February 13, 2012

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POLITICAL PULSE: Legislative Highlights of the Week, Including Continuing Negotiations and Uncertainly on Supplemental Budget Agreement

While the 13-member Joint Standing Committee on Appropriations & Financial Affairs last week reached unanimous agreement on a supplemental budget deal that would keep HHS solvent through the current fiscal year, Governor Paul LePage threatened a veto because it does not make sufficient structural changes in Maine's Medicaid program in his view.  He singled out the failure to eliminate the childless adult coverage (the "non-categoricals") as especially troubling to him.  The budget could come up for debate in the House as early as tomorrow.


In the early morning hours of last Wednesday, February 8th, the Appropriations Committee reached a bipartisan agreement to address the shortfall for FY 2012, the period between today and June 30, 2012.  The Committee found the means to address a shortfall of approximately $121 million in FY 2012 and left a gap of approximately $86 million for FY 2013.  Most of the really difficult choices are left to FY 2013.  

Although MMA has not seen any documentation of the budget deal, we understand it to include the following:

MaineCare Eligibility

  • Enrollment for adults without children living at home (the "non-categoricals") will be frozen.  This compromise protects coverage for the approximately 17,000 individuals currently on the program; however, individuals on the waiting list will not be able to get coverage (at least through FY 2013) and if an individual's income increases above the eligibility level, he or she will not be able to get coverage again.
  • Parents between 133% and 200% of the FPL will lose their coverage effective October 1, 2012.  This would affect approximately 14,000 individuals.

MaineCare Services

  • The deal includes the hospital inpatient visit limit of 5, but excludes the hospital outpatient visit limit.
  • Coverage for smoking cessation is cut by half, but it is not clear how this will be implemented.
  • Routine eye exams will be available once every 3 years.
  • Chiropractic visits are limited to 12 per year.
  • Occupational therapy, physical therapy, and podiatry services are subject to a 10% cut in reimbursement.

The Legislature is expected to debate this proposal this week, perhaps as early as tomorrow.  The Governor has suggested that he may veto the bill because it does not make the "structural" changes in the MaineCare program he advocates.  He cited in particular, the failure to eliminate non-categorical coverage.  Although there has been plenty of tension between the Governor and Republican legislative leaders, achieving a 2/3 vote in both chambers of the legislature to override a gubernatorial veto is never certain.

The supplemental budget bill is L.D. 1746:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280043557.

You can find the Appropriations Committee materials on the web at:  http://www.maine.gov/legis/ofpr/appropriations_committee/materials/index.htm.


The Committee continues to work on L.D. 1691, An Act Related to Specialty Tiers in Prescription Drug Pricing.  The bill would prohibit health insurers from including in plan designs so-called "specialty tiers" whereby the insurance carrier includes a fourth or even a fifth tier of drug coverage beyond the typical three tiers.  These specialty tiers have a co-insurance rather than a co-payment obligation by the patient and pose a significant cost barrier to patients with chronic conditions needing expensive drugs.  During the last work session, the Committee seemed to be leaning towards subjecting these drugs either to the annual out-of-pocket maximum or a separate prescription drug out-of-pocket maximum in the certificate of coverage instead of the prohibition in the original bill.  The bill is back on the work session agenda for tomorrow.

Members also reviewed final language for the 7-6 "ought to pass as amended" report on L.D. 882, An Act to Limit Health Care Mandates.  The majority report is re-titled, An Act to Provide that Carriers are not Required to Offer Health Plans that Exceed the Minimum Essential Benefits Package.  It would enact 24-A M.R.S.A. sec. 4303(1-A) as follows:

1-A.  Minimum essential benefits.  Notwithstanding any other provision of this Title or Title 24, a carrier offering or renewing a health plan in this State on or after January 1, 2014 may not be required to provide benefits or coverage that exceeds the health care benefits included in the minimum essential benefits package determined by the Secretary of the United States Department of Health and Human Services pursuant to the Federal Act.


