June 13, 2011

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Appropriations Committee Unanimously Approves Biennial Budget

The Legislature's Appropriations Committee on Thursday night approved a biennial budget for the two years beginning July 1, 2011 and all thirteen members voted in support of it.  For the most part, physicians and other health interests fared very well, with the proposed cuts to Medicaid restored along with most cuts to the Fund for Healthy Maine.  The final package did include an increase in the projected savings to MaineCare through a managed care initiative (increased to $8.1 million) but the language in the budget document contains no details on how the savings will be accomplished.  The Legislature is expected to adjourn the FIrst Regular Session late this week.

The $6.1 billion biennial budget, L.D. 1043, for the two state fiscal years beginning July 1, 2011 restores many of the health care and social service cuts proposed by the Governor in early February.  The Appropriations Committee unanimous report restores most of the cuts to the Fund for a Healthy Maine, avoids elimination of so-called "non-categorical" MaineCare coverage, and moderates the Governor's other "welfare reform" proposals.  It would, however, eliminate MaineCare coverage for an estimated 1550 legal non-citizens who have not lived in the U.S. for at least 5 years.  In the waning hours of the negotiations, the Committee booked $20 million in future revenue from wholesale liquor sales to offset some of these restorations.

On Saturday, June 11th, the Kennebec Journal published a good overview of the final budget negotiations in an article by Susan M. Cover entitled, Budget deal anchored in compromise.

You can find the Appropriations Committee materials on the web at:  http://www.maine.gov/legis/ofpr/appropriations_committee/materials/index.htm.

The biennial budget could be up for debate in the House as early as tomorrow.

Maine Ranks Highly in AHRQ's 2010 State Snapshots of Health Care Quality Improvement

On June 1st, the Agency for Healthcare Research & Quality (AHRQ), part of DHHS, announced its 2010 State Snapshots in which it cited New Hampshire, Minnesota, Maine, Massachusetts, and Rhode Island as the states showing the greatest improvement in health care quality.  The report found the least improvement in Kentucky, Louisiana, New Mexico, Oklahoma, and Texas.  The agency identifies racial and income disparities as significant factors in the health care quality comparisons.

 You can see the 2010 State Snapshots on the web at:  http://statesnapshots.ahrq.gov/snaps10/index.jsp.

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Katrin Teel, RN, MBA Named Senior Policy Adviser to Governor LePage

Governor Paul LePage announced last Monday, June 6th the appointment of Katrin Teel, RN, MBA of Bangor as his senior health policy adviser.  The position had been vacant since Mary Mayhew moved from that position to the position of Commissioner of the Department of Health & Human Services.  MMA knows Katrin well as she served at one time as Associate Director of Quality Counts which is co-located with MMA in the Frank O. Stred Building in Manchester.

Prior to serving as Associate Director as Quality Counts, Katrin served for three years as director of the Wellness Council of Maine, an employee wellness organization housed at the Bangor Chamber of Commerce.  More recently, Katrin has worked as an instructor in the business management and allied health departments at Beal College in Bangor.

In 2010, she ran for the legislature from a house district in Bangor, but was unsuccessful.

In announcing the appointment, Governor LePage released the following statement:

    I am pleased that Katrin is joining my staff to continue to serve the people of Maine.  We can create a health care system that is more efficient, so patients and families have peace of mind they are receiving top-notch, affordable care anywhere in the state and Katrin will help us reach that goal.

Katrin began work in her new position last Monday. [return to top]

Report From Dirigo Health Agency Board of Trustees Meeting Held This Morning

The Board of Trustees of the Dirigo Health Agency held its monthly Board meeting this morning in Augusta.  Most of the discussion involved reviewing the finances of the DirigoChoice account in light of the reduction in the assessment on a gradual basis over the next 30 months.  At the end of this month, it is anticipated that enrollment in all categories will be approximately 15, 600 people.  Excluding the MaineCare and voucher programs, there are 6233 subsidized enrollees and 2306 who do not receive a state subsidy.  The DirigoChoice product continues to be offered by Harvard Pilgrim.

Over its last two meetings, the Board has examined a number of options aimed at continuing to provide coverage to as many people as possible.  At a previous meeting, the Board had voted to increase DirigoChoice deductible levels by $250, effective October 1, 2011.   At this meeting, the Board voted to reduce subsidies in various categories, in order to be able to continue coverage to new enrollees.

It is hoped to continue coverage for existing enrollees and to take on some new enrollees until January 1, 2014, at which time it is hoped that a new insurance exchange will be operational.

