September 26, 2011

 
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New Laws Effective Wednesday, Sept. 28

Unless a provision of a statute provides otherwise, laws enacted by the Maine legislature and signed by the Governor generally become effective 90 days following adjournment of the Session.  This year, that date is this coming Wednesday, September 28th.  Many of these laws are of interest to physicians, including provisions of the new health insurance law, amendments to the medical marijuana law, HIV testing (see article below), authorization for temporary disability parking permits, amendments to Maine's health insurance exchange law, amendments to the state Prescription Monitoring Program and changes in law to prohibit the sale or possession of so-called bath salts.

A fifty page summary of all the legislative action in 2011 impacting physicians is available on the Association's website at www.mainemed.com.  Copies of the summary are also available by calling the MMA office at 622-3374 (ext. 219).  MMA's three attorneys are available to provide a presentation on the 2011 legislative changes to interested medical staff and practices.

Laws of particular interest with effective dates other than Sept. 28th include:

  • Legalization of fireworks (MMA opposed).  (Effective January 1, 2012). 
  • Increasing the availability of Independent Medical Examiners Under the Workers' Comp Statute (was effective June 3, 2011).
  • An act requiring use of the Electronic Death Registration System (effective July 1, 2012).
  • Changes to Maine's Certificate of Need law (effective February 15, 2012).
  • A law prohibiting use of "Most Favored Nation" clauses in health plan provider contracts (applies to contracts executed or renewed on or after January 1, 2012).

 

Reschedued: Practice Managers Needed as Volunteers for Focus Group, Oct 12th in Bangor

As part of the Association's efforts to improve health coverage opportunities for patients, MMA is conducting a series of focus groups with practice managers of primary care practices.  The intent is to learn about how MMA can be more effective in assisting practices with finding better coverage and increased benefits for patients. Certain messages will be tested to see if the practice managers think that patients will react favorably and take action on them. The effort is funded through a grant from the Maine Health Access Foundation (MeHAF).  A successful session was held in Portland in August. 

Wednesday, October 12, 2011 ~ 12:30 pm - 2:30 pm 

Hilton Garden Inn, Bangor, Maine

Eight to ten individuals are needed

Lunch and $100 gift card provided to each participant. 

The focus groups will be conducted professionally by Sam Surprise of Surprise Advertising, a MMA Corporate Affiliate.

If you or a colleague are interested in participating, please contact Jessa Barnard at jbarnard@mainemed.com or 207-622-3374 x 211.  

 
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New HIV Testing Law Effective September 28th

The MeCDC is reminding clinicians that 5 MRSA §19203-A, Maine's HIV testing and consent law, was amended this past legislative session to include a sixth subsection on the “protection of newborn infants,” which goes into effect this Wednesday, September 28th. 

The amended section of the law requires health care providers caring for pregnant women to include HIV tests in the standard set of medical tests performed, subject to the consent and procedure requirements of 5 MRSA §19203-A, sub-§ 1.  That sections requires that a patient must be informed orally or in writing that an HIV test will be performed, unless the patient declines.

Under the new law, health care providers caring for newborn infants are also required to test the infant for HIV and ensure that the results are available within 12 hours of birth if the health care provider does not know the HIV status of the mother or the health care provider believes that HIV testing is medically necessary.  There is an exception if a parent objects to the test on the grounds that it conflicts with the sincere religious or conscientious beliefs and practices of the parent.  The full text of the new law is available here: http://www.mainelegislature.org/legis/bills/bills_125th/chappdfs/PUBLIC229.pdf 

The amendments to the law are intended to make HIV testing routine and standard for all pregnant women, and to make paramount the interest of the infant.  While consent of the patient is still required, the law now requires that every pregnant woman be offered HIV testing, and further requires that the infant be tested if the HIV status of the mother is unknown (but either parent has the right to object). MMA's three attorneys are able to provide general advice on the intent of the law and its practical implications.  Hospital-based physicians should also look to their institutional health lawyers to assist with some of the more difficult questions about this change in practice.
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MedPAC Lists $230 Billion in Cuts To Providers to Fund Medicare SGR Fix

The Medicare Payment Advisory Commission has released a list of $230 billion in Medicare spending reductions that could be used to pay for its proposal to revamp Medicare's physician payment system.

On September 15th, MedPAC unveiled draft recommendations for a four-step, budget-neutral plan that would repeal the current system of Medicare reimbursements for Part B health professionals and replace it with a series of budgetary actions favoring primary care physicians over specialists. To avoid a 30 percent cut in reimbursements for doctors and other providers in 2012 as a result of the sustainable growth rate formula, the plan by MedPAC also would require pay reductions for other health care sectors.

