October 3, 2011

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Final CME Program on Chronic Pain/Diversion/Addiction Still Available this Friday, Oct. 7

The last of of three OSA-funded CME programs on Chronic Pain/Diversion/Addiction will be held on this coming Friday morning, October 7th from 8:30 a.m. to 12:30 p.m. at the MMA offices in Manchester and also available via Webex.  Three hours of CME are available and there is no cost.  Faculty includes a local DEA agent, MMA attorneys, OSA Prescription Monitoring Program staff, and Tamas Peredy, M.D. of the Northern New England Poison Control Center.

Registration is available on the MMA website at www.mainemed.com or by calling the MMA offices at 622-3374, ext. 210.  The agenda for the program is as follows:

8:00 am   Registration and breakfast for those attending in Manchester

8:30 am   Welcome, introductions and opening comments:  Gordon H. Smith, Esq, Executive Vice President, MMA

8:45 am   Tamas Peredy, M.D.

9:45 am    Lowell "Chip"  Woodman, DEA

10:30 am   Break

10:45 am   Patricia Lapera, MS, Program Manager, OSA Prescription Monitoring Program

11:30 am   Andrew MacLean, Esq., Deputy EVP, Maine Medical Association

Noon:      Q & A


Legislature Convenes for Special Session; Passes Bath Salts Bill & Confirms Gubernatorial Appointments

During its Special Session this past week, the Maine Legislature took important steps to halt the distribution and abuse of so-called bath salts in the state.  Emergency physicians have been seeing increasing use of the substances.  

The bill passed unanimously at final enactment and was signed into law by Governor Paul LePage almost immediately.  As it was passed with an emergency preamble, the law took effect upon receiving the Governor's signature.

As passed, L.D. 1589 accomplishes the following:

  • Possession of bath salts increases from a civil violation to a Class D misdemeanor or crime, punishable by up to a year in jail;
  • Unlawful trafficking of the drug goes from a Class E misdemeanor to a Class B felony, punishable by up to 10 years in prison;
  • Aggravated trafficking increases from a Class C crime to a Class A felony, with a maximum penalty of 25 years in prison; and
  • Unlawful trafficking and aggravated furnishing would increase from Class E and D misdemeanors respectively to Class C and B felonies.

Most of the debate on the bill in the Committee focused on the costs associated with the enforcing the new restrictions.

The Legislature also took action on 91 nominations submitted by Governor LePage for legislative approval.  All 91 nominees were confirmed.  They include Eric Cioppa who was confirmed as the Superintendent of the Bureau of Insurance.  MMA EVP Gordon Smith testified in favor of Mr. Cioppa's nomination before the Joint Standing Committee on Insurance & Financial Services on the 26th.  Mr. Smith referenced Mr. Cioppa's depth of experience on issues including workers' compensation and health insurance as well as his calm demeanor as reasons he is well suited for the position. 

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CMS Adopts Medicine's Recommendations in Medicaid RAC Program

The Centers for Medicare & Medicaid Services (CMS) recently released the Medicaid Recovery Audit Contractor (RAC) final rule.  In January, the AMA and 80 state and specialty societies submitted comments to CMS on the Medicaid RAC proposed rule and, while the AMA is currently analyzing the final regulation, an initial review reveals that many of medicine's specific recommendations were accepted.  These include:  1) a 3-year maximum claims look-back period, 2) RACs are required to employ a full-time physician medical director, 3) states must set limits on the number and frequency of medical record requests, 4) RACs must hire certified coders, 5) RACs must provide outreach and notify providers of audit policies and protocols, 6) RACs must accept submission of electronic medical records by fax or CD/DVD, 7) RACs cannot audit claims that have already been audited or are currently being audited by another entity, 8) RACs must return the contingency fee if an overpayment determination is reversed at any level of appeal, 9) states must adequately incentivize the identification of underpayments, and 10) states must coordinate the efforts of the RACs with other auditing entities.  The final rule sets an implementation deadline of January 1, 2012. [return to top]

Medicare eRx Payment Adjustment - November 1, 2011 Deadline Approaching

Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment byreviewing the MLN Article SE1107 .   If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule.  A Quick Reference Guide is available to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program.  As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit  a significant hardship exemption request and rationale.  Individual eligible professionals must submit their hardship exemption requests through the  Quality Communications Support Page and group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS.  

Additional information and resources are available at www.cms.gov/erxincentive

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Medicare Open Enrollment Period Begins October 15th

Starting in 2011, Fall Open Enrollment (also known as the Annual Coordinated Election Period, or ACEP) for Medicare beneficiaries begins on October 15th and lasts through December 7th.

During this period, people with Medicare have the right to change their Medicare health and drug coverage options without restriction. They can make as many changes as they need, and the last change they make on or before December 7th will take effect on January 1, 2012.

For more information, see https://www.cms.gov/center/openenrollment.asp.  Patients can contact their local Area on Aging at 1-877-353-3771. 

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MMA Board of Directors Meets This Wednesday

In accordance with revised bylaws approved at the General Membership meeting at the MMA Annual Session in early September, the MMA Executive Committee has been renamed the Board of Directors.  The Board of Directors will hold its first meeting since the changes this Wednesday, October 5th at 4 p.m.  The meeting will take place at the MMA headquarters at the Frank O. Stred Building in Manchester.  In addition to regular reports on membership, operations, and finances, the Board will discuss the recent Annual Session, the composition and role of the Nominating Committee under the new bylaws, and the redesign of the MMA web site.  

The Chair of the Board is Kenneth Christian, M.D. and the President is Nancy Cummings, M.D.