In other business, the Board heard an update from staff on the three priorities of the Maine Quality Forum and received a report on the Agency's role in the proposed Advisory Committee on Maine's Health Insurance Exchange.  The Advisory Committee will consist of no more than 9 members and will meet several times through the summer in order to provide a report to the Governor and the Legislature by September 1, 2011.  The charge to the Committee is to make recommendations to the Legislature and to the Governor on courses of action to ensure federal funding for the creation of a health insurance exchange and to provide draft enabling legislation for the creation of a health insurance exchange.

The Board will not meet in July but will convene again on Monday, August 8th at 9:00 a.m. at its offices on Water Street in Augusta.




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SAVE THE DATE: CMS' Boston Regional Office's 2011 National Medicare Workshop in Late August/Early September

The CMS Boston Regional Office invites you to attend the 2011 National Medicare Workshop scheduled for Tuesday, August 30th through Thursday, September 1st at the Sheraton Portsmouth Harborside Hotel & Conference Center in Portsmouth, New Hampshire.

The agenda includes:

  • A half-day basic track for those new to Medicare and those wanting a refresher;

  • Basic information and detailed casework - tailored to your needs;

  • Medicare training materials and information that are current, accurate, and consistent;

  • Opportunities to network with CMS staff and other partners who share your commitment;

  • Subject matter experts;

  • 2011 CD Suite/USB wafer card - with the training modules, videos, resource guide, and more!


Online registration is available at:  http://2011nationalmedicaretrainingprogram.blsmeetings.net/.  You must enter the password maureen1 (password is case sensitive) to register for the meeting.  Please register for each workshop participant individually.  If you have any questions, call Sydney Vranna at 301-577-0244 begin_of_the_skype_highlighting            301-577-0244      end_of_the_skype_highlighting, ext. 2800.

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Three Openings on Board of Licensure in Medicine

There are currently three openings on the nine-member Board of Licensure in Medicine, occasioned by the completion of the terms of Sheridan Oldham, M.D., the resignation of George "Joe" Dreyer, M.D., and the resignation of the newest public member of the Board, Meredith Baxter.  Qualifications for appointment to the Board include five years of continuous medical practice in the state immediately prior to appointment.  Terms are for six years.  The Board meets for a full day the second Tuesday of each month and at least one day of preparation for the meeting is generally required.  Compensation is nominal.

The appointments are considered personal appointments of the Governor, meaning that no confirmation hearings or legislative review is required.  Physicians interested in serving on the Board should send a current CV and a letter expressing interest to:

                                                                           Michael Hersey  (Att:  Scott Van Ormand)

                                                                           Director of Boards and Commissions

                                                                           1 State House Station

                                                                            Augusta, Maine 04333

While the Board is particularly interested in surgeons and psychiatrists, given the current mix of specialties represented, any physician meeting the above noted statutory requirements may apply.

In July, the Board will elect new officers for a term year period.  Dr. Oldham has chaired the Board for the last four years and has served two six-year terms. She has been a strong and effective leader at the Board during her tenure.  Likewise, Dr. Dreyer has served admirably during his term on the Board.



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Space still Available at Labor & Employmnet Law Seminar Presented by Pierce Atwood, Co-sponsored by MMA, Friday, June 17th

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

Labor & Employment Issues for the Maine Healthcare Industry

Portland, Maine

Date: June 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 aelliott@pierceatwood.com or 207-791-1143 begin_of_the_skype_highlighting            207-791-1143      end_of_the_skype_highlighting.

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

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State Prescription Monitoring Program Offers On-Line Trainng Course

The Prescription Monitoring Program operated by the Maine Office of Substance Abuse has announced the availability of a new training course offered at no cost on the web.  The course can be accessed by going to http://www.maine.gov/dhhs/osa, following the links to Maine's Prescription Monitoring Program and the the "Web Course" link in the third section of the PMP index page.  Your computer must allow pop ups in order to view the course.

The Prescription Monitoring Program (PMP) is an on-line database that provides prescribers with information on prescriptions attributable to them and dispensed to their patients whether prescribed by them or others.  The PMP has become a valuable resource in the effort to combat the illegal diversion of controlled substances.

For further information on the Program, go to www.maine.gov/pmp (technical information) or www.maine.gov/dhhs/osa (policy information).




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Register Now for MMA's 158th Annual Session in Bar Harbor, September 9-11

Registration materials for MMA's 158th Annual Session are now available and were included as an insert in the recent issue of Maine Medicine which arrived in members' offices the week before last.  You may also register on the MMA website at www.mainemed.com.  The meeting will be held September 9-11 in Bar Harbor with the Friday educational program being held again this year at the Jackson Laboratory and the Saturday and Sunday morning events being held at the Bar Harbor Club adjacent to the Harborside Hotel.