Last week, the HHS Committee voted out three bills in which MMA has been engaged.  The most disappointing action was a partisan division on L.D. 1629, An Act to Allow for a Contingency Fee Agreement with a MaineCare Recovery Audit Contractor with all Republicans voting in favor of the bill and all Democrats, including the one physician in the legislature, voting against the bill.  The MMA is strongly opposed to the contingency fee approach to MaineCare audits and a previous DHHS contingency fee audit initiative approximately 10 years ago so incensed the physician community that the MMA passed a bill to prohibit them.  This bill would permit a return to contingency fee MaineCare audits now by distinguishing these RAC audits from other fraud and abuse efforts.  You can view the MMA's comment letter on this issue on the MMA web site at:  http://www.mainemed.com/spotlight/2012/MMALetter_HHSComm_LD1629.pdf.  The Committee chairs have agreed to give the MMA some time to discuss a possible compromise with DHHS officials on this topic.

The Committee also voted unanimously in favor of L.D. 1679, An Act to Conform Maine's Prescription Drug Privacy Laws with the United States Constitution.  Democratic members dropped their effort to include additional protections for physician and other prescriber data that might withstand constitutional scrutiny in the bill.  

Finally, the Committee voted unanimously in favor of an amended version of L.D. 1688, An Act to Clarify the Status of Patients Held Under Involuntary Commitment Applications.


At a work session last Thursday, the members of the Labor, Commerce, Research & Economic Development Committee voted unanimously in favor of an amended version of L.D. 1715, An Act to Allow for Timely Access to and Enhanced Administration of All Vaccines.  The bill expands the vaccines that certain trained pharmacists may provide.


Today, the Criminal Justice Committee held public hearings on a series of bills addressing domestic violence, a topic cited as a priority for Governor LePage and a long-standing priority for the MMA Public Health Committee.  MMA Assistant General Counsel Jessa Barnard spoke in favor of two of the bills and provided some relevant MMA and AMA policy statements to the Committee.  The two bills of particular interest to MMA are L.D. 1711, An Act to Mandate the Use of Standardized Risk Assessment in the Management of Domestic Violence Crimes and L.D. 1760, An Act to Ensure Notification of Victims of Domestic Violence, Sexual Assault and Stalking When Defendants are Released on Bail.

MMA Legislative Committee Call, Tomorrow 8 pm

The MMA's Legislative Committee has held very 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, February 14th 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.  In addition to reviewing the two bills below, we will cover the ongoing supplemental budget negotiations, particularly new language on prescription drug diversion and suboxone treatment, and other pending issues at the State House.  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.

L.D. 1806, An Act To Promote Transparency in Government (monitor)

L.D. 1811, Resolve, Directing the Department of Health and Human Services To Review Reimbursement for Prescription Drugs under the MaineCare Program (monitor)

L.D. 1813, An Act To Amend the Laws Governing Confidentiality of Health Care Information (support; emergency physicians)

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Maine Prescription Drug Abuse Task Force Appointees Announced

On Wednesday, February 1st, Governor Paul LePage issued an Executive Order establishing a 17-member task force to continue to work on the issue of prescription drug abuse, focusing on the action items identified by the stakeholders present at the Drug Abuse Summit held by the Attorney General in October 2011.  The Task Force will be chaired by Joseph Bruno of Raymond, a pharmacist and former legislator.  Bruno also is CEO of Community Pharmacies, a chain of pharmacies located exclusively in Maine.  Other appointees include MMA CEO Gordon Smith, Esq. and Steven Gressitt, M.D., a psychiatrist with a special interest in proper drug disposal.

The full membership of the task force, along with the assignments by topic, are as follows:

Chairman:  Joe Bruno, President and CEO of Community Pharmacies, LP.

Disposal:  Dr. Stean Gressitt, founding director, International Institute for Pharmaceutical Safety; William Savage, assistant Attorney General; Greg Couture, assistant to the Commissioner, Maine Department of Public Safety; and Patricia Aho, Commissioner of the Maine Department of Environmental Protection.

DiversionAlert:  Darrell Crandell, Commander, Maine Drug Enforcement Agency; Natalie Morse, prevention center director, MaineGeneral Medical Center; state Representative Susan Morissette; and Dr. Denise Theriault, Southern Maine Periodontal Associates.

