainemed.com; 622-3374, ext. 219).

  • FMI:  Andrew MacLean, Deputy EVP, amaclean@mainemed.com; 622-3374, ext. 214

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