July 18, 2011

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Congress and the President Work on Budget Deal to Avoid August 2 Deadline

Racing against the clock, Congress and the President continue to work toward a solution that will allow an increase in the nation's debt ceiling which must happen prior to August 2 if a potential government default is to be avoided.  While just a few days ago, a long-term agreement which might have implicated Medicare and Medicaid spending looked possible, the most likely scenario now is for a much shorter agreement nowhere near approaching the $2 to $4 trillion package discussed earlier.

House Republicans are prepared to vote this week on allowing an increase in the government's borrowing limit through 2012 as long as Congress approved a balanced-budget constitutional amendment, a result that is highly unlikely.  In the Senate, leaders of both parties worked on a bi-partisan plan that would allow the President to raise the debt limit without a prior vote by the Congress.  In that scenario, long-term deficit reduction would still have to be agreed to in order to satisfy house Republicans.

A weekend deadline the President gave congressional leaders to choose one of three deficit reduction options became a moot point after House and Senate leaders made it clear to the President on Friday that they were moving ahead with their own plans.

Also on Friday, the President made clear that he would accept a smaller package than the $2 to $4 trillion dollar package that he was calling for earlier.  A smaller package would not necessarily include revenue increases the President had also called for earlier.

Amendments to Medical Marijuana Law Effective Sept. 28, 2011

Perhaps surprisingly, the legislature this past session significantly amended the medical marijuana legislation which had been originally adopted by the voters in November 2009 and significantly amended by the legislature in 2010.  The amendments, embodied in L.D. 1296, "An Act To Amend the Maine Medical Use of Marijuana Act To Protect Patient Privacy," were passed unanimously in the Health and Human Services Committee and passed without debate in the House and Senate.

For physicians, the most significant changes are as follows:

  1. The written certification prepared by the physician will no longer specify the qualifying patient's debilitating medical condition.
  2. Registration of patients with the state will be voluntary.
  3. The physician certificate will have to be prepared on tamper resistant paper.  "Tamper-resistant paper" means paper that possesses an industry-recognized feature that prevents copying of the paper, erasure or modification of information on the paper and the use of counterfeit documentation."  MMA will inform members of appropriate sources of such paper prior to the effective date of the law.  You will likely be able to purchase such paper from whomever you purchase tamper-resistant prescription pads from.
  4. Prior to providing written certification for the medical use of marijuana by a minor qualifying patient, a physician must consult with a consulting physician.  The consulting physician must be from a list of physicians who may be willing to act as consulting physicians maintained by the Department of Human Services.  The consultation may consist of examination of the patient or review of the patient's medical file.  This opinion is simply advisory to the treating physician.

Physicians who are willing to serve as consultants may contact the Department or Gordon Smith at MMA (gsmith@mainemed.com).

Changes to the law become effective on September 28, 2011. [return to top]

Save the Date: Chemicals, Obesity, and Diabetes, Oct. 14 in Waterville


How Science Leads Us to Action


Colby College, Waterville, Maine

Registration Fee: $50 • Lunch included • Time: 8:30am-5:00pm

Presented by the Environmental Health Strategy Center (EHSC), in partnership with the Goldfarb Center at Colby College

Critical, ongoing public health efforts to reduce obesity are addressing multiple societal factors through policy, environmental and social justice system changes to address contributing factors which include inadequate nutrition and physical inactivity. Recent scientific research shows that chemical exposures may also be a risk factor.  Our conference will explore two questions about chemical “obesogens:”

  • What is the current state of the science that links chemical exposures to obesity, diabetes and other diseases?
  • What public health policy actions are appropriate based on the current evidence?

Keynote Speaker: Bruce Blumberg, PhD: University of California-Irvine, Department of Developmental and Cell Biology. National expert on the role of chemical exposures as a contributing factor for obesity and diabetes.