The theme of this year's educational program is INNOVATION and 8 hours of CME category 1 credits are being offered.  The educational program begins at 1:00 p.m. Friday, September 9th with a keynote presentation by Carol Bult, PhD.  Dr. Bult is a Principal Investigator in the Mouse Genome Informatics database consortium at the Jackson Laboratory.   Tours of the Lab will again be available at 3:00 p.m. following the two lectures.  The Friday evening reception will be held at the Laboratory as has been the case the last two years.

Saturday's events will be held back at the Bar Harbor Club with the Annual Meeting in the morning, featuring the presentation of 50 year pins at 10:30 a.m.  At noontime, J. Randy Darby, M.D. of Spectrum Medical Group will keynote the afternoon educational session with a presentation entitled, Innovations in Medical Education and Team Building.  Dr. Darby's presentation will be followed by a panel on clinical technology innovation and a presentation on nanotechnology. 

Saturday evening will feature the annual President's Reception and Annual Awards Banquet at which time President Jo Linder, M.D. will pass the President's gavel to President-elect Nancy Cummings, M.D. 

Sunday morning will begin bright and early at 6:30 a.m. with the 31st running of the Edmund Hardy Road Race, again sponsored by Medical Mutual Insurance Company of Maine.  Following brunch at 8:00 a.m., a panel focusing on Innovations in Physician Wellness, moderated by Dr. Cummings, will inform attendees on how to incorporate mindfulness, wellness and balance into busy lives.

DONATIONS NEEDED!  We will once again be conducting a silent auction to benefit one or more programs falling under the Maine Medical Education Trust (MMET).  If you have something you'd be willing to donate as a silent auction item, please contact Dee DeHaas at ddehaas@mainemed.com.

We look forward to seeing you in Bar Harbor! [return to top]

Proposed Rule on Five-Year Review of the RBRVS

On May 24th, CMS released a Notice of Proposed Rulemaking (NPRM) on the 4th Five-Year Review of the Resource Based Relative Value Scale (RBRVS).  This review is required by law and provides the public with the opportunity to comment on potential misvaluation within the Medicare Physician Payment Schedule.  The AMA/Specialty Society RVS Update Committee (RUC) recommendations for the 4th Five-Year Review reflected a total of 292 services submitted to CMS from April 2010 through February 2011.  CMS has proposed to accept 2/3 of the RUC recommendations.  For the approximately 70% of those that were "rejected," CMS has proposed work values within 10% of the RUC recommendation.  A number of the rejections are the result of a major policy disagreement with CMS regarding payment for hospital observation services.  CMS has not yet accepted RUC recommendations to equate observation visits to hospital inpatient visits.  CMS does propose, however, to publish the RUC recommendations for significant increases to preventive medicine services.  These CPT codes are not covered by Medicare, but many Medicaid plans and private payers use the RBRVS to establish physician payment rates.  In addition, CMS states in the proposed rule that, "we greatly appreciate the considerable sustained efforts made by all members and staff of the AMA RUC to date, and we look forward to continuing our collaborative work with the AMA RUC toward our mutual goal of ensuring that CPT codes are appropriately valued."  Comments on the NPRM are due July 25th, and CMS is expected to convene a refinement panel in August to consider public comments on specific services. [return to top]

Silent Auction Items Needed for Annual Session

Last year, MMA held its first annual silent auction to benefit the Maine Medical Education Trust and the John C. Dalco Fund, with proceeds totaling approximately $4,500.  There were 24 items donated by MMA members and corporate affiliates.  Donated items included event tickets, weekend and week-long stays at member’s vacation homes, golf packages, gift baskets, books, restaurant and spa certificates, and special items made by members and friends such as paintings, sculptures and carvings! 

The proceeds from this year’s auction will be directed to the MMET Scholarship Fund created by Dr. Linder during her term as President.  This fund will be used to provide scholarships for medical students who are Maine residents.  We encourage you to participate by donating an item to the auction to benefit this worthy cause, and by attending the event which is being held on Saturday, September 10th, during the MMA Annual Session in Bar Harbor.  

Look for the donation form to be mailed soon with annual session materials and for it to be posted soon on the MMA web site, www.mainemed.com.



