May 16, 2011

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Maine Superintendent of Insurance, Mila Kofman, Announces Resignation Effective June 1st

The Maine Medical Association was sorry to learn today of the resignation of Mila Kofman, J.D. as Maine's Superintendent of Insurance.  Ms. Kofman has led the Bureau of Insurance since March of 2008 and last year was appointed for a full five-year term.  In a letter delivered today to Governor Paul LePage, the Superintendent cites the Governor's need to "have a regulator who shares your philosophy."  The entire text of her letter of resignation is included in the article below.  Despite the resignation, Ms. Kofman will still be one of the keynote speakers at the Association's Practice Management Forum this coming Wednesday at the Augusta Civic Center.  Ms. Kofman will be speaking at 12:15 p.m.

During her term as Superintendent, Ms. Kofman has emphasized efficiency, accountability, and transparency.  Notably, she took on the annual request by Anthem Blue Cross Blue Shield of Maine for substantial increases in the individual market and prevailed in a recent court decision.  As a member of the National Association of Insurance Commissioner's (NAIC) Executive Committee, Ms. Kofman was instrumental in retaining the strong medical loss-ratios included in the Affordable Care Act against the attempts by health plans to weaken the law and its impact..  This past January, she was invited to address the annual Advocacy Forum of the AMA and was well received.

"Mila has treated the interests of both consumers and providers with diligence and compassion and we are very sorry to see her leave the position," stated Gordon Smith, Esq., Executive Vice President of the MMA.  "At the same time, we wish her well in her future endeavors and are confident that her considerable talents will be sought elsewhere."

The full text of the letter of resignation is as follows:

 May 2, 2011


The Honorable Paul LePage

Governor of Maine

One Statehouse Station

Augusta, ME 04330


Dear Governor LePage:


The purpose of this letter is to notify you of my intent to resign effective June 1, 2011. 

May 31, 2011 will be my last day as Superintendent of Insurance at the Maine Bureau of Insurance. I recognize that health reform is one of your top priorities.  I also recognize your need to have a regulator who shares your philosophy.

Although we have many similar goals, including ensuring that all of Maine’s businesses and people have access to more affordable health coverage options, we have different approaches of how to get there.  I sincerely hope that you will succeed in your efforts to lower health care costs and to ensure that all Mainers have access to affordable and reliable health insurance options. 

It has been a privilege and a great honor to have been able to serve Maine’s businesses and people since March of 2008.  During the last three years, my top priorities have been to increase efficiency, accountability and transparency.  By effectively balancing consumer protection and the needs of the regulated community, as well as ensuring fair and balanced regulatory oversight and accountability (through enforcement and market conduct), my tenure has seen more companies coming to Maine (Property and Casualty) and greater market stability (Life and Health).  I am proud of improving services to the regulated community and most importantly of improving protections for Maine’s consumers.  

I am also very proud of my solid record of seeking solutions to challenging issues, working with businesses, unions, consumer advocates, insurance agents, insurance companies, physicians, trial attorneys, state policymakers and our Congressional delegation – never putting politics ahead of good public policy and balanced regulation, always having an evidenced-based approach to problem solving.

Under my leadership and the strong dedication of the Bureau of Insurance team, Maine’s insurance market remains strong and is well positioned for the future.  During the last three years, the nation experienced unprecedented and in many ways unpredictable events affecting state-based regulation of insurance, e.g., AIG, financial markets turmoil, H1N1 Pandemic. I took appropriate action to ensure Maine’s market and consumers were well protected – Maine’s companies remain financially strong, and promises to consumers have been kept.  I am also proud of the work I did with our Congressional delegation to ensure that state-based insurance regulation is protected.  Both the Dodd-Frank Act and the Patient Protection and Affordable Care Act recognize the role of states and state-based insurance regulation. 

I am leaving a team that is well positioned to address small and large challenges, whether predictable or unpredictable. 

It has been an honor of a lifetime to serve as Maine’s Superintendent of Insurance!