Education:  Lauri Sidelko, alcohol and drug educational programs, University of Maine; Jayne Harper, drug overdose prevention educator, MaineGeneral Prevention Center; Gordon Smith, Executive Vice President, MMA; Melissa Petro, regional director, state government and legislative affairs, Purdue Pharma; and Neill Miner, project director, Southern Kennebec Alliance for Substance Abuse Prevention.

Prescription Monitoring Program:  Roy McKinney, director, Maine Drug Enforcement Agency; Brenda Kielty, special assistant to the attorney general; and Patricia Lapera, project coordinator, prescription monitoring program; Office of Substance Abuse.

The action items identified at the Fall Summit include the following:

  1. Develop long-term controlled substance disposal solutions;
  2. Implement a statewide Diversion Alert Program that provides prescribers with drug crime information from local law enforcement to assist in determining whether patients are legitimately in need of controlled substance prescriptions;
  3. Develop and field an evidence-based public education campaign, with a unified message addressing prescription drug misuse, abuse and diversion for statement dissemination in both community education and prescriber training venues;  and
  4. Conduct an active review of the Maine Prescription Monitoring Program, including the scope of access, utilization of available data, thresholds for notification, and mean to achieve near-universal use by prescribers and pharmacists.                                                                                                   

The Task Force will submit a report to the Governor every six months detailing is progress in implementing the action items and other initiatives.  The report shall also be sent to the Attorney General, the Commissioner of Public Safety, the Commissioner of Environmental Protection, and the Joint Standing Committee on Health & Human Services.

The Task Force will hold its first meeting on Tuesday, February 21st at 3:00 p.m. at the Office of the Attorney General. [return to top]

MMA Leaders in Washington Today to Work on Medicare SGR Problem

MMA President Nancy M. Cummings, M.D. and EVP Gordon Smith are in Washington D.C. this week attending the AMA's National Advocacy Conference which is focused on obtaining a temporary or permanent fix to the Medicare SGR problem.  Dr. Cummings and Mr. Smith will meet with members of Maine's congressional delegation today and tomorrow and will emphasize the very serious negative effect a 30% reduction in Medicare fees would have in the state.  The impact on physicians and hospitals would be in excess of $100 million annually.

Both the House and Senate are scheduled to be in recess during the week of February 20th and the current short-term fix expires at the end of this month.  According to a recent Congressional Budget Office (CBO) report, the cost to maintain the 2011 Medicare reimbursement rate for physicians would be $316 billion over 10 years.  Senator Jon Kyl (R-AZ), a member of the panel, has stated that the group has considered recommending use of unspent money for the wars in Iraq and Afghanistan to fund a permanent fix.  Unfortunately, late last week House Speaker John Boehner (R-OH) stated that he is opposed to using the war funding for this purpose.  The time pressure may make a permanent fix before March 1st unlikely, but it is a positive sign that members of both parties in both chambers recognize the need to work hard to develop a new Medicare physician payment methodology.

In the meantime, the Centers for Medicare & Medicaid Services (CMS) has extended the annual Medicare participation enrollment period through February 14th. The previous deadline was December 31st.

 You can find more advocacy information about the issue on the AMA web site at:  http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/medicare-physician-payment-reform-regulatory-relief.page.

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MMA Seeking Volunteers for New Nominations Committee

The Association membership voted last September in favor of substantial bylaw revisions which, among other things, provide for the appointment of a Nominations Committee that will meet on a regular basis to solicit and review candidates for MMA committees, AMA delegate positions, and leadership positions.  With members of the Board of Directors no longer being proposed by county medical societies, one of the goals of the new Nominations Committee is to reach out broadly to the physician community in the state to find members interested in committee assignments and positions of leadership.

At this point in the process, the Association is seeking five to six members who are willing to join Nominations Committee Chair Stephanie Lash, M.D. and MMA President-elect Dieter Kreckel, M.D. in serving on the committee.  While it is anticipated that the first meeting of the committee will be in person at the Association offices in Manchester, further meetings would be conducted largely through webex or conference calls.

Any MMA member interested in serving on the committee should contact either Diane McMahon at MMA (622-3374, ext. 216 or via e-mail to dmcmahon@mainemed.com) or Executive Vice President Gordon Smith (622-3374, ext. 212 or via e-mail to gsmith@mainemed.com).