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POLITICAL PULSE: Significant Changes in Medical Marijuana Law Likely


The Legislature this week will consider an amendment to Maine's Medical Use of Marijuana Act which would make very substantial changes to the law passed by the Legislature last year.  That law was an amendment to the law passed by Maine voters in November, 2009.  The legislation has been sponsored by Rep. Deborah Sanderson (R-Chelsea) and has been supported by the Maine Chapter of the American Civil Liberties Union.  The primary concern of the supporters of the amendment was the privacy interests of the certificate holders.

L.D. 1296, An Act to Amend the Maine Medical Use of Marijuana Act to Protect Patient Privacy, in amended form, has received a unanimous "ought to pass" report from the Joint Standing Committee on Health & Human Services and Governor LePage has expressed support for it.  Therefore, the proposal is very likely to pass.  Among the most substantial changes from the existing law are the following:

1.  Patients who have receive a certificate from their physician will no longer be required to register with the state.  The registration process would be voluntary.

2.  The physician certificate would no longer include the condition or diagnosis of the patient, although issuance of a certificate would still require the physician to certify that the patient had one of the conditions or symptoms listed in the law (the list remains unchanged).

3.  No later than 120 days after the effective date of the amendment, HHS must adopt rules regarding the consideration of petitions from the public to add medical conditions or treatments to the list of debilitating medical conditions set forth in the law. 

4.  The Advisory Committee established last year in the law is abolished (The committee never was appointed).

5.  The provision enacted last year regarding minors has been substantially changed to provide for a second opinion to just go to the physician who has prepared the medical marijuana certificate and the opinion would not be binding.

A physician certificate still would expire one year form the date of its issuance.

 MMA continues to provide education sessions on the law which will now incorporate these significant changes. To arrange for a CME presentation, contact Gail Begin at MMA at 622-3374, ext. 210 or via e-mail to gbegin@mainemed.com.  The Association normally charges $200 for the presentation by one of its attorneys.


On Thursday, June 9th, the Insurance & Financial Services Committee held a public hearing on L.D. 1583, An Act to Provide Oversight in Certain Negotiations, a Governor's Bill sponsored by the IFS Committee co-chairs that replaces L.D. 1222 on the same subject.  The MMA, Maine Optometric Association, and Maine Chapter of the American Physical Therapy Association all supported the bill.  No one spoke in opposition to it, but Anthem testified "neither for nor against" the bill.  The Committee held a work session immediately after the public hearing and the discussion focused on the language of a provision for a waiver of the prohibition that could be granted by the Superintendent of Insurance upon a petition by either a provider or a carrier.  Ultimately, the Committee voted unanimously that L.D. 1583 "ought to pass as amended."  It certainly seems likely that the bill will be enacted and signed by the Governor before the end of the week.


Last week, the Revisor's Office reported out the unanimous Committee Amendment from the Labor, Commerce, Research & Economic Development Committee (LCRED) on L.D. 1244, An Act Regarding Payment of Medical Fees in the Workers' Compensation System.  You can see the Committee Amendment on the web at:  http://www.mainelegislature.org/legis/bills/bills_125th/billpdfs/SP036502.pdf.


Also last week, the Revisor's Office reported out the unanimous Committee Amendment from the Education & Cultural Affairs Committee on L.D. 98, Resolve, Directing the Commissioner of Education to Adopt a Policy Regarding Management of Head Injuries in Youth Sports.  You can see the Committee Amendment on the web at:  http://www.mainelegislature.org/legis/bills/bills_125th/billpdfs/HP008402.pdf.  The Resolve directs the Commissioner of Education to reconvene a working group to develop a model policy on the management of head injuries in school athletic activities.  The MMA has heard concern from numerous Maine physicians and the national organization representing physicians specializing in physical medicine and rehabilitation that the original bill's provision that a neurologist or athletic trainer only is authorized to certify a student athlete's readiness to return to play.  This language still is found in the "charge" to the working group (see page 2, lines 9 and 10 of the proposed Committee Amendment), but it is not "mandatory" as it was in the original bill.  The MMA will work to ensure that the working group's recommendations broaden the language regarding those authorized to certify a return to play.

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Legislative Committee Conference Call This Tuesday

The MMA's Legislative Committee will hold its next (and most likely final) weekly conference call this Tuesday, June 14th 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 begin_of_the_skype_highlighting            1-877-669-3239      end_of_the_skype_highlighting 

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.

There are no new bills for review this week.  The MMA staff will provide an update on the most recent activities at the State House.  This will be the last week of the current legislative session.  While it is uncertain whether the legislature can accomplish all of its work by the statutory adjournment date this Wednesday, June 15th, the legislature most likely will adjourn by the end of the week.

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