Very truly yours,




LAST CALL: MMA's 20th Annual Practice Education Seminar, May 18th

MMA's 20th Annual Practice Education Seminar, being held again this year at the Augusta Civic Center, will feature presentations on a number of topics that members say are difficult for them to get their hands around.  The program will be held on Wednesday, May 18, 2011 from 8:30 a.m. to 4:30 p.m.  Registrations materials were mailed to all MMA members and practice managers two weeks ago.

Recently, new Maine CDC Director Sheila Pinette, D.O. confirmed that she will attend the Seminar in the morning and provide some brief remarks shortly before the 10:30 a.m. break.  Dr. Pinette began her work at the Center this past Monday. 

Among the topics are the following: 

  • Measuring Quality in a physician practice;
  • What's New at Medicare;
  • Achieving Meaningful Use in a Meaningful Way;
  • Preparing for Accountable Care Organizations;
  • Addressing Issues with Elderly Drivers;
  • Social Media in Your Practice:  Friend or Foe; and
  • Preventing Prescription Drug Abuse

 In addition to Dr. Pinette, other presenters include Insurance Superintendent Mila Koffman, J.D., John Freedman, M.D. of Freedman HealthCare, Thomas Arnold, Deputy Secretary of State and Elizabeth Mitchell, President of the Maine Health Management Coalition, and William Kassler, M.D., Medical Director of Region I, Centers for Medicaid and Medicare Services (CMS).

Interested individuals may also register now on the MMA website at  For one information on the Annual Seminar, contact Gail Begin at MMA via e-mail to




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Please Plan to Attend Physicians' Day at the Legislature on May 26th



State House, Hall of Flags, Second Floor

May 26, 2011, 8:00 am to 4:00 pm

Speak with your legislators and participate in the legislative process.  Speak up on issues of significance to physicians, such as:  health care reform; Medicaid funding; scope of practice; state budget priorities; childhood obesity prevention efforts; and more.

We strongly urge you to attend and invite your colleagues.

Our State House visits make a very positive impression on legislators.

In addition to the traditional events in the Hall of Flags, the MMA & MOA would like to start the day at 7a.m. with a Walk/Run, along the Kennebec River Rail Trail.  All physicians and legislators are welcome.  The Kennebec Valley YMCA’s locker rooms will be available to all participants before and after the walk/run.  The starting point and ending point will be the Kennebec River Rail Trail Message Board at Capitol Park, which is located west of the YMCA on the opposite side of the football field.  The participants will walk/run along the trail to Hallowell and back (2 miles).  Come start your morning with a healthy walk/run along the beautiful Kennebec River Rail Trail!


Contact Maureen Elwell:

(207) 622-3374 begin_of_the_skype_highlighting            (207) 622-3374      end_of_the_skype_highlighting ext. 219

Maine Medical Association

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Emergency Physicians' Annual Lobster Bake is June 23rd




June 23, 2011

Enjoy the beautiful Maine coast and network with fellow ED physicians by signing up for the ACEP Lobster and Clam Bake on Cabbage Island in Boothbay Harbor on Thursday, June 23, 2011.  Guests are welcome and encouraged!


WhatMaine ACEP’s Annual Lobster and Clam Bake

WhenThursday, June 23, 2011.  4:30 pm – 8:30 pm.  Meet at 4:30pm.  Boat leaves at 5 pm sharp and waits for no one! (RAIN OR SHINE)

WherePier 6, Fisherman’s Wharf, Boothbay Harbor.

Cost:    ACEP will cover the expenses for its members.  Guests are charged $59.95 per person, which covers the boat ride and food (twin lobster meal).  Chicken is available.  Kids 2-11 can get a hotdog meal and boat-ride for $27.50 A ticket only for the boat-ride is $23.00 (only available to kids 2-11).  

For more information, contact Maureen Elwell at 622-3374, ext. 219 or at [return to top]

MICIS Now Offers Atrial Fibrillation Module

Atrial Fibrillation Module NOW Available!!!

