August 8, 2011

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Substance Abuse Services Commission Convenes Working Group on Opioid Overuse and Abuse

On Friday (August 5), the State Substance Abuse Services Commission convened a legislatively-mandated work group to review and make recommendations for improvements in how physicians and other prescribers treat  chronic, non-cancer pain without causing addiction or diversion.  The group's recommendations will be reported to the Health and Human Services Committee by December 1, 2011.  These recommendations and any subsequent enactment of them by the legislature could have a very profound impact on medical practice. 

The work group is the result of the HHS Committee deliberation and action on L.D. 1501, An Act to Reduce Opioid Overprescription, Overuse and Abuse,  which was introduced by Portland representative Jon Hinck.  As originally drafted, the legislation would have imposed the same requirements as recently established in the state of Washington, including: mandatory CME, mandatory referrals and mandatory use of the Prescription Monitoring Program for physicians and other prescribers who treat chronic pain with controlled substances.  Ultimately, the legislation was amended to simply require the existing Substance Abuse Services Commission to convene a working group of interested parties to review existing practices and make recommendations for improvements.  Specifically, the working group is to:

  • Review current efforts in the State aimed at preventing addiction and diversion.
  • Examine similar efforts in other states, including Washington State, which earlier this year implemented comprehensive legislation on this subject.
  • Consider additional tools that could lead to decreased abuse while not unduly restricting access to adequate pain control.
  • Consider enhancements to the current Controlled Substances Prescription Monitoring Program.

The Friday morning meeting was the first of the group and virtually all the discussion involved the process of how the work of the group will get done and who should be around the table.  The group agreed to meet every two weeks for two to three hours until the report is finalized for the legislature.  The next three meetings will be held on August 19, September 9, and September 23rd, all beginning at 9:00am at the offices of the Office of Substance Abuse in Augusta.  All the meetings are open to the public.

MMA was well represented at the work group meeting and four physicians were also present, including Mark Publicker, M.D., Steve Hull, M.D., Scott Davis, M.D. and Steve Gressitt, M.D.   State Representative Linda Sanborn was also at the meeting. Representative Sanborn is a retired family physician and is a member of the Substance Abuse Services Commission.  Representatives of PA's and Nurse Practitioners were also present representing members of their respective professions.

Governor Appoints Members to Advisory Council on Health Insurance Exchange

On Wednesday, August 3rd, the Governor's office announced the names of individuals appointed to serve on the Advisory Committee on Maine's Health Exchange.  Pursuant to Chapter 105, L.D. 1582, Resolve, Creating the Advisory Committee on Maine's Health Insurance Exchange, the committee is to be established to develop and provide recommendations, including suggested enabling legislation, to the Governor and the Legislature for a health insurance exchange that addresses the core areas specified by the Federal Government and considers the views of the health care industry and other stakeholders.  The report of the Committee is due to the Governor and the Joint Standing Committee on Insurance and Financial Services no later than September 1, 2011, leaving the committee with only a small window of time to complete its work.

Following the announcement of the committee members, the Dirigo Health Agency, which provides the primary staffing for the committee, announced that the group would meet on Tuesday, August 16th from 9:00am to noon and Tuesday, August 23rd from 9:00am to noon in the Boardroom of the Dirigo Health Agency at 211 Water St. in Augusta.

The members of the Advisory Committee are:

  • Dan McCormack, CEO, Intermed
  • Steve Michaud, President, Maine Hospital Association
  • Kristine Ossenfort, Esq., Director of Government Relations, Anthem Blue Cross Blue Shield
  • Joel Allumbaugh, CEO, National Worksite Benefit Group, Inc.
  • Dan Bernier, Attorney, Waterville
  • Jamie Bissonette Lewey, Chair, Maine Indian Tribal State Committee
  • Edward Kane, Vice President for Maine, Harvard Pilgrim Health Care
  • David R. Clough, Maine State Director, National Federation of Independent Business
  • Joseph Bruno, Chair, Dirigo Health Agency Board of Trustees

The Governor also announced his appointment of Joe Bruno as chair of the committee.

MMA will follow the work of this committee closely and will report to members through the Weekly Update on its progress. [return to top]

Save the Date: Three Free MMA/OSA Programs Offered Across the State on Prescription Drug Abuse

Through funding provided by the State Office of Substance Abuse, the Maine Medical Association is presenting three CME programs in Bangor, Lewiston and Manchester on August 30, September 14 and October 7th, respectively. 

The August 30th program will be held at EMMC in Mason Auditorium from 4:00pm to 8:00pm.  Dinner will be provided.  The September 14th program will be held at St. Mary's General Hospital, also from 4:00 to 8:00pm with dinner provided.  The October 7th program will be held as part of MMA's popular First Fridays educational series from 9:00am to noon and will also be offered as a webinar.  There is no cost for these programs.

