January 23, 2012

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POLITICAL PULSE: Legislative Highlights of the Week

The focus at the Statehouse last week continued to be the Governor's proposed supplemental budget to fill the shortfall in Department of Health and Human Services finances.  The Appropriations Committee held a number work sessions and the Health and Human Services Committee weighed in with their recommendation to accept a number of the Administration's proposed cuts.  With the short session, other committees have quickly picked up the pace and are holding public hearings and work sessions on carry over bills and new legislation submitted this year, including a bill that potentially puts Maine's health insurance coverage mandates at risk. 


The Appropriations Committee continued with supplemental budget work sessions last week, although the Committee is moving to spending more time in party caucuses rather than in public work sessions.  On Tuesday, members of the Committee questioned MaineCare Medical Director, Dr. Kevin Flanigan, for over an hour.  The majority of their questions focused on the proposal to limit Suboxone for MaineCare members to two years.  Dr. Flanigan assured Committee members that there would be a prior authorization process allowing continued medication if members are unable to wean from Suboxone within the two-year limit, however Committee members had questions about who would review the PAs, the budgeted savings, and the standard for the PA.  The MMA will continue to work with members of the Northern New England Society of Addiction Medicine, including Drs. Mark Publicker and David Moltz, to oppose this proposal.   Legislators are increasingly interested in an alternative to to this cut, and have suggested it be replaced with a limit on any opioid-based pain reliever to fifteen days for acute conditions. 

The Health and Human Services Committee also reported back its recommendations on several areas of the budget proposal to the Appropriations Committee.  A majority of the HHS Committee voted to accept all proposed cuts that they reviewed, including cuts to the Fund for Health Maine (eliminating FHM money for Oral Health, Donated Dental, Home Visitation, Community Grants, Family Planning, Adult Immunizations, Child Care, Head Start and Drugs for the Elderly)  and MaineCare eligibility (ending coverage for 19-20 year olds, some parents and childless adults). The Appropriations Committee will continue its deliberations on the budget this week.  Budget documents, including the HHS report, can be found on the Appropriations Committee website.  Should you wish to communicate with members of the Appropriations Committee about the proposed cuts to DHHS programs, you will find the members and their contact information on the web at:  http://www.maine.gov/legis/house/jt_com/afa.htm.

Several events are being planned for this week at the Statehouse in opposition to the proposed cuts, including a candlelight vigil on Tuesday at 6 pm before the Governor's State of the State address and a press event on Wednesday at 10 am to promote a fair and balanced budget.  More information about these events can be found here


Last Wednesday, a majority of the Insurance and Financial Services Committee voted to pass LD 882, An Act to Limit Health Care Mandates.  Though modified from the version initially introduced, the bill as revised would give health insurance companies the ability to exclude from coverage any state health insurance mandate not enumerated in the essential health benefits package required by the federal Affordable Care Act as of January 1, 2014.   Because the federal Department of Health and Human Services has announced that they will leave it up to states to pick a "benchmark" plan that will set the state's essential benefits, right now we have little idea what will or will not be included in Maine's essential benefits. The essential benefits could be set by any of the plans on the spreadsheet provided here by the Bureau of Insurance.  While the plan chosen could include all of the state mandates Maine has now, it could just as easily end up being the plan with the least number or scope of mandates. 

While the bill has passed out of Committee, it is not too late to contact members of the Committee, or your own legislators, to share your concerns with the bill before it is on the House and Senate floor for debate. Committee members can be found here and you can look up your legislators here.  


The Labor, Commerce, Research and Economic Development Committee took up LD 1715 last week.  The bill, An Act to Allow for Timely Access to and Enhanced Administration of All Vaccines, would allow pharmacists to administer to those over 18 any vaccination approved by the FDA, rather than the enumerated list allowed by law currently.   The MMA was the only group that testified in opposition to the proposal, however Committee members raised a number of the issues of concern to physicians, including how information regarding the administration will be reported back to primary care practices, fragmentation of care, and pharmacy participation in the State's immunization registry.  The Committee will next take up the bill in a work session. 


The Education Committee continued its discussion of L.D. 1237, An Act to Prohibit Bullying in Schools last week.  Representatives of the Maine Civil Liberties Union, Maine School Management Association (representing school boards and superintendents) and the Maine Principals' Association presented the Committee with an update of their negotiations on the bill's language but the principals and School Management Association continue to have concerns with how prescriptive the legislation will be in areas such as the policies school boards must adopt and mandatory reporting of bullying by school staff.  The Committee tabled the bill and will hear back from the parties again this week.  


