March 7, 2011

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President Suggests that Nation's Governors Apply for Waivers from Affordable Care Act

President Obama told the nation's governors this past week that the administration is considering allowing states to apply for waivers from the ACA.  States would still be expected to meet the objectives of the law.  In the meantime, Congress appears headed for an impasse as the parties are dug in on the conditions under which the debt limit can be extended.  Meanwhile, federal judge Roger Vinson in Florida, who earlier this year found the ACA unconstitutional, declared last week that the law could be implemented until the appeal of his decision is completed.  It is not yet clear whether the appeal will be expedited.

In speaking at the National Governors' Association meeting in Washington D.C. this past week, the President also suggested that the Wyden-Brown bill might be considered for implementation in 2014 rather than 2017 as previously thought.  The Wyden-Brown bill entitled, The Empowering States to Innovate Act (S. 248) has been sponsored on a bipartisan basis by Oregon Democratic Senator Ronald Wyden and Massachusetts Republican Senator Scott Brown.

The Wyden-Brown proposal is considered more modest than the ACA and is expected to attract moderate Senators on both sides of the aisle.

On the other hand, the White House has indicated it is not supporting changing the Medicaid program from an entitlement to a block grant model.  In a letter to State Medicaid Directors on February 25th, CMS has outlined the state options on the "maintenance of effort" (MOE) requirements of the ACA.

These issues were raised in DHHS Commissioner Mary Mayhew's introductory comments on the DHHS portions of the FY 2012-2013 biennial budget to the Appropriations and HHS Committees this morning.

In other action this past week related to health system reform, 42 of 47 Republican Senators wrote a letter to the President asking him to withdraw the nomination of Donald Berwick, M.D. as CMS Administrator.  The White House responded that the President would not withdraw the nomination.  The only Republican Senators not signing the letter were Maine Senators Olympia Snowe and Susan Collins, Lisa Murkowski (Alaska), Scott Brown (MA), and Rob Portman (Ohio).  The letter cites Dr. Berwick's lack of management skills but also alludes to some of the positions he has taken that are seem as controversial and objectionable to conservative Republicans.

In recent meetings with Maine's congressional delegation, MMA representatives have urged support for Dr. Berwick's nomination.  Many Maine physicians have worked with Dr. Berwick, particularly in connection with the Institute for Healthcare Improvement.


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 8th 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 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. 746, An Act Regarding the Consent of Minors for Mental Health and Substance Abuse Aid (oppose; pediatricians)

L.D. 758, Resolve, to Establish a Schoolchildren's Well-being Stakeholder Group (monitor; pediatricians, psychiatrists)

L.D. 759, An Act to Increase Efficiency and Effectiveness in the Licensing of Certain Health and Human Services Providers (monitor; psychiatrists)

L.D. 773, An Act to Further Restrict the Availability of Methamphetamine and Amphetamine PIlls (monitor)

L.D. 774, An Act to Allow Access to Pseudoephedrine by Prescription Only (monitor)

L.D. 806, An Act to Provide Public Access to Price Lists of Hospitals and Ambulatory Surgical Facilities (oppose)

 L.D. 827, An Act to Bring the State's Laws into Compliance with the National Instant Criminal Background Check System (monitor; Public Health Committee)

L.D. 831, An Act to Protect the State from Accumulating Future Hospital Debt (monitor or support)

L.D. 834, An Act to Exempt Orthotics from Sales Tax (monitor)

L.D. 837, An Act to Protect Children's Health and Promote Safe Schools and Child Care Centers by Limiting the Use of Pesticides (monitor; pediatricians, Public Health Committee)

Consent bills for discussion only if raised by call participant:

L.D. 743Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual Chapter III, Section 21: Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder, a Major Substantive Rule of the Department of Health and Human Services (monitor; pediatricians, psychiatrists)

L.D. 744, An Act to Amend the Definition of "Service Animal" to Conform with Federal Law (monitor)

L.D. 747, An Act to Require Hospital Credit Reporting that is Fair to Consumers (monitor)

L.D. 757, An Act to Add a Member to the Advisory Council on Health Systems Development (monitor)

L.D. 767, An Act to Amend and Clarify Certain Portions of the Dental Practice Laws (monitor)


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New Health Care and You Coalition Launched Nationally

The Health Care and You Coalition has launched the website to give consumers state-by-state information about how the Affordable Care Act affects them.  The Coalition is made up of the AARP, American Academy of Family Physicians, American Cancer Society Cancer Action Network, American College of Physicians, the American Medical Association, the American Nurses Association, the Catholic Health Association, and the National Community Pharmacists Association.