Slow(er), even if not steady, wins the race

The Maine Independent Clinical Information Service is launching a new academic detailing module on the management of atrial fibrillation.  Atrial fibrillation (AF) is the most common arrhythmia, affecting nearly 2.5 million Americans.  Because its prevalence rises rapidly over 60 years of age, this number is likely to increase significantly as the population ages.  Regardless of underlying causes, or if no cause be found, the patient should be evaluated for rate or rhythm control.  Rate control appears to cause fewer adverse drug effects and hospitalizations than rhythm control.

AF is a major cause of stroke, but treatment can reduce that risk by two-thirds. Most AF patients will require long-term anticoagulant or anti-platelet medication to reduce their risk of stroke however, there is ample evidence that anticoagulation is vastly under-utilized in patients with AF, particularly the elderly. This appears to result from an incorrect assumption that the risks of bleeding from these regimens are greater than the risk of stroke, which is generally not the case.

This module covers the following important information for the care of patients with AF:

Treatment targets: Control the rate, or control the rhythm?

Beta blockers, calcium channel blockers, digoxin and antiarrhythmics

Using the CHADS2 scoring system and the HAS-BLED risk index to guide thromboprophylactic therapy

Aspirin, clopidogrel, warfarin and dabigatran

For more information, or to request an educational session at no cost to your practice, contact the Maine Medical Association: 207.622.3374 or

For more information on MICIS and academic detailing, visit:

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Results of Latest MMA Membership Survey

The MMA recently concluded a periodic "Survey Monkey" survey of the membership.  The survey posed the following questions.  The percentage responses follow the question.

Question 1.  The 10th Scope of Work for the Medicare Quality Improvement Organization (QIO) was recently announced by CMS.  Do you support moving from a physician access organization (with no Maine physician representation) to a physician sponsored organization requiring membership from at least 20% of physicians in the state?


  • Yes:  46.7%

  • No:  8.4%

  • Need more information:  53.9%

Question 2.  The Maine legislature will hear a bill (L.D. 1501) on May 9th that attempts to address the prescription drug abuse problem in the state by requiring mandatory CME on the topic and participation in the Prescription Monitoring Program.  Do you support these initiatives?


  • Yes:  46.4%

  • No:  54.8%

Question 3.  Another legislative proposal would allow a physician to prepare a medical certificate for marijuana use for a patient without regard to the present list of illnesses and conditions.  Do you support this broadening of physician discretion under the law?


  • Yes:  12%

  • No:  89.2%

The MMA will conduct short surveys like this on a variety of topics in the future.

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Attend the EHR Educational Events For Critical Access Hospitals and Primary Care Providers

MEREC, in partnership with Quality Counts, will be hosting the second in a series of free regional forums about electronic health records, meaningful use, and related federal and state incentive programs.  The forums are specifically targeted for primary care providers and staff of small independent practices as well as clinical and administrative staff in Maine’s rural and critical access hospitals.  The events will include a panel of health information technology experts, both local and national, a specific discussion on the integration of HIT in the patient centered medical home, and as group breakout sessions focused on using EHRs (inpatient and outpatient) to improve health care quality and outcomes, reduce costs and ultimately achieve federal meaningful use requirements.  Hope to see you at one of the following events:

•       Franklin Memorial Hospital:  Tues, May 10, 1:30 - 5:30 p.m.
•       Mt. Desert Island Hospital:  Wed, May 11, 2 - 6 p.m.
•       Mayo Hospital:  Wed, May 25, 2 - 6 p.m.
•       Goodall Hospital:  Wed, Jun 1, 2 - 6 p.m.

Register online at or by calling Maria Stevenson at 207-541-9250 begin_of_the_skype_highlighting            207-541-9250      end_of_the_skype_highlighting, ext 201.

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New Vendor Directory Helps Physicians Select a Practice Management System

Is your practice looking for a new practice management system or an upgraded system that can integrate with electronic health records?  You can get the information you need to select the right software with the help of the new Practice Management System Software (PMSS) Directory.  