MMA Legislative Committee Call, Tomorrow 8 pm

The MMA's Legislative Committee has held two successful weekly conference calls so far this session.  They have been well attended and we appreciate the individuals and specialty societies that took the time to participate in the call and share their feedback on pending legislative proposals. 

The next call is tomorrow, Tuesday, January 24th 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

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.  There have been no new bills printed this week, so discussion tomorrow will  focus on the MMA's response to the supplemental budget and other pending issues at the statehouse.  For the full list of bills the MMA is currently tracking, click here

If you have any questions about the conference calls, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

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MMA to Present Prescription Drug Abuse Program in Washington County, Monday, Feb. 6

At the invitation of State Senate President Kevin Raye (R., Perry), the Maine Medical Medical Association will present a three hour CME program in Washington County on Monday, February 6th aimed at presenting practical tools for treating chronic pain while preventing diversion and addiction.  The program will be held from 3:00pm to 6:00pm at the Regional Medical Center in Lubec.  There is no cost to attend the program but registration is required.  The program may be available via webinar at remote sites in the Machias and Calais areas.

Senator Raye will speak at the conference, as will Attorney General William Schneider.  Other speakers include Patricia Lapera, coordinator of the state Prescription Monitoring Program, Rebecca Morin of the Maine Primary Care Association and Gordon Smith, Esq., Executive Vice President of MMA.  An additional clinical speaker may be added.

To register, call the Maine Medical Association at 622-3374 (press 0) or by sending an e-mail to Gordon Smith at gsmith@mainemed.com.

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AMA Offers Grassroots Advocacy Training Webinar, Feb. 7

On February 7, 2012 at 8 p.m., the AMA will host a grassroots training webinar as part of the Very Influential Physician (VIP) program entitled, "Communicating with Congress:  How to be an Effective Citizen Advocate."

Led by Brad Fitch of the Congressional Management Foundation (CMF), this webinar will focus on the SGR cuts scheduled to take effect on March 1st, and how physicians can act as leaders in successfully influencing  lawmakers to permanently eliminate the SGR.  Brad and CMF have conducted exhaustive research on how Congressional offices process and respond to all the communications they receive, and what specifically impacts their thinking.

Take part in this webinar and learn:

  • What congressional staff believe are the most effective communications tactics for influencing members of Congress;
  • The differences between different forms of grassroots communications (email, mail, phone calls, in-person visits, etc.);
  • How to conduct effective in-person meetings, influence legislators at town hall meetings and other effective advocacy techniques that you can apply in your state/congressional district;
  • Where the AMA stands with current efforts to repeal the SGR once and for all, and how physicians can best leverage their relationships in Congress to amplify the repeal message.

Mark your calendars for this important webinar and stay tuned for registration and call-in details.  If you are not already a member of the VIP program, please visit the following page on the AMA web site to join:  https://www.surveymonkey.com/s.aspx?sm=NqXN8aqmcgUhAXC04fHeVg_3d_3d.

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State-supplied Influenza Vaccine Reminders

Maine CDC recommends that Health Care Providers continue vaccinating to protect against influenza this year according to the following guidelines: 

Health Care Providers should use state-supplied vaccine for patients in the following circumstances: 

  • The patient is a child ages 6 months through 18 years; 
  • The patient is pregnant or the partner of a pregnant patient; 
  • The patient’s insurance does not cover vaccinations; 
  • The patient is uninsured. 

Health Care Providers may use state-supplied vaccine for other patients only if

  • The Health Care Provider has already vaccinated all eligible patients listed above and has excess state-supplied vaccine; and 
  • Privately purchased vaccine is not available. 

Providers may not charge for state-supplied vaccine. It is reasonable and allowable to charge an administration fee in some circumstances, provided that: 

  1. MaineCare-eligible children are not charged an out of pocket administration fee;  
  2. administration fees do not exceed the regional Medicare maximum ($14.37/vaccine administration); and 
  3. no one is denied vaccine because of their inability to pay an administration fee.
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Medical Certifiers/Medical Examiners Encouraged to Go Online

Maine CDC’s Data, Research, and Vital Statistics (DRVS) office processes approximately 13,000 death certificates each year.  Until recently, Maine’s death registration system was paper based.  Data providers used typewriters or completed vital records by hand.  Death records were hand carried or mailed to doctors’ offices for completion of the cause of death section and then mailed or hand carried to municipal offices.  This paper-based system no longer met the needs of customers or public health officials who need the data for public health monitoring and reporting. 