The list of funding options was released September 19th. It is split into two sections: the first, totaling $50 billion, is drawn from previous commission recommendations. The second, totaling $180 billion, comprises other sources, such as the Congressional Budget Office and the Department of Health and Human Services Office of Inspector General, as well as MedPAC.

The commission, which recommends Medicare reimbursement policy to Congress, also said lawmakers could use funding sources outside of Medicare to help pay for the physician pay fix.

The first list contains options that would reduce spending for numerous health care providers, including home health agencies, hospitals, Medicare Advantage plans, and physicians. The second section also contains spending cuts for many providers. The largest reduction would come from drugmakers, whose Medicare reimbursement would be reduced $75 billion over 10 years by requiring them to offer rebates as they do under Medicaid. The list also includes $23 billion in savings from nursing homes over 10 years for rebasing their reimbursement rates, and $21 billion for reducing payments by 10 percent for clinical lab services.


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Affordable Care Act Helps One Million Additional Young Adults Get Health Insurance

Last week, the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) released data illustrating that the Affordable Care Act has helped increase the number of young adults who have health insurance. Data from the National Health Interview Survey (NHIS) shows that in the first quarter of 2011, the percentage of adults between the ages of 19 and 25 with health insurance increased by 3.5 percentage points, representing approximately 1 million additional young adults with insurance coverage compared to a year ago.

The Affordable Care Act allows most children to remain on their parents’ health insurance plans until age 26. No other age group experienced a gain in coverage, and experts agree that the Affordable Care Act made a difference.

“As a mom, I know how scary it is to think about what could happen to your kids if they go without health care coverage, which is what makes today’s news so important,” said HHS Secretary Kathleen Sebelius.  “Thanks to the Affordable Care Act hundreds of thousands more young people have the health care coverage they need.”

The data released today are consistent with reports from other data sources, which indicate that the number of young adults with health insurance has increased since the Affordable Care Act was enacted. A newly-released Gallup survey shows a significant increase in rates of insured adults ages 18-25, from 71.0 percent in the first quarter of 2010 to 75.1 percent in the second quarter of 2011. And earlier this month, the U.S. Census Bureau released its results from the Current Population Survey, describing insurance coverage for calendar year 2010, which found that roughly 400,000 additional adults ages 19-25 were insured during 2010 compared to 2009. These results, along with the latest NHIS data, are highlighted in an HHS Issue Brief.

“Overall, these three national surveys show a consistent pattern of expanded health coverage among young adults due to the Affordable Care Act,” said Sherry Glied, Ph.D., HHS assistant secretary for planning and evaluation. “The law helped many young adults get the health insurance they need, and it is continuing to expand insurance coverage to uninsured Americans all across the country.”

For more information about the CDC NHIS data released last week, please visit http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201109.pdf.  The MMA can also provide education to your practice on benefits available to your patients under the ACA.  To schedule a training, contact Jessa Barnard at jbarnard@mainemed.com or 207-622-3374 x211.

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MaineCare Tobacco Treatment Benefits Reminder

MaineCare - Working With You To Stop Tobacco Use

While overall smoking rates in Maine have been on the decline, certain subpopulations continue to smoke at rates that far exceed state and national averages.  According to 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey data, 41.4% of MaineCare members smoke; a rate that is more than double that of the general adult population (17.2%). 

In an effort to reduce tobacco use by MaineCare members, the Office of MaineCare Services and Partnership For A Tobacco Free Maine continue to collaborate to increase access to tobacco treatment options, including pharmacotherapy and counseling services.  MaineCare’s tobacco treatment benefit is both comprehensive and affordable for MaineCare members, and providers are strongly encouraged to participate in efforts to help patients end their addiction to tobacco.

MaineCare allows reimbursement to providers who screen for tobacco use.  MaineCare also pays for  preventive and intensive counseling services to patients who use tobacco.  Codes 99401, 99402, 99403, 99406, and 99407 can be used to bill for counseling services provided through your practice, with limits of up to three session per member, per calendar year.  In addition, patients can be referred to the Maine Tobacco HelpLine at no cost where they can  receive counseling treatment from certified tobacco treatment specialists.  MaineCare sent out a mailing to primary care providers last spring which included fax referral forms to the help line.  The fax referral form can be used when your patient has given permission for the tobacco helpline to reach out to them by telephone to provide tobacco treatment counseling and support.

Tobacco addiction places an extreme burden on MaineCare members, and the State of Maine as a whole.  Each year, tobacco use costs the MaineCare system more than $216 million  due to treating the chronic conditions that result from long-term tobacco use.  By working with your patients and providing support and motivation to quit, you can help MaineCare members live longer, healthier, more productive lives while saving millions of dollars in the process. 