The format for each program is identical, although faculty varies.  Each program will begin with a review of the problem by a local DEA agent, followed by presentations by program staff for the prescription monitoring program, legal staff for MMA and a clinical talk by a physician experienced in addiction and diversion.

Watch for further information on the programs but you may reserve a seat now by registering with Gail Begin at MMA through e-mail to or call the MMA office at 622-3374 and press 0 for the attendant. [return to top]

Primary Care Practice Managers Needed as Volunteers for Focus Groups August 23 and 29

As part of the Association's efforts to improve coverage opportunities for patients, MMA is conducting a series of focus groups of practice managers of primary care practices.  The intent is to learn more about how MMA can be more effective in assisting practices with finding better coverage and increased benefits for patients.  The effort is funded through a grant from the Maine Health Access Foundation (MeHAF).

Two focus groups are planned for Portland on Tuesday, August 23rd, with the first in the afternoon and the second in the evening.  A session in Bangor is planned for the evening of Monday, August 29th.  Eight to ten individuals are needed for each session.  Meals will be provided and a $100 gift card given to each participant to recognize their time. The focus groups will be conducted professionally by Sam Surprise of Surprise Advertising, an MMA Corporate Affiliate.

If you or a colleague are interested in participating, please contact EVP Gordon Smith at [return to top]

MMA Weighs in on Rule 850 Changes

Last Friday, Eric Cioppa, Acting Superintendent of Maine's Bureau of Insurance, called a meeting to gather feedback regarding how to implement changes to Bureau of Insurance Rule 850, which currently sets geographic accessibility standards for managed care plans in Maine.  Public Law Chapter 90 (LD 1333) passed the legislature this session and requires several changes to Rule 850.  It repeals the statute that led to most of Rule 850 and replaces it with a requirement that "A carrier offering...a managed care plan provide to its members reasonable access to health care services.  A carrier may provide incentives to members to use designated providers based on cost or quality, but may not require members to use designated providers of health services."  

On Friday, a number of insurance carriers and consumer advocates, as well as the MMA and the Maine Hospital Association, provided suggestions on how the Bureau should interpret and implement this change.  The MMA commented that the new language authorized the Bureau to create more flexible exceptions to the current geographic requirements (30 minutes travel to primary care, 60 minutes to specialty and hospital services) but did not repeal those requirements.  In addition, the MMA stated that the Bureau should weigh both cost and quality in deciding which providers to incent patients to visit, should use transparent and reliable sources of cost and quality data, and should ensure that modest incentives used to encourage use of certain providers do not become penalties for not traveling.  The carriers shared their desire that any change should allow them more flexibility to create plans that employers and consumers can afford. The Bureau will begin formal rule making this week.  

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President Signs Debt Ceiling Bill; Concern About Cuts in Health Spending Remains

On August 2nd, President Obama signed the Budget Control Act of 2011 (S. 365), a bill that authorizes an increase in the country's debt ceiling, but also establishes a new bipartisan committee charged with recommending at least $1.2 trillion in savings.  The federal health care programs, such as Medicare and Medicaid are likely to be part of the discussions.  If Congress fails to take action on the Committee's recommendations before December 23rd, automatic cuts in defense and health care spending will become effective.  

The Senate passed S. 365 on August 2nd by a vote of 74-26.  The House passed the bill on August 1st by a vote of 269-161.

The bill does not address the Medicare physician payment issue, the sustainable growth rate (SGR), but the AMA issued a statement indicating it believes the SGR will be a part of the Committee discussion.  Physicians face a 29.5% cut in Medicare reimbursement at the end of the year.

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Third Circuit Court Rules Doctor Lacks Standing to Challenge ACA

The U.S. Court of Appeals for the Third Circuit has issued the first appellate decision on standing rather than the merits of a challenge to the ACA in New Jersey Physicians, Inc. v. Obama, 3rd Cir., No. 10-4600, 8/3/11.  In order to have standing under Article III of the U.S. Constitution, a plaintiff must allege an injury in fact, one that is both "concrete and particularized" and "actual or imminent."  The Court ruled that the physician, Mario A. Criscito, failed to meet this standard.  The only facts asserted by the physician were:

  • "Criscito, in the course of his individual practice of medicine, treats patients," and
  • "[s]ome of those patients pay Dr. Criscito for his care and do not rely on a third-party payor to do so on their behalf." 

The Court found that these assertions "state very little."

Click here for an update on the status of 26 federal lawsuits challenging the ACA. 

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Affordable Care Act to Ensure Women Receive Preventive Services at No Additional Cost

New guidelines that will ensure women receive preventive health services at no additional cost were announced last week by the U.S. Department of Health and Human Services (HHS). Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women’s preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance or a deductible.