The AMA and the Medical Group Management Association (MGMA) offer this free resource for their members as a complement to the recently released "Selecting a Practice Management System" toolkit.  Built on specific responses to survey questions posed to vendors, this directory can make the search for practice management system software easier.  AMA and MGMA members can query, filter options and print out detailed vendor responses to all survey questions.  

You can find more information on the directory and related toolkit resources on the web at:

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SAVE THE DATE: Pierce Atwood Labor & Employment Seminars, Co-sponsored by MMA, June 10th & 17th

Save the Date! Pierce Atwood Program in your area June 10 & 17:

Labor & Employment Issues for the Maine Healthcare Industry

 Brewer & Portland, Maine

Date: June 10 and 17, 2011
Time: 8:30 AM - 3:00 PM

The Pierce Atwood Employment Group, with our co-sponsor Maine Medical Association, is pleased to invite you to a program on Labor & Employment Issues in the Healthcare Industry.  We will be offering this program twice.

  • June 10, also sponsored and hosted by Eastern Maine Healthcare Systems, at the EMHS Brewer office 
  • June 17, also sponsored by Martin's Point HealthCare, at The Woodlands Club in Falmouth

Our tentative agenda includes the following topics:

  • Managing the impaired worker
  • Wage-hour challenges for healthcare employers
  • The latest on union activities around the state including, Maine State Nurses Association/California Nurses Association, Teamsters and others
  • Significant developments in Augusta and Washington
  • Immigration issues in the healthcare industry
  • HIPAA, privacy and technology, including duties of employers and employees
  • Special guest Short Fuse Theater: "Coping with the high performing, high risk healthcare employee". (Portland only) 
  • Rapid-fire round - questions and answers on topics across the labor & employment spectrum

Our agenda is tentative because we want your help in shaping it.  When you register, please use the box on the registration screen to suggest questions or topics you'd like to see us address.  We'll synthesize your responses and incorporate as many as we can into our presentation.

Also, when registering, please indicate which program you wish to attend.

This program will be of interest to senior management, human resources management and staff, in-house counsel, risk managers and upper level supervisors.  Please forward to any interested persons in your organization.

The program will run from 8:30 am to approximately 3:00 pm.  There is no charge to register, and lunch will be served.  Our sincere thanks to our co-sponsors for helping to make these events possible.

Please check your email box for a reminder in the next couple of weeks.

If you have any questions, please contact Amber Elliott at or 207-791-1143.

Copyright � 2011. Pierce Atwood LLP. All rights reserved.

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CMS Releases 2009 Quality Measurement & E-Prescribing Data Report

On April 19th, the Centers for Medicare & Medicaid Services (CMS) released its 2009 Physician Quality Reporting System (PQRS) and e-prescribing incentive program experience report.  According to the report, 119,804 physicians and other eligible professionals in 12,647 practices satisfactorily reported on quality measures to Medicare and received an incentive payment.  The average 2009 PQRS incentive payment was $1956 per eligible professional and $18,525 per practice.  For the 2009 e-prescribing program, the average incentive payment was just over $3000 per eligible professional and $14,501 per practice.  While participation in both programs increased, successful participation in the 2009 PQRS program was around 56%, and 57% for the 2009 e-prescribing program.  In an effort to improve successful participation in both CMS programs, the AMA continues to advocate for more timely and meaningful participation feedback and outreach.  The full 2009 PQRS and e-Prescribing Experience Report is available on the CMS web site at: [return to top]

BNN Learning Center & MMA Offer Upcoming Coding Certification Course at USM

The Learning Center at Baker Newman Noyes in conjunction with the Maine Medical Association is offering a AAPC Approved Coding Certification course.

´  Thursdays, June 9, 2011 to September 22, 2011

´  4:00pm – 8:00pm

´  University of Southern Maine in Portland (#1 Payson Smith Room)

Click Here for the link to the Learning Center’s website for additional details and a Registration form.