For more information, see the flyer at http://www.preventharm.org/Images/443/Conf%20STD%20Email.pdf or contact Michelle Surdoval, Project Manager, 207-650-8704, msurdoval@preventharm.org



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Give Your Input on Critical New Privacy Requirement

MGMA is conducting a brief Legislative and Executive Advocacy Response Network (LEARN) study on a new Department of Health and Human Services, Office for Civil Rights (OCR) proposed rule that would require physician practices with EHRs and their business associates to produce a report of each time patient health information was accessed inside the practice. The report must list times a patient’s health information was accessed for any purpose, including for treatment, payment and healthcare operations. 
In the proposed rule, practices would have to develop tracking systems to produce these “access reports” that would include the:

  • Name of the staff person who accessed the information
  • Date and time it was accessed
  • Reason it was accessed
  • Ultimate use of that information, if known

Practices will be required to include information accessed by any business associate’s staff for up to three previous years and make these reports available to the patient within 30 days of the request.

MGMA members are encouraged to complete this short questionnaire and share your perspective on these potentially burdensome new requirements. The questionnaire should only take about 10 minutes to complete and all responses are kept strictly confidential.

The results from this LEARN will be utilized in our formal comment letter to OCR and aid in MGMA’s advocacy efforts.

Participate today!

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Report on MMA Committee on Physician Quality Meeting, July 14

MMA's Committee on Physician Quality, chaired by David Hallbert, M.D. of Belfast,  met on July 14th and considered a number of initiatives, including the following:

  1. The status of the Association's Office-Based Quality Improvement Program which provides protection to office-based quality improvement plans.
  2. The status of the Association's External Peer Review Program which provides peer review services to Maine's hospitals, FQHC's and office practices.
  3. The several current initiatives of Quality Counts, Aligning Forces for Quality, and the Maine Health Management Coalition.
  4. The current CPQ Charter as found in the MMA Bylaws.

The Committee also referred to the MMA Executive Committee the issue of potential membership or participation in the new Partnership for Patients program, announced recently by the US Department of Health and Human Services.  The program will provide up to $500 million to help hospitals, healthcare provider organizations and others improve care and prevent injuries and complications related to healthcare acquired conditions and unnecessary readmissions.  The funding, made available by the Affordable Care Act, will be awarded by the CMS Innovation Center. [return to top]

Obama Administration Announces Proposed Rules on Insurance Exchanges

Today, the U.S. Department of Health & Human Services (DHHS) has issued a press release announcing the issuance of two proposed rules on insurance exchanges under the ACA.  The first rule would address the establishment of health insurance exchanges and the second addresses standards for reinsurance, risk corridors, and risk adjustment.  Both rules are scheduled to be published in the Federal Register on July 15th with comments due 75 days after publication.  

You can see the HHS press release on the web at:  http://www.hhs.gov/news/press/2011pres/07/20110711a.html.

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CMS Publishes Proposed Rule on Medicare Data Release

The Centers for Medicare & Medicaid Services (CMS) published its proposed rule on June 8th regarding the "Availability of Medicare Data for Performance Measurement."  The ACA authorizes the release of standardized extracts of claims data under Medicare parts A, B, and D to "qualified entities" for evaluating the performance of providers and suppliers.  These data may be provided to qualified entities beginning January 1, 2012.  While the ACA as being drafted, the AMA secured several safeguards in these provisions, including requirements that enable physicians to review, appeal, and correct errors in the reports prior to publication.

The proposed regulation defines a "qualified entity" as a public or private entity that is qualified to use claims data to evaluate the performance of service providers and suppliers on measures of quality, efficiency, effectiveness, and resource use.  To evaluate an organization's qualifications, CMS will examine three areas:  organizational and governance capabilities; ability to add claims data from other sources; and data privacy and security.  The regulation also requires entities applying for data access to describe their risk adjustment and physician attribution methods, as well as data specifications.  In addition, they must outline processes for physicians to review, appeal, and correct errors.