“The Affordable Care Act helps stop health problems before they start,” said HHS Secretary Kathleen Sebelius.  “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.”

Last summer, HHS released new insurance market rules under the Affordable Care Act requiring all new private health plans to cover several evidence-based preventive services like mammograms, colonoscopies, blood pressure checks, and childhood immunizations without charging a copayment, deductible or coinsurance. The Affordable Care Act also made recommended preventive services free for people on Medicare.

HHS's announcement last week builds on that progress by making sure women have access to a full range of recommended preventive services without cost sharing, including:

  • well-woman visits;
  • screening for gestational diabetes;
  • human papillomavirus (HPV) DNA testing for women 30 years and older;
  • sexually-transmitted infection counseling;
  • human immunodeficiency virus (HIV) screening and counseling;
  • FDA-approved contraception methods and contraceptive counseling;
  • breastfeeding support, supplies, and counseling; and
  • domestic violence screening and counseling.

New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012. 

For more information on the HHS guidelines for expanding women’s preventive services, please visit: The guidelines can be found

To learn more about the Affordable Care Act or request a presentation for your office or medical staff on the topic, contact Jessa Barnard (, 622-3374 x 211). 

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Universal Vaccination Program Updates

Maine's Universal Childhood Immunization Program was established by 2009 Public Law 595 to provide all children from birth until 19 years of age in the State with access to a uniform set of vaccines as determined by the Maine Vaccine Board.   Vaccine purchase is funded by an assessment on health insurance carriers and 3rd-party administrators.  Patients will not be charged for the cost of the vaccine.  Therefore, financial barriers, (e.g. high insurance deductibles and out-of-pocket expenses), will no longer be an obstacle for children to receive vaccine.

The Program has recently launched a website with FAQs for physician practices -  providing information about vaccination purchasing, office procedures and other changes practices and patients will see under the program -  and the list of vaccines that will be covered in for the program year commencing on July 1, 2011.

In answering what changes you might see in your office under the program, the FAQs state that the Maine Immunization Program will operate much the same as it currently does.  Availability of state supplied vaccines will be expanded to all children and more vaccine choices will be available.  Vaccine ordering and accountability processes are expected to remain relatively the same.  All providers who receive state supplied vaccine will be required to use the ImmPact2 Immunization Information System for ordering and vaccine accounting.  The program also recommends that physician practices evaluate their upcoming vaccine need for privately insured patients from now until January.  Pre-planning will help offices deplete private inventory and prepare for universal vaccine supply in January 2012.  Practices will still bill insurers normally for vaccine administration. 

For additional information, please contact the Maine Immunization Program at 1-800-867-4775 or or the Maine Vaccine Board at: or

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Dirigo Health Agency Board of Directors Today Discussed Health Insurance Exchange and Priorities for the Maine Quality Forum

The Board of Directors of the Dirigo Health Agency met this morning (August 8) and focused almost exclusively on the work involved in establishing a health insurance exchange for the State under the provisions of the Affordable Care Act (ACA) and the priorities of the Maine Quality Forum during the remaining months of the Agency.  It is expected that the Agency will, during the next 30 months, transition into a new organization that would operate the state's health insurance exchange.  If it does not transition to a new entity, it will be closing its doors as its core funding derived through the assessment on health insurance claims expires in approximately 30 months.  Agency staff noted that much work is required in order to develop a "migration strategy" as the Agency transitions.

Karynlee Harrington, Director of the Agency presented the priorities of the Maine Quality Forum.  They include:

  • Promoting use of a patient experience survey tool.
  • Working with partners in the private sector to establish a database of physicians and physician practices.
  • Focusing attention on healthcare associated infections.    

Ms. Harrington noted that the Agency would, in all likelihood, hire a project manager to work with staff on the projects but that the manager would be hired on a consulting basis.

Much of the discussion on the topic of the health insurance exchange focused on the Agency's role and the funding of the design and implementation phases of the exchange.  The federal government released preliminary rules on the exchanges but many more rules are expected, as well as significant changes in the proposed rules. The federal government has funding available for design through Level I so-called Establishment grants.  Level II grants would follow.  Additional funding may be available through MaineCare, which is eligible for funding on a 9 to 1 match basis (i.e., federal government pays for 90%).  Director Harrington proposed that the preliminary 2013 fiscal year budget include $2 million to help MaineCare seed this match.  Some members of the Board pushed back on this request noting that there has been no commitment from the legislature or the Governor regarding the Dirigo Agency or its successor serving as the Exchange.  The issue was not resolved as the Board has several months before a final 2013 budget needs to be adopted.

The Board meets next on Monday morning, September 12th, at 9:00am.

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