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MMA Awarded Health Care Reform Outreach Grant

MeHAF recently awarded a second round of funding totaling $373,750 to 11 nonprofit organizations to ensure that Maine people will have trusted resources for information, inquiries and advice to understand their benefits under both the 2010 Affordable Care Act and recent changes in state law. 

The grantee organizations are:

  • Consumers for Affordable Health Care

  • Eastern Area Agency on Aging

  • Legal Services for the Elderly

  • Maine Equal Justice Partners

  • Maine Medical Education Trust/Maine Medical Association

  • Maine Migrant Health Program

  • Maine People's Resource Center

  • Maine Primary Care Association

  • MaineHealth: CarePartners

  • Somali Culture and Development Association

  • Western Maine Community Action

This group of knowledgeable and trusted Maine organizations with reputations for being the "go-to" sources for their constituents began providing outreach and education with funding that was first awarded in 2010.  The grants require that the organizations work together to communicate reform provisions simply and with common language to promote a broader understanding of tangible benefits.  Together, the organizations developed a simple, straightforward brochure and other educational materials that explain benefits and programs available to the uninsured, young adults, Medicare members, refugees and all insured Maine people.

Primary care practices interested in partnering with the MMA to receive patient materials or trainings on the ACA as a part of this grant should contact Jessa Barnard at 207-622-3374 x 211 or jbarnard@mainemed.com.

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Patient Experience Stakeholder Meeting, March 6th

Patient Experience Matters

A Stakeholder meeting convened by the Dirigo Health Agency's Maine Quality Forum

Who should attend: Administrative and clinical leaders of health systems, PHOs, and primary care and specialty practices.

When: March 6, 2012 from 8:00 am - 10:00 am

Where: Maine Medical Association, 30 Association Drive, Manchester, Maine.

Please join us on March 6 for a breakfast meeting to learn about a statewide effort to collect and publicly report experiences that patients have during office visits with their primary care and specialty providers.  The Dirigo Health Agency's (DHA) Maine Quality Forum, working with Maine Quality Counts and the Maine Health Management Coalition under the state's Aligning Forces for Quality initiative, is convening stakeholders to discuss the value of collecting standardized information on patient experience, our approach to supporting practices in these efforts, and how you can participate.   

For further information: Contact Alexander Dragatsi, Maine Quality Forum, alexander.dragatsi@maine.gov or 207.287.9965

TO REGISTER or learn more, click here  

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Gastroenterology Practice Seeking Part Time NP

Busy Gastroenterology practice seeks part-time temporary Gastroenterology Nurse Practitioner.  NP will work in conjunction with an experienced, board certified gastroenterologist to provide care to adult gastroenterology patients.  This includes assessment, diagnosis and treatment of GI illnesses, both acute and chronic. Candidates must have a MS in Nursing, current license to practice as NP by Maine State Board of Nursing and current CPR and DEA Licenses.  

For more information please contact Adam Shlager at 207-490-7861 or ashlager@goodallhospital.org 

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MeCDC Division Medical Director Opening

Maine CDC Division of Population Health has an opening for a full time medical director based in Augusta.  The successful candidate will provide leadership for public health activities within the State that pertain to maternal and child health and chronic diseases and their prevention.  

Direct Hire applications must be completed and sent to Human Resources by Feb 17, 2012.  

To learn more, go to: http://www.maine.gov/tools/whatsnew/index.php?topic=dhhs_direct_hire_jobs&id=347967&v=dhhs

Position Description:

The Population Health Medical Director serves as the principal medical subject matter expert and resource in the Population Health Division of the Maine CDC. This position provides leadership and medical direction for public health activities within the State that pertain to maternal and child health and chronic diseases and their prevention. Assists program managers with program planning and implementation. Provides guidance and consultation to ensure programming is evidence-based or best practices. Provides technical assistance to epidemiologists in the Division and assists in developing reports on disease burden and epidemiology. Represents the Division as the medical subject matter expert on internal and external workgroups and committees.