MaineCare thanks you for your participation in this effort. 

Below is a list of services for which MaineCare reimbursement is available.  Do not hesitate to contact the Office of MaineCare Services, Health Care Management for fax referral forms or if you need more information by calling Valoree Berlan at (207) 287-4827.

MaineCare Tobacco Cessation Coverage:

NRT Gum (P)

Limit: up to three (3) months duration per year.  May be used in combination or with bupropoin tablets for cessation.

Varenicline- chantix (P)

Covered with Prior Authorization

NRT Patch (P)

-Limit: up to three (3) months duration per year.  May be used in combination or with bupropoin tablets for cessation.

Bupropoin (P)

Bupropoin SR 100 and 150mg instead, which is the generic form of Zyban.

NRT Nasal Spray

Covered with Prior Authorization, if gum and patch tried and failed, or if presence of a condition that prevents usage of preferred drug or interaction with another drug and preferred drug exist.

Tobacco Screening

Covered when provided in a physician’s office

NRT Inhaler

Covered with Prior Authorization, if gum and patch tried and failed or if presence of a condition that prevents usage of preferred drug or interaction with another drug and preferred drug exist.

Individual Counseling

Members are covered for three (3) individual counseling appointments per year

NRT Lozenge

Covered for members not able to tolerate the patch or gum. May be used in combination or with bupropoin tablets for cessation.

Group Counseling

(not covered)

All tobacco cessation products require a visit and prescription from the member’s primary care provider, as well as a $3.00 member co-pay. Individual tobacco counseling is a reimbursable measure on the incentive payment for private physicians. 


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Upcoming Events & Conferences

Fall is conference season!  Take advantage of the many upcoming learning opportunities, including: 

 

Maine Medical Group Management Association Half Day Educational Session

Tuesday, September 27, 2011 ~ 8:00 a.m. to 12:00 p.m.

Maine Medical Association, 30 Association Drive, Manchester, Maine 

Trends in Prescription Drug Diversion by DEA agent Tony Milligan &

The Healing Power of Humor by Maine Humorist Gary Crocker

For questions or registration, please contact Karen Wheeler at (207) 873-6173 or by email: kwheeler@mmimvw.com

 

8th Annual International Symposium on Safe Medicine

The world’s oldest continuous drug disposal conference and Maine’s oldest prescription drug abuse conference

Sunday-Tuesday, October 2-4, 2011

Holiday Inn by the Bay Hotel and Conference Center, Portland, Maine

Registration information available at: 
http://benzos.une.edu/2011conference.htm

 

Chemicals, Obesity & Diabetes: How Science Leads Us to Action 

Friday, October 14, 2011 ~ 8:30 a.m. - 6 p.m. 

Colby College, Waterville, Maine 

Keynote Speaker: Bruce Blumberg, PhD, University of California-Irvine, Department of Developmental and Cell Biology 

The Environmental Health Strategy Center (EHSC) and the Goldfarb Center at Colby College are bringing together national and state scientific and public health scholars, practitioners, and advocates, as well as national and state policy-makers, faculty and students, to explore the environmental links to obesity.

Click here for a full agenda; Registration available here

 

The American Lung Association in Maine: 2011 Annual Meeting Awards Ceremony & Luncheon

The Clean Air Act -  40 Years Protecting Public Health

Friday, October 14, 2011 ~ 11:00 a.m. to 2:00 p.m.

Sable Oaks Marriott, South Portland, Maine

Keynote: Curt Spalding, Administrator, New England (Region I), US Environmental Protection Agency

Registration information available here.

 

Maine Public Health Association Pre-Conference Reception 

Perspectives From the Front Line: Top Public Health Achievements in the 21st Century

Monday, October 17, 2011 ~ 5:30 p.m. - 7:00 p.m. 

Peter A. McKernan Hospitality Center, Southern Maine Community College, 2 Fort Road, South Portland

An opportunity for public health and primary care professionals in Maine to hear from a panel comprised of national and local experts on the importance and successes of partnerships between public health and primary care. 

Registration information available here

 

Maine Public Health Association 27th Annual Conference

Facing Public Health Challenges Today for a Healthier Tomorrow 

Tuesday, October 18, 2011 ~ 8:45 a.m - 3:45 p.m. 

MaineHealth, 110 Free Street, Portland, Maine 

Keynote: Dr. Georges Benjamin, Executive Director, American Public Health Association 

Registration information available here

 

2011 Infectious Disease Conference 

Tuesday, November 15, 2011 ~ 8:30 a.m. - 4:00 p.m. 