AMA staff participated in a September 20, 2010 CMS Listening Session that solicited input from relevant stakeholders on implementation of the Medicare data release program.  The AMA also submitted a formal statement to the agency:  http://www.ama-assn.org/resources/doc/washington/medicare-data-performance-measurement-statement-27sept2010.pdf.  The AMA will be coordinating comments on the proposed rule prior to the August 8th comment deadline.

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MMA Joins Clean Air Coalition

The Maine Medical Association is pleased to announce that our organization has joined the Maine Healthy Air Coalition!  Created by the American Lung Association, the Maine Healthy Air Coalition will be working to defend the Clean Air Act and protect Maine's children and adults from the harmful effects of breathing toxic air. 

In the State of the Air report released last month, we learned that more than half the people in Maine live in counties with unsafe air. This is unacceptable, according to Ed Miller of the American Lung Association, as he announced Maine's air quality grades

At the event launching the Coalition, MMA Public Health Committee co-chair Dr. Norma Dreyfus, explained, "Maine is particularly vulnerable to air pollution because of prevailing winds that convey pollution from the industrial Midwest. Not only does the clean air act need to be enforced immediately, but it needs to be strengthenend." Dr. Dreyfus says there's an economic price to pay for pollution in lost work time and higher health care costs.

If you want to help protect our air, there are a few steps you can take right now. 

First, the Coalition is building its list of health experts who can speak at press conferences and other media events.  They are also look for people who have struggled with the effects of unhealthy air, like parents of children with asthma or adults with lung or cardiovascular illness, to tell their stories. If you are interested in being added to the list of health experts, or if someone you know would be willing to share their personal experiences, please contact Amy Cookson, the Maine Healthy Air Coalition Coordinator, at acookson@lungne.org or at 207-624-0323.

Second, send an email to acookson@lungne.org to ask to be added to the Clean Air Alert list. If there is breaking news, or urgent action is needed, the Maine Healthy Air Coalition will make sure you are among the first to know, and have the opportunity to speak out in favor of strong laws, like the Clean Air Act, that protect our air.   Finally, if you are interested in joining the MMA Public Health Committee to become more involved with this or other public health issues, contact Jessa Barnard, MMA Director of Public Health Policy at jbarnard@mainemed.com or 207-622-3374 x 211. 

Click here to read the full MPBN story announcing the launch of the Coalition.  



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Governor LePage Signs Bills on "Most Favored Nation" Clauses, CON, Among Others

On July 6th, Governor LePage signed L.D. 1583, An Act to Provide Oversight in Certain Negotiations (P.L. 2011, Chapter 451).  L.D. 1583 was a Governor's bill submitted at the request of the Chairs of the Joint Standing Committee on Insurance & Financial Services following the Governor's veto of L.D. 1222, An Act to Promote Fairness in Negotiations between Health Insurance Carriers and Health Care Service Providers, a bill submitted by Representative Sharon Treat (D-Hallowell) on behalf of the MMA.  L.D. 1222 prohibited the use of "most favored nation" clauses while L.D. 1583 prohibits their inclusion in provider agreements unless approved by the Superintendent of Insurance upon request of a party to provider agreement negotiations.  Both bills received the unanimous support of the Insurance & Financial Services Committee.  The MMA asked Representative Treat to submit the original bill at the request of a Bangor area practice that had been unsuccessful in negotiating the removal of such a clause from a provider agreement following several years of trying.  The Federal Trade Commission and U.S. Department of Justice find these clauses to be anti-competitive, particularly in regions where there is a dominant health insurance carrier and the agencies are investigating several carriers' use of such clauses in health insurance markets around the country.  In addition to the MMA, the state association of physical therapists, the Maine Hospital Association, and several other provider groups participated in the development of this legislation.

You can find more information about L.D. 1583 on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280042088.