Should you have any questions, please don’t hesitate to contact either the Learning Center or Hayat Freeman-Lutes, CPC, CEMC at 207-791-7126 begin_of_the_skype_highlighting            207-791-7126      end_of_the_skype_highlighting. [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, May 17th 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. 1558, Resolve, to Study Allocations of the Fund for a Healthy Maine (monitor; Public Health Committee)

L.D. 1562, An Act to Prohibit the Sale or Possession of So-called Bath Salts Containing Dangerous Synthetic Drugs (monitor)

L.D. 1568, An Act to Ensure Fair Business Competition in Agriculture (monitor)

L.D. 1571, An Act to Amend the Laws Governing Workers' Compensation (monitor)

Consent bills for discussion only if requested by a call participant:

 L.D. 1560, An Act to Update Professional and Occupational Licensing Statutes (monitor)


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POLITICAL PULSE: Legislative Highlights of the Week


Majority Republicans seemed determined to complete floor action on the controversial insurance reform bill, L.D. 1333, last week and to get it to the Governor's desk for signature.  The House enacted the bill on Thursday, May 12th and the Senate convened that evening to debate it.  During the Senate debate, two amendments were adopted.  One amended the community rating provisions and the proposal on the geographic access standards for insurance carrier provider networks in an effort to address concerns raised by Democrats about the possibility of negative impacts for health insurance purchasers and consumers in rural parts of the state.  The other caps an assessment to cover net losses in the reinsurance pool at $2 per month per covered life.  The bill was sent down to the House for consideration of these amendments.  The Senate worked on the bill until approximately 2 a.m. on Friday.  Some time towards the end of the evening, the Republicans convened the Appropriations Committee on very short notice to the Democratic members in order to remove the fiscal note to the bill.  This action soured otherwise good relations between members of the two parties on the Appropriations Committee and the evening ended on a poor note.  On Friday, Appropriations Committee House Chair Pat Flood (R-Winthrop) apparently was distressed enough by the turn of events that he attempted to resign his position as Chair.  Speaker Bob Nutting (R-Oakland) declined and told the press that Republicans would discuss the situation over the weekend.

During today's session, the Senate enacted the version of the bill enacted last week in the House, despite efforts by Democrats to slow the process down.

You can see the procedural status of L.D. 1333 on the web here:


In addition to the political issues described above, the Appropriations Committee work on the FY 2012-2013 biennial budget last week was further delayed by the Governor's release of an "updated change package" - further amendments to the change package recently announced.  The key elements of this updated change package are:

  • Restoration of Maine Clean Election Act funding for gubernatorial candidates, previously proposed for elimination by the Governor;
  • Reducing hospital reimbursement by $9.3 M (General Fund) by delaying the conversion of the payment system to the APC methodology to January 1, 2012; and
  • Elimination of all General Fund payments in support of Maine Public Broadcasting Network ($1.95 M in each year of the biennium).

You can find the Appropriations Committee materials, including the change package update of May 11th, on the web at:



Last week, the Insurance & Financial Services Committee held public hearings and work sessions on the following bills related to the implementation of the Affordable Care Act (ACA) in Maine:

  • L.D. 1497, An Act to Comply with the Health Insurance Exchange Provision of the Patient Protection and Affordable Care Act;
  • L.D. 1498, An Act to Phase Out Dirigo Health and Establish the Maine Health Benefit Exchange for Small Businesses and Individuals
  • L.D. 882, An Act to Limit Health Care Mandates; and 
  • L.D. 1030, An Act to Reduce Costs for Small Businesses.

L.D. 1497 and L.D. 1498 represent the Republican and Democratic visions of the ACA's exchange respectively.  No one spoke against these bills.  All stakeholders, including the MMA, spoke in favor generally about both bills, commenting about preferences in how one bill handles certain issues over the other, but encouraging the parties to work together to develop an exchange concept both sides could support.  As expected, during a work session on Friday, May 13th, the Committee voted unanimously to carry over all four of these bills to the next session.  CMS is expected to release an exchange regulation in September.