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Mainer Jeanne Lambrew, PhD Leaving HHS to Head up Whilte House Office

Jeaane Lambrew, Ph.D., daughter of MMA member and cardiologist Gus Lambrew, M.D., is leaving the federal Department of Health & Human Services to lead a newly consolidated health care office at the White House.  Andrea Palm, formerly Hillary Clinton's chief health advisor, will be assisting Lambrew.  Nancy Ann DeParle will be moving up to be Deputy Chief of Staff to the President.

Lambrew is one of the leading health policy wonks in the nation, having authored a major book on the subject of health care reform with former Senate Majority Leader Thomas Daschle.  [return to top]

POLITICAL PULSE: Legislative Highlights of the Week


Last week, the Health and Human Services Committee took up LD 216, Resolve, To Prohibit Smokers from Receiving MaineCare Benefits.  Senator Tom Saviello introduced the bill, which received significant public attention.  After speaking with public health advocates, Senator Saviello agreed to modify the bill to meet his primary goal of reducing the smoking rate among MaineCare beneficiaries.  On Friday, the Committee approved a complete re-write of the bill which, instead of prohibiting smokers from receiving MaineCare, charges the Department of Health and Human Services with identifying best practice measures for reducing tobacco use by MaineCare members and increasing utilization of the MaineCare tobacco treatment benefit.  Under the new bill, the Department will have to report back to the Health and Human Service Committee by November 30, 2011 on any progress made.  


Last Wednesday, the Insurance & Financial Services Committee held a public hearing on L.D. 364, Resolve, Directing Updated Review and Evaluation of Maine's Mental Health Parity Law.  Representative Mark Dion (D-Portland), a former Cumberland County Sheriff, sponsored the bill on behalf of the Maine Mental Health Parity Coalition.  This hearing on L.D. 364 was the first bill dealing with mandated health insurance benefits to be heard before the Insurance Committee this session and the MMA staff was pleasantly surprised at the positive feedback from the Committee about the parity issue.  The purpose of the bill is to prevent a rash decision about rolling back the mental health parity law among the various mandated benefits.  Representative Dion was eloquent in his presentation of the bill and two other legislators also spoke in favor - HHS Committee House Chair, Representative Meredith Strang Burgess (R-Cumberland) and Representative Jeff McCabe (D-Skowhegan).  Representative McCabe told the Committee about his own family experience with mental illness. The other proponents at the hearing were Randy Seaver, an individual whose mental illness is well managed, MMAj Deputy EVP Andrew MacLean on behalf of the parity coalition, MAPP member James Maier, M.D., Peter Kraut with the Maine Primary Care Association, and a representative of the Wounded Warriors who spoke about issues of particular concern to veterans.  Kris Ossenfort of Anthem was the only opponent of the bill.  The Bureau of Insurance spoke "neither for nor against" the bill.  The Committee has scheduled its first work session on the bill for this Wednesday morning. [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, former Maine Quality Forum Director and cardiologist D. Joshua Cutler, M.D., and perhaps 1 other.

  • 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 (; 622-3374, ext. 219).

  • FMI:  Andrew MacLean, Deputy EVP,; 622-3374, ext. 214

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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     [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:

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 [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 or by fax to 207.622.3616.

You can link directly to the abstract submission form through the MPHA website at

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]

CMS Limits RAC Documentation Requests

In response to advocacy by the AMA and other medical societies, RACs now are limited to requesting 10 records in 45 days from offices with 5 or fewer physicians and non-physician practitioners.  This is a significant improvement over prior CMS proposals to base Additional Documentation Request (ADR) limits on a percentage of annual claims submitted, a methodology the AMA strongly advocated against.  The new ADR limits will be based on the servicing physician or non-physician practitioner's billing Tax Identification Number (TIN) as well as location.  For examples and additional information, please view CMS' publication, [return to top]

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