Currently there are approximately 115 funeral establishments, 229 municipalities, 66 medical certifiers, and 14 medical examiners that have been trained to use a new electronic system and are utilizing DAVE (Database Application for Vital Events).  While this is a good start, the goal is to have all providers enrolled as users of the system by July 2012. 
An online training link for funeral directors, medical certifiers and municipal clerks is available at http://dave.trainingserver.net.

The DRVS website has posted a brochure and additional information about the electronic system which is available at http://go.usa.gov/RnJ

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Maine PCMH Pilot Notice of Phase 2 Expansion

Conveners of the multi-payer Maine Patient Centered Medical Home (PCMH), the Dirigo Health Agency’s Maine Quality Forum, Maine Quality Counts, and the Maine Health Management Coalition, announce plans to expand the Pilot to include an additional 20 adult practices in January 2013.  An application process will be announced and made available online on or before February 1, 2012.  This information is being made available as an introduction to the expectations for application and selection.

Interested practice sites are advised to read the full “Notice of Plan for Phase 2 Expansion” posted on the Maine Quality Counts website (www.mainequalitycounts.org/major-programs/patient-centered-medical-home.html), and should register their intent to apply by completing the “Phase 2 Intent to Apply” form online at http://www.surveymonkey.com/s/ME_PCMH_Pilot_Phase2_Intent_to_Apply.

Timeline for Pilot Practices

  • January 12, 2012 – Pilot Conveners communicate plans for Phase 2 expansion broadly within state
  • January 2012 – Interested practices are asked to submit online Intent to Apply.
  • February 1, 2012 –Maine PCMH Pilot Phase 2 practice application posted online
  • March 31, 2012 - Deadline for practices to submit online application
  • April – May, 2012 – Review of applications by Pilot staff, PCMH Pilot Selection Committee
  • May 1, 2012 – Phase 2 Community Care Team (CCT) application posted online
  • May 31, 2012 -  Phase 2 practices selected
  • July 15, 2012 – Deadline for CCTs to submit online application
  • August 1, 2012 – Phase 2 CCTs selected
  • January 1, 2013 – Phase 2 practices and CCTs begin participation in Maine PCMH Pilot
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CMS Promotes Glaucoma Awareness & Screening

With January designated as National Glaucoma Awareness Month, CMS is asking clinicians to join them in promoting increased awareness of glaucoma and the glaucoma screening service covered by Medicare.  Today, more than 2.2 million Americans age 40 and older have open angle glaucoma, the most common form of glaucoma, and at least half don't even know they have it. Through early detection and treatment, we can help prevent blindness.

Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups:

  • Individuals with diabetes mellitus
  • Individuals with a family history of glaucoma
  • African-Americans age 50 and older
  • Hispanic-Americans age 65 and older 

Medicare's coverage of glaucoma screening includes a dilated eye examination with an intraocular pressure (IOP) measurement and a direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.

What Can You Do?

As a healthcare professional who provides care to seniors and others with Medicare, you can help protect the vision of your patients who may be at high-risk for glaucoma by educating them about their risk factors and reminding them of the importance of getting an annual glaucoma screening exam covered by Medicare.

For More Information:

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Attorney General Schneider Warns Consumers of Supplemental Health Insurance Scams

Attorney General William J. Schneider is warning consumers about recent reports of calls from individuals claiming to represent supplemental health insurance offers. There are reports from Maine seniors who have received phone calls claiming to be from Medicare or from "the health office." The callers ask for the Mainer by name and appear to be offering seniors some sort of supplemental health insurance or prescription coverage.

"Seniors can protect themselves by never giving any personal information to anyone over the phone," said Attorney General Schneider. 

If you or a patient think you have experienced a Medicare scam, call the Attorney General's Consumer Protection Hotline at (207) 626-8849.

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Gastroenterologists, Urologists, Meeting Feb 3-5th

Maine Gastroenterology Society

2012 Annual Winter CME Meeting

February 3-5, 2012

Point Lookout, Northport, ME 

For more information, or to register, contact Gail Begin, gbegin@mainemed.com


Maine Urological Association 

Annual Winter Meeting

February 3-5, 2012

Sugarloaf Mountain Hotel, Carrabassett Valley, ME 

For more information or to register, contact Maureen Elwell, melwell@mainemed.com, 622-3374 Ext: 219

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