March 14, 2011

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Legislative Committee Forum on Health Care/Insurance Reform Tomorrow Night, March 15th

Please join Legislative Committee Chair Lisa Ryan, D.O., MMA members and friends, staff, and guests Mila Kofman, Maine Superintendent of Insurance, former Maine Quality Forum Director Josh Cutler, M.D., and National Worksite Benefit Group CEO Joel Allumbaugh for a forum discussion on the health care reform/health insurance reform debate in the 125th Maine Legislature.

The MMA Legislative Committee plans one of its periodic issue oriented meetings tomorrow night.  

The topic for discussion for the evening is the health care/insurance reform debate in the 125th Maine Legislature, First Regular Session, including specifically the following bills printed to date:

L.D. 226, An Act To Allow Maine Citizens To Buy Health Insurance across State Lines

L.D. 410, An Act To Repeal the Provisions in the Insurance Laws Governing Guaranteed Issue and Community Rating:

L.D. 455, Resolve, Directing the Superintendent of Insurance To Form a Compact with Other State Commissioners of Insurance on the Purchase of Insurance out of State:

L.D. 473, An Act To Enable Maine Residents To Purchase Health Insurance over State Lines

L.D. 496, An Act To Amend the Laws Governing Financial Incentives and Geographic Accessibility of Services Covered by Health Insurance Providers:

L.D. 645,  Resolve, To Replace Maine's Health Insurance System with the Type of System Used in New Hampshire

L.D. 882, An Act To Limit Health Care Mandates:

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., National Worksite Benefit Group CEO Joel Allumbaugh, 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

  • We will have conference calling ability, using the regular Legislative Committee number and password:

    Conference call number:  1-877-669-3239

    Password:  23045263


NO Legislative Committee Conference Call This Week

Because of the Legislative Committee Forum scheduled for tomorrow night, there will be no Legislative Committee conference call this week.  The calls will resume next Tuesday, March 22nd at 8:00 p.m.  We will review no new bills this week, so we can have a focused discussion on several health care reform/health insurance reform bills during the Forum.  [return to top]

POLITICAL PULSE: Legislative Highlights of the Week


More than 150 people gathered in the State House Hall of Flags last Friday morning to protest proposed cuts to the Fund for a Healthy Maine.  The fund, which is supported by tobacco settlement money, would be cut by more than $17 million in the 2012 fiscal year under Gov. Paul LePage's proposed budget.  The cuts include a reduction of $4.3 million to substance abuse prevention, $4.6 million to the home visitation program, and $4.2 million from Dirigo Health as well as cuts to oral health, bone marrow screening, the Drugs for the Elderly program, and family planning.  Among the speakers on Friday was Dr. Barbara Covey, an emergency physician, who spoke to the importance of dedicating funds for prevention to keep people out of the emergency room. 

The Legislature's Appropriations and Health & Human Services Committees held a scheduled public hearing on the budget proposal Friday following the protest.

Last Friday, the Appropriations Committee and HHS Committee completed a week of hearings on the DHHS portions of the Governor's proposed biennial budget.  This week, the Appropriations Committee continues its public hearings on other parts of the biennial budget and the HHS Committee will begin work sessions on the DHHS portions of the budget.


On Friday, the Transportation Committee held a work session on L.D. 456, which would allow a physician, physician assistant, nurse practitioner or registered nurse to issue a 21-day disability parking permit to a patient while the person is obtaining a temporary or permanent disability parking credential from the Bureau of Motor Vehicles.  The Bureau of Motor Vehicles was in support of the proposal and the Committee heard no testimony in opposition.  At the work session, the Committee voted unanimously that the bill ought to pass.  


On Tuesday, March 8th, the Insurance & Financial Services Committee held a public hearing on L.D. 540, An Act to Implement the Insurance Payment Reform Recommendations of the Advisory Council on Health Systems Development.  The bill's prime sponsor is freshman Representative Anne P. Graham (D - North Yarmouth), a pediatric nurse practitioner who was a member of the Advisory Council before her election to the legislature. Testimony in favor of the bill came from the Bureau of Insurance, Advisory Council Chair Brian Rines, Ph.D., the MMA, the Maine Primary Care Association, Consumers for Affordable Health Care, and the Maine Center for Economic Policy (MECEP).  No one spoke in opposition to the bill.  Insurers Anthem and Aetna mentioned technical points in testimony "neither for nor against" the bill and the Maine Hospital Association questioned the approach to rulemaking in the same category.

On Wednesday, March 9th, the Committee held its first work session on L.D. 364, Resolve, Directing Updated Review and Evaluation of Maine's Mental Health Parity Law, a bill submitted by Representative Mark Dion (D - Portland) on behalf of the Maine Mental Health Parity Coalition.  Following a discussion about other mandated benefit bills expected during the session, the cost and timing of studies by the Bureau of Insurance, and the larger health care reform debate, the Committee voted to table the bill until later in the session.  The vote was a closely divided partisan split with Democrats favoring the tabling motion and Republicans opposing it.  