The meeting is open to any member who is interested in attending.

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HHS launches new Affordable Care Act Initiative to Strengthen Primary Care

Last Wednesday, the U.S. Department of Health and Human Services (HHS) launched a new initiative made possible by the Affordable Care Act to help primary care practices deliver higher quality, more coordinated and patient-centered care. Under the new initiative, Medicare will work with commercial and state health insurance plans to offer additional support to primary care doctors who better coordinate care for their patients. This collaboration, known as the Comprehensive Primary Care initiative, is modeled after innovative practices developed by large employers and leading private health insurers in the private sector.

“Thanks to the Affordable Care Act, we are helping primary care doctors better coordinate care with patients so they get better care and we use our health care dollars more wisely,” said HHS Secretary Kathleen Sebelius.

The voluntary initiative will begin as a demonstration project available in five to seven health care markets across the country. Public and private health care payers interested in applying to participate in the Comprehensive Primary Care Initiative must submit a Letter of Intent by November 15, 2011. In the selected markets, Medicare and its partners will enroll interested primary care providers into the initiative.

Primary care practices that choose to participate in this initiative will be given support to better coordinate primary care for their Medicare patients.
This support will help doctors: 

  • Help patients with serious or chronic diseases follow personalized care plans; 

  • Give patients 24-hour access to care and health information; 

  • Deliver preventive care; 

  • Engage patients and their families in their own care; 

  • Work together with other doctors, including specialists, to provide better coordinated care. 

CMS will pay primary care practices a monthly fee for these activities in addition to the usual Medicare fees that these practices would receive for delivering Medicare covered services. This collaborative approach has the potential to strengthen the primary care system for all Americans and reduce health care costs by using resources more wisely and preventing disease before it happens.

For more information, please see the Comprehensive Primary Care initiative web site at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/cpci/

For an overview fact sheet about the Comprehensive Primary Care initiative, visit: http://www.healthcare.gov/news/factsheets/2011/09/primary-care09282011a.html

Interested parties may obtain answers to specific questions by e-mailing CMS at: CPCi@cms.hhs.gov
For more information about the CMS Innovation Center, please visit: http://www.innovations.cms.gov.
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Administration Seeks Supreme Court Review of ACA

The U.S. Department of Justice last Wednesday filed a petition in the U.S. Supreme Court requesting review of an appeals court decision invalidating a key provision of the federal health reform law (Florida v. HHS, U.S., No. 11-398, filed 9/28/11).

The petition is the third to ask the high court to review the U.S. Court of Appeals for the Eleventh Circuit's decision in Florida v. HHS.

The Eleventh Circuit held unconstitutional the Patient Protection and Affordable Care Act‘s individual mandate, but stopped short of invalidating the entire law, holding that the insurance mandate was severable from the remainder of ACA.

The government's petition directly challenges the ruling on the individual mandate. If upheld, the provision would require virtually all citizens to buy health insurance or pay a penalty. The mandate is scheduled to take effect in 2014.

Twenty-six states, including Maine, and the National Federation of Independent Business (NFIB) filed two separate petitions asking the court to hear the severability issue raised by the case. The states' petition also argued that the Medicaid expansion provision upheld by the Eleventh Circuit should be invalidated.


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Maine Health Centers Receive Funding for PCMH Initiatives

Last week, the U.S. Department of Health and Human Services (HHS) announced a series of initiatives that will help over 900 community health centers and community-based organizations enhance the quality and coordination of health care services across the country.  A total of $47 million, made available by the Affordable Care Act, was awarded in every state and will help improve quality and access to services for millions of Americans.  They will also support better primary care and behavioral health services for people with mental and substance abuse disorders.

Both the HHS Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) released awards on the same day in an effort to better coordinate care across the health care spectrum.  HRSA awarded $32 million to 904 community health centers nationwide. These resources will provide upfront assistance to existing health centers as they try to achieve recognition as a patient-centered medical home.  Activities will include care planning, support for team-based models of service delivery, and system upgrades.

The following health centers in Maine each received $35,000: 

Penobscot Community Health Center, Inc.



Bucksport Regional Health Center



Pines Health Services



Fish River Rural Health

Eagle Lake


Eastport Health Care, Inc.



Harrington Family Health Center



DFD Russell Medical Center



Health Access Network, Inc.



Regional Medical Center at Lubec, Inc.



Sebasticook Family Doctors



Sacopee Valley Health Center



Katahdin Valley Health Center



City of Portland Maine



St. Croix Regional Family Health Center



York County Community Action Corporation



Islands Community Medical Services, Inc



Healthreach Community Health Centers


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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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New HIV Testing Law In Effect

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,” and went into effect last 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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Comment Deadline Passes on Workers' Compensation Board Medical Fee Schedule Rule

The Maine Workers' Compensation Board received comments through last Thursday, September 29th 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 assembled comments from several practices and submitted them by the comment deadline.  The MMA will publish the Board's responses to all the comments received when available.

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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Upcoming Events & Conferences

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


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

Spotlight on Coding and Compliance with National Speaker Margie Vaught!

MaineGeneral Medical Center 2011 Fall Coding & Compliance Conference

Augusta Civic Center, North Wing, Augusta/Capital/PIne Tree Room

Friday, November 4, 2011, 8 a.m. to 4 p.m.

Starring Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR


$125 (includes breakfast, lunch, & breaks); registration deadline is October 24th.

FMI:  Lisa Beeckel, CPC, Physician Liaison; lisa.beeckel@mainegeneral.org; 626-1094.

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