Also on July 6th, the Governor signed L.D. 360, An Act to Amend the Maine Certificate of Need Act of 2002 (P.L. 2011, Chapter 424).  Following months of work by the Joint Standing Committee on Health & Human Services on more than half a dozen bills on the topic and debate in the legislature in the waning hours of the session, the Governor has signed a bill making the most substantial changes in the state's CON statute in its history, including increases in the various thresholds triggering CON review.  

You can find more information about L.D. 360 on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280039484.  The MMA, MHA, and other provider organization's planning departments will need to spend some time thinking through the implications for future health care investment in Maine following enactment of this sweeping bill.  

Finally on July 6th, the Governor signed L.D. 1562, An Act to Prohibit the Sale or Possession of So-called Bath Salts Containing Dangerous Synthetic Drugs (P.L. 2011, Chapter 447).  You can find more information about this bill on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280041671.

Governor LePage also has signed L.D. 966, An Act Regarding the Use of Methadone by Operators of Commercial Motor Vehicles (P.L. 2011, Chapter 455), a bill sponsored by Representative Anne Graham (D-North Yarmouth), a pediatric nurse practitioner.  You can find more information about this bill on the web at:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280040381.

Most bills become effective 90 days following adjournment of the legislature - September 28, 2011.  Bills including an emergency preamble take effect immediately upon the Governor's signature.  A few bills have specified effective dates within their text.  

The MMA's summary of all health care legislation tracked by the MMA Legislative Committee will be available later this summer.  If you have any questions about any legislation from the First Regular Session of the 125th Maine Legislature, please contact Andrew MacLean, Deputy EVP (amaclean@mainemed.com; 622-3374, ext. 214), Gordon Smith, EVP (gsmith@mainemed.com; 622-3374, ext. 212), or Jessa Barnard, Director of Public Health Policy (jbarnard@mainemed.com; 622-3374, ext. 211).

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MeCDC Hosts Universal Immunization Program Regional Trainings

Maine Immunization Program Regional Trainings 

Vaccines for Children: Public Law 595 - Implications for Maine Immunization Providers

These workshops will provide an overview of the new Universal Childhood Immunization Program and provide information to help Maine immunization providers prepare for implementation in January 2012. The training will focus on vaccine management, ordering and accountability; provider requirements; Maine Immunization Registry; and information on vaccines that will be available through the Universal Childhood Immunization Program. There will also be information on the ACIP schedule, vaccine administration, vaccine usage and vaccine myths.

July 28, 2011- Presque Isle

August 4, 2011 - Bangor

August 11, 2011 - Portland

August 12, 2011 - Augusta

8:30 am - 3:30 pm; Registration begins at 8 am 

Sponsor: Maine Department of Health and Human Services, Center for Disease Control and Prevention, Division of Infectious Disease, Immunization Program

Space is limited.  For more information or to register, see http://www.maine.gov/dhhs/boh/ddc/immunization/

For an overview of the Universal Childhood Immunization Program, see the presentation available at:  http://www.maine.gov/dhhs/boh/ddc/immunization/providers

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New Toolkit Helps Physicians Prepare for Jan. 1 HIPAA Compliance

Prepare for January 1st HIPAA compliance with new AMA toolkit 

Are you on track to meet the Jan. 1, 2012 compliance deadline for using Version 5010 of the HIPAA electronic standard transactions? If you or your vendor submit claims electronically, you must comply with this deadline. Physician practices who aren't prepared risk rejected claims and cash flow interruptions. 

With the deadline less than six months away, now is the time to make sure your practice is ready to use the Version 5010 electronic standard transactions. Learn the steps you need to take with the new 5010 toolkit from the AMA. This toolkit also explains the differences you should expect in Version 5010, how to test your readiness for the Version 5010 transactions, and steps you can take to prevent interruptions to your cash flow. 

Access this toolkit (http://www.ama-assn.org/resources/doc/washington/5010-toolkit.pdf) and additional AMA resources to make sure your practice is ready.  [return to top]

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