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UNE Physician Assistant Program Seeking Physicians Interested in Becoming Clinical Preceptors

The University of New England (UNE) Physician Assistant Program is looking for physicians and physician assistants who are interested in joining their team of dedicated faculty as clinical preceptors.  Beginning June 1, 2011, the PA Program will be offering clinical preceptors an honorarium along with a University adjunct faculty appointment.  Internists are particularly needed.

The UNE PA Program is the only PA program in Maine.  It's mission is to provide primary care to Maine's underserved and geriatric populations and its graduates currently account for 34% of the PA's currently practicing in Maine.

If you would like to learn more about this opportunity, please contact the Clinical Coordinator, Karen Marlin, PA, at 207-221-4408 or via e-mail to

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Bill Green of Bill Green's Maine and the Green Outdoors to Keynote Annual Corporate Affiliate Breakfast April 14

MMA is pleased to announce that WCSH commentator Bill Green, host of the popular weekly show Bill Green's Maine and the Green Outdoors will be the featured speaker at the annual MMA Corporate Affiliate Breakfast on Thursday, April 14th.  Bill has been behind a camera or in front of one continually since l975 and we are excited to have him as our guest at the breakfast which will once again by held at the Portland Country Club in Falmouth.  Breakfast will be available at 7:30 a.m. with Mr. Green speaking at approximately 8:00 a.m.

The annual breakfast is an opportunity for MMA to thank its Corporate Affiliates for the support they provide to MMA and Maine's physicians all year long.  Up to three individuals from any MMA Corporate Affiliate may attend without charge.  Members of the Association's Executive Committee and Committee on Membership & Member Benefits are also invited to attend.

Invitations will be mailed this coming week.  Questions about the event may be directed to Buell Miller, M.D. or Lisa Martin, MMA Membership Coordinator, at or respectively. [return to top]

DHHS Announces $66 Milllion Overpayment to Hospitals

Last Thursday, DHHS Commissioner Mary Mayhew announced that the Department had erroneously paid Maine's hospitals $66 million more than budgeted in the current fiscal year as a result of the Baldacci administration "failing to make needed changes in the way hospitals have traditionally been paid when a new payment system was implemented last September."  As a result, hospitals have been receiving both the traditional monthly prospective payments as well as DRG (diagnosis-related group) payments.  If the problem of these dual payments is not corrected, the Department would overspend its budget by $119 million by the end of the fiscal year.

In response to some legislators implying that hospitals should have realized the double payments and reported them to the Department, MHA lobbyist Jeff Austin noted that it was the Department's error and that it was not reasonable to blame hospitals who legitimately assumed the state was minding to its own budget.

In a letter sent on Thursday to Maine's hospitals on Thursday, Stephanie Nadeau, acting director of MaineCare, said hospitals would see reductions in both prospective and DRG payments between now and the end of the fiscal year to make up for the error.

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April 1 First Friday Program Featuring Coding Update Moved to Afternoon

The April 1st First Friday educational program, entitled, No April's Fool, Annual Coding Update, has been moved from the morning to the afternoon from 1:00 p.m. to 4:00 p.m.  Featuring Laurie Desjardins, CPC and Jana Purrell, CPC from the Learning Center (formerly the Coding Center of MMA) at Baker, Newman & Noyes, this annual update will feature several current coding topics.  A flier including the topics and agenda will be distributed this week and placed on the MMA website at  The cost of the seminar is $65 and interested individuals may attend either via WebEx or by joining the faculty at the MMA offices in Manchester.  MMA Executive Vice President Gordon H. Smith, Esq. will be moderating the afternoon discussion.

Questions about the program and any First Friday program may be addressed to Gail Begin or Maureen Elwell at MMA at 622-3374 or via e-mail to or, respectively.



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Maine Granted Waiver of ACA MLR Standard for Individual Health Insurance Market

On March 8th, Steven Larsen, Director of the Center for Consumer Information & Insurance Oversight (CCIIO), a part of CMS, wrote to Maine Insurance Superintendent Mila Kofman granting her request to establish a 65% "medical loss ratio" (MLR) for the state's individual health insurance market rather than the 80% required by the ACA.  Maine is the first state to seek and receive such a waiver having submitted its request in July 2010.  The waiver is for three years, but the State has to submit updated data in the final year.  The CCIIO based its decision on a "reasonable likelihood of destabilization in the individual market."  Maine has only three carriers in the individual insurance market (Anthem BCBS, MEGA Life & Health Insurance Company, and HPHC Insurance Company) and the Bureau of Insurance feared that MEGA Life would pull out of the market if held to the higher MLR.  You can see a copy of the CCIIO letter and other documents regarding this issue on the Bureau of Insurance web site: [return to top]

AAFP, AAP, ACP, & AOA Issue Patient Centered Medical Home Accreditation Guidelines

On March 8th, the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA) released joint Guidelines for Patient-Centered Medical Home Recognition & Accreditation Programs building upon Joint Principles of the Patient-Centered Medical Home issued by the four groups in February 2007.  You can see a press release addressing the new guidelines on the AAP web site: [return to top]

MIHMS Practice Focus Groups REGISTER TODAY!