Augusta Civic Center, Augusta, Maine 

Since 1983, the Maine Center for Disease Control and Prevention, Division of Infectious Disease, Department of Health and Human Services has organized an annual infectious disease conference targeting public health issues of emerging concern to medical practitioners throughout the State.

For more information, or to register, click here


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NNEPC Bath Salts Webinar Available

The Northern New England Poison Center (NNEPC) is offering recorded webinar presentations regarding the new synthetic drugs known as “bath salts.”

The webinar is a slide and audio presentation recroded by Dr. Karen Simone, NNEPC Director, and Dr. Tamas Peredy, NNEPC Medical Director.  The presentation is available for viewing at any time.  It can be accessed through our website, www.nnepc.org, or directly at http://www.surveymonkey.com/s/Bath_Salts.  

The presentation is given in two parts.  The first is a general overview of bath salts appropriate for all audiences.  The second is aimed at health care professionals and gives information related to treating bath salts patients.

NNEPC is currently able to offer continuing education credits for Maine and New Hampshire EMS personnel for the bath salts recorded webinar.  They expect to be able to offer other types of continuing education credits in the near future.

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Workers' Compensation Board Holds Public Hearing on Medical Fee Schedule Rule

The Maine Workers' Compensation Board held a public hearing last Monday (Sept. 19) in Augusta on a revision to its Rule Chapter 5:  Medical Fees; Reimbursement Level; Reporting, a matter that has been in debate before the Board and subject to litigation for more than 5 years.  The MMA, MEMIC, the Maine AFL-CIO, and the physical therapists' association all spoke in favor of the proposed revisions.  The proposal updates the fee schedule to the current Medicare RBRVS and CPT, and retains the $60 conversion factor for professional fees.  The proposal also establishes a facility fee schedule that largely reflects the methodology developed by the Board's consultant, Eric Anderson with Ingenix, that was the subject of 2009 rulemaking before the Board that was never completed.  In this proposal, the Board includes a provision for payment of up to $30 for each 10 minutes spent by a practitioner in preparing a narrative report or an M-1.  At the hearing this morning, MEMIC acknowledged that the practitioner should be compensated for completing the M-1, but argued that the proposed amount is too high.  

The MMA seeks your feedback on this rule and will be submitting further written comments before the comment deadline on September 29th.  

You can find the complete rulemaking documents on the Workers' Compensation Board web site at:  http://maine.gov/wcb/rules/proposed.htm.

If you have further questions or comments about the WCB medical fee schedule, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

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Resolution Addressing Prescription Drug Abuse Passed at Annual Meeting

At the Association's Annual Meeting last week in Bar Harbor, members endorsed a resolution aimed at reducing the amount of prescription drug abuse and diversion in the state.  Introduced by the Executive Committee, the Resolution directs the Association to:

  • Continue its efforts to educate all prescribers concerning the tools available to identify diversion, including the Prescription Monitoring Program (PMP). 
  • Encourage all physicians who prescribe controlled substances for chronic pain to enroll in the PMP and access it when appropriate.
  • Encourage the Office of Substance Abuse to improve the interface and website portal for the PMP, to eliminate the requirement that applications be notorized, and to provide adequate staff to respond to inquiries about the PMP and educate potential users.
  • Continue to support programs and projects aimed addressing the problem of diversion, such as the Chronic Pain Project funded by the Board of Licensure in Medicine, and seek funding from additional sources for such programs.
  • Review the impact of amending Maine law to allow the public use of opioid antagonist agents (such as naloxone) in order to reduce the risk of death from accidental overdose in collaboration with other interested parties; and
  • Participate in efforts by the Maine Attorney General's Office, the Office of Substance Abuse, the Department of Public Safety and the U.S. Attorney's Office to address the problem of diversion and inform members and non-members of these efforts.

MMA offers confidential consultations at no cost to practices needing assistance with treatment of chronic pain patients and prevention of diversion.  To schedule a consultation, contact Gordon Smith, Esq., at gsmith@mainemed.com. [return to top]

Former Governor McKernan to Represent Senator Snowe at Event this Evening at the Woodlands

Because of a change in the Senate schedule in Washington, Senator Olympia Snowe will now be able to participate in tonight's event at the Woodlands in Falmouth only by telephone hook-up.  Important Senate votes have  been scheduled for later today.  Former Maine Governor John R. McKernan, the Senator's husband, will speak for the Senator at the event.  Attendees will also be invited to attend another campaign event at some point during the election cycle.

The fundraising event is scheduled from 6:00pm to 7:30pm at the Woodlands Country Club in Falmouth.  The co-hosts include Stuart Gilbert, M.D. and MMA EVP Gordon Smith.  The requested contribution to attend is $100. [return to top]

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