Graduation from an accredited Medical or Osteopathic School in the United States (Graduates of foreign medical schools must present evidence of having passed FLEX or National Board Examinations or of current Maine licensure) AND a Masters Degree in Public Health or at least two (2) years of full-time experience in specialty area. Certificate of registration with the right to practice medicine and surgery in Maine as issued by the State Board of Registration of Medicine is required. Preference will be given to candidates with experience in public health, preventive medicine, or quality improvement. [return to top]

Most States Will See Drop in Federal Match Rate in FY 2014

According to a report released by the National Association of Medicaid Directors (NAMD) on February 3rd, federal Medicaid match rates, the federal medical assistance percentage (FMAP), will decrease in 30 states, including Maine, and will increase only in four to seven in FY 2014.  CMS recalculates the FMAP every year and it is based on each state's average per capita personal income over the three most recent calendar years compared with the national average.  It also is affected by the most recent census data.  You can find the report, Preliminary Projections of FY 2014 Federal Medical Assistance Percentages on the web at:  http://medicaiddirectors.org/node/311. [return to top]

DHA Votes to Close Program to New Subsidized Enrollment Effective May 1st

The Dirigo Health Agency Board of Trustees held its regular meeting this morning at the DHA offices on Water Street in Augusta.  The DHA trustees and staff discussed at length the budget challenges facing the agency and its programs in light of the reduction in access payments enacted in Part BBB of the biennial budget last session (L.D. 1043/P.L. 2011, Chapter 280).  The biennial budget reduced the access payments from third-party payers as follows:

  • 2.14% on claims for services provided through June 30, 2011;

  • 1.87% on claims for services provided from July 1, 2011 to June 30, 2012;

  • 1.64% on claims for services provided from July 1, 2012 to June 30, 2013; and

  • 1.14% on claims for services provided from July 1, 2013 to December 31, 2013

  • The access payments terminate completely on January 1, 2014.

After the discussion, the Board voted 8-1 in favor of closing the DirigoChoice program to new subsidized enrollees effective May 1, 2012.  Trustee and former Chair Jonathan Beal voted against the motion.  The group also discussed the requirement of Section BBB-3 of the biennial budget that the Agency report on the transition from DirigoChoice to a health insurance exchange to the Appropriations and IFS Committees by March 1, 2012. Dirigo's current membership stands at 16,577.

The next meeting of the DHA Board of Trustees is scheduled for 9:00 a.m. on Monday, March 12, 2012.

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Maine PCMH Pilot Phase 2 Expansion & MaineCare Health Homes Initiative Launched


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, have announced plans to expand the Pilot to include an additional 20 adult practices in January 2013, and have opened an online application process.

Interested practice sites are encouraged to read more information and review eligibility requirements and a copy of the online application posted on the Maine Quality Counts website (www.mainequalitycounts.org/major-programs/patient-centered-medical-home.html).  The PCMH Pilot application is available online at www.surveymonkey.com/s/ME_PCMH_Pilot_Phase2_Expansion_Applic.  Interested practices must complete the online application by March 31, 2012

Maine's Medicaid program, MaineCare, has also announced its plans to expand its support for the PCMH model by developing a "Health Homes" initiative that will provide any qualified practice an opportunity to get additional support for providing Health Homes services to patients with chronic conditions.   The Maine PCMH Pilot is working in partnership with MaineCare to offer a joint application process for both the Pilot expansion and the MaineCare Health Homes initiative.  Interested practices are encouraged to read more information about the MaineCare Health Homes initiative at www.maine.gov/dhhs/oms/vbp or www.mainequalitycounts.org.  Practices interested in applying for participation in the MaineCare Health Homes initiative should complete the same online application being used for the Pilot expansion - available at www.surveymonkey.com/s/ME_PCMH_Pilot_Phase2_Expansion_Applic .

Timeline for Practice Application:

*    February 1, 2012 -Maine PCMH Pilot Phase 2 & MaineCare Health Homes 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 and MaineCare

*    May 1, 2012 - Phase 2 Community Care Team (CCT) application posted online

*    May 31, 2012 - Phase 2 and Health Homes practices selected

*    July 1, 2012 - MaineCare Health Homes program begins (tentative)

*    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 [return to top]

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