MaineCare and Molina Medicaid Solutions would like to hear practice feedback on MIHMS (Maine Integrated Health Management Solution).

Focus groups are planned to take place across the state throughout the months of March and April.  Each focus group session will be followed by afternoon demonstrations. 

The morning session will include:

  • Overview of known issues and progress report on resolving these
  • Small-group discussions (by provider type) on how MIHMS is working, and what can be improved

Please note that the purpose of the morning will be to gather high level feedback for process improvement from providers as it relates to MIHMS.  Questions and answers related to specific claims and payments issues will not be addressed in these sessions.  We anticipate providing the opportunity for this type of discussion at future events.  

At the afternoon session, providers can see a demonstration of the MIHMS Online Portal. Demonstration areas will include:  Member Eligibility, Authorizations, Claims, and Remittance Advice Statements.

You can view the dates, locations and register online for all  sessions at:

Note: Special hospital-only and dentists-only sessions are planned but not yet scheduled.


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Organized Medicine Urges Changes to Health IT Program

The AMA and 37 specialty societies sent a strong letter to the Obama Administration to modify its policy and provide more flexibility for the next stages of Medicare's electronic health records (EHRs) incentive program.  The Administration recently sought input on draft recommendations for Stages 2-3 of the EHR incentive program.  The pending draft recommendations would significantly expand the Stage 1 requirements, and add new requirements calling for bi-directional data exchange and measures that would require physicians to rely on others to meet.  The AMA sought extensive input from the federation on these aggressive new requirements. Subsequently, the AMA and specialty societies called for greater flexibility in meeting requirements and ensuring that what is required is appropriate for the individual specialist, rather than using a one-size-fits-all approach. You can see the comment letter on the AMA web site at:  The AMA will continue to seek input from both the state and specialty societies on meaningful use of EHRs and advocate for reasonable requirements. [return to top]

Maine Psychiatrists Respond to Those Affected by Japan Earthquake

The Maine Association of Psychiatric Physicians (MAPP) joins all Mainers, Americans and the international community in mourning the tragic loss of life that occurred as a result of the earthquake and tsunamis in Japan.

We express our deepest sympathy to the residents of the communities affected by the catastrophe, as well as to our Japanese students and expatriates who live in Maine. We express our support to those who are still awaiting word on the fates of family members, friends, and colleagues in the affected areas. We also wish to convey empathy with those who are experiencing the effects of disruptions of social supports and destruction and loss of property. The grief associated with this disaster is universal, and touches all of our lives.  Psychiatrists, as part of the world medical community, reach out to those who are affected by all forms of disaster.  

Maine psychiatric physicians have an important role to reach out to our communities, including schools and universities that are hosting Japanese students, as well as those who work with these students.  In particular, psychiatrists and other mental health professionals may be called upon to provide treatment for individuals with particular vulnerabilities, including pre-existing mental illnesses, who might become more severely disabled without specialized care. At a broader level, health care and social service providers, and other responders in the community should be aware of strategies for helping to promote people’s psychosocial wellbeing and resilience and further reduce distress or harm to disaster victims. In addition, MAPP offers a reminder to parents, teachers and the media to limit children's exposure to upsetting images on the television and the Internet.

Anthony T. Ng, MD FAPA, Medical Director of Psychiatric Emergency Services at Acadia Hospital, is a nationally recognized expert in psychiatric responses to disasters and traumatic events.  "People who have been affected directly and indirectly by disasters or traumatic events may experience an array of psychological or bodily reactions, including fear, anxiety, sadness, emotional numbing, sleeplessness, and various bodily ailments such as headaches. Reactions may also include distrust of others and a loss of confidence in themselves," advises Dr. Ng.  "As the world psychiatric community engages the challenge of reaching out to individuals in Japan, it will be particularly crucial that any supportive as well as therapeutic interventions appreciate and respect cultural variations in grief reactions and coping strategies.  It is important for health care providers and others to avoid defining as pathological normal stress responses in disaster situations. Many of these reactions are transient and may resolve. In some instances, however, it may be appropriate for affected persons to seek treatment for trauma-related emotional states."

Individuals seeking information or other resources are encouraged to contact MAPP at 622-7743. Also, the American Psychiatric Association and other organizations have helpful websites where interested individuals can obtain more information about coping with the mental health aspects of disasters.

For more information contact:

Anthony T. Ng, MD FAPA
Medical Director, Psychiatric Emergency Services
Acadia Hospital
Tel: 207-973-6345


James Maier, MD DFAPA

Public Affairs Representative, MAPP


Tel: 207-883-5420

Julie Keller Pease, MD DFAPA

President, MAPP


Tel: 207-409-8621

Contact for questions regarding guidelines for donations of pharmaceuticals:

Stevan Gressitt, M.D.

Executive Committee, MAPP

Founding Director, International Institute for Pharmaceutical Safety


Tel: 207-441-0291

Contact for general questions about Maine Association of Psychiatric Physicians:

Warene Eldridge, Executive Director, MAPP

P.O. Box 190, Manchester, ME 04251-1090

Tel: 207-622-7743


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