The Committee also discussed the outline of a Resolve, Creating a State Advisory Committee on the Creation of Maine's Health Insurance Exchange.


Last week, the Health & Human Services Committee held both a public hearing and work session on L.D. 1501, An Act to Reduce Opioid Overprescription, Overuse & Abuse, a controversial bill based upon legislation enacted recently in Washington state and sponsored by Representative Jon Hinck (D-Portland).  Following the public hearing, the interested parties met several times to discuss a collaborative approach to addressing the goal all share - to reduce opioid overprescription and abuse and the Committee appears poised to recommend passage of a Resolve in place of this bill.  L.D. 1501 may be found on the web here:

The certificate-of-need (CON) issue remains active in the Committee as well.  Though it's not been reported out yet, the Committee is expected to divide closely on L.D. 360, An Act to Repeal the Maine Certificate of Need Act of 2002.  The Committee is also retaining a bill (L.D. 582) that would relax, but not eliminate the CON law.


On Friday, May 13th, the Judiciary Committee held a work session on three bills seeking to amend current law relating to abortion that will affect the physician-patient relationship and gave them each either an 8-3 or 7-4 "ought not to pass" report.  The bills are:

  • L.D. 116, An Act to Require a 24-Hour Waiting Period Prior to an Abortion (Rep. Clark, R-Easton) (vote 8-3 with Republican Representatives Nass, Foster, & Waterhouse in the minority);

  • L.D. 924, An Act to Educate Women on the Medical Risks Associated with Abortion (Rep. Espling, R-New Gloucester) (vote 7-4 with Republican Representatives Nass, Foster, Waterhouse, & Moulton in the minority); and

  • L.D. 1457, An Act to Strengthen the Consent Laws for Abortions Performed on Minors and Incapacitated Persons (Rep. Crafts, R-Lisbon) (vote 8-3 with Republican Representatives Nass, Foster, & Waterhouse in the minority).

The critical point about these divided reports is that all three Senators (a Republican, a Democrat, & an Independent) all voted against the bills, meaning enactment in the Senate would be a challenge.

During the same Friday work session, the Committee voted by an even stronger 9-1 (Republican Representative Waterhouse the lone minority member) in opposition to two bills on minors' rights to confidential medical treatment:

  • L.D. 31, An Act to Protect the Safety of Maine Children by Requiring the Express Consent of a Legal Guardian to Dispense Prescription Medication to a Minor; and
  • L.D. 746, An Act Regarding the Consent of Minors for Mental Health and Substance Abuse Aid.

Based on these committee votes, none of these bills are expected to be enacted on the floor.


Several weeks ago, during a work session on L.D. 1244, An Act to Clarify Usual and Customary Charges under the Workers' Compensation Laws in the Labor, Commerce, Research & Economic Development Committee, Portland attorney John Lambert presented a proposed amendment on behalf of the Maine State Chamber of Commerce, the group behind the original bill.  The Committee asked Workers' Compensation Board Executive Director Paul Sighinolfi to have the Board review the amendment at its next meeting.  During that meeting on Tuesday, May 10th, the Board heard extensive arguments for the proposal from proponents including Mr. Lambert and from opponents, the Maine Medical Association and Maine Hospital Association.  The Board ultimately split 4-3 in favor of the proposed amendment with the Executive Director joining the management members of the Board in favor of it.  The LCRED Committee had a work session scheduled again on L.D. 1244 on the afternoon of Wednesday, the 11th.  During the work session the MMA submitted a letter to the Committee along with a memo from Central Maine Orthopaedics CEO Michael Cox, Ph.D. restating our strong opposition to the proposed amendment.  Following caucuses on the proposal, during which the MMA was invited to address Committee Democrats, the Committee voted 7-6 with all Democrats and one Republican voting against the Lambert proposal.  The MMA drafted an alternative proposal for the majority and bill will be in work session before the LCRED Committee again on Tuesday afternoon.


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