February 20, 2012

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Congress Passes 10-Month Patch on Medicare SGR Issue

Last Friday (Feb. 17), the House and Senate approved a payroll tax package that includes a provision to stave off the 27.4% cut in Medicare physician payment rates scheduled for March 1 and freezes rates at their current level until Dec. 31, 2012.  AMA officials expressed disappointment that the delay was for only 10 months and is partly paid for through a 30% cut in 2013.  

On Thursday, February 16th, members of a House-Senate Conference Committee reached an agreement on a package that cancels the scheduled Medicare physician payment cut for the rest of the year and also includes provisions on the payroll tax holiday and unemployment insurance.  The agreement freezes Medicare physician payment rates for the next 10 months, but sets up physicians for a cut of more than 30% on January 1, 2013.  Although it was part of the Committee discussion, in the end there was insufficient support for using unspent Iraq and Afghanistan war funds for a permanent SGR fix.  The AMA, the Medical Group Management Association, and other representatives of organized medicine expressed disappointment in the failure to propose a permanent SGR fix.  

The offsets required to pay for the $18 billion agreement included reducing by $5 billion the prevention and public health fund established in the Affordable Care Act (ACA).  Hospitals were also hit for $6.9 billion via a reduction in the amount paid in recognition of bad debt (also impacts FQHC's, nursing facilities and dialysis centers).  Clinical lab service payments will be reduced by $2.7 billion and Medicaid DSH (disproportionate share) payments will be reduced by $4.1 billion.  Finally, the controversial extra payments of Medicaid funds for the state of Louisiana will be eliminated.

 On Friday, February 17th, the conference report to H.R. 3630 passed both the House and Senate.  The House vote was 293-132 and the Senate vote was 60-36.  All members of Maine's Congressional delegation voted in favor of the measure.

Maine has over 260,000 Medicare patients and over 40,000 Tricare patients whose physicians are paid off the Medicare fee schedule. Compared to the rest of the country, Maine, at 20%, has an above-average proportion of Medicare patients.

 You can find more information on the recent SGR action on the AMA web site at:  http://www.ama-assn.org/ama/pub/amawire/2012-february-15/2012-february-15-general_news1.shtml.

MMA Legislative Committee Call, Tuesday Night at 8:00 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 tonight, Tuesday, February 21st 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. 1816, An Act To Implement the Recommendations of the Streamline and Prioritize Core Government Services Task Force for the Fiscal Years Ending June 30, 2012 and June 30, 2013 and To Make Certain Other Allocations and Appropriations and Changes to the Law Necessary to the Operation of State Government (oppose; this is the first part of the supplemental budget focusing on FY 2012, the current year; it failed enactment by 2/3 in the Senate on Thursday, February 16th; there likely will be an effort to gain additional Senate votes today)

L.D. 1818, Resolve, To Extend the Reporting Deadline of the Working Group on an All-payor Claims Database System (monitor)

L.D. 1824, An Act To Provide Immunity for Prescribing and Dispensing Intranasal Naloxone Kits (support)

L.D. 1825, An Act To Change the Statutes of Limitations on Prosecution for Crimes of Sexual Abuse and for Civil Actions for Sexual Abuse When the Actor Is a Person in a Position of Authority (monitor; psychiatrists)

L.D. 1827An Act To Amend the Laws Governing Prosecution of Individuals Possessing a Controlled Substance under Certain Circumstances (monitor or support)

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POLITICAL PULSE: Supplemental Budget Fails to Get 2/3 Vote in Senate; Negotiations Continue & More Votes Expected this Week


Despite a unanimous agreement in the Joint Standing Committee on Appropriations & Financial Affairs, as noted in last week's Update, the state Senate on Thursday failed to achieve the two-thirds vote required to pass the supplemental budget on an emergency basis.  The majority of Senate Democrats voted against the compromise proposal, citing their concern about removing thousands of Mainers from MaineCare.  Further votes will take place this coming week and the proposal is likely to be passed eventually, but perhaps after some further tweaking.

Two important changes to the package were achieved in the House, including a restoration of some of the MaineCare cuts to hospitals and elimination of the proposal in the compromise budget that would have slowed down the periodic reduction in the assessment for Dirigo.

The legislature has divided the supplemental budget into two parts.  The legislation before the House and Senate now is L.D. 1816, a bill to implement recommendations of the Streamline and Prioritize Core Government Services Task Force (a part of last session's biennial budget, L.D. 1043/P.L. 2011, Chapter 380) and supplemental budget items primarily for FY 2012.  This leaves L.D. 1746, the Governor's original supplemental budget proposal this session, in the Appropriations Committee as a vehicle for FY 2013 items.

You can see the procedural status of L.D. 1816 here:  http://www.mainelegislature.org/LawMakerWeb/summary.asp?ID=280043806.

You can see the text of L.D. 1816 here:  http://www.mainelegislature.org/legis/bills/bills_125th/billtexts/HP133901.asp.

You can see the text of House Amendment D, restoring some of the hospital cuts, here:  http://www.mainelegislature.org/legis/bills/bills_125th/billtexts/HP133906.asp.

 You can see the last roll call vote in the Senate here:  http://www.mainelegislature.org/LawMakerWeb/rollcall.asp?ID=280043806&chamber=Senate&serialnumber=358.

The votes last Thursday were 121-25 in favor of passage to be engrossed in the House and 22-13 to be enacted in the Senate (short of the 2/3 necessary to pass as an emergency measure).

The prescription drug aspects of the budget in which the MMA has been involved in negotiating may be found as follows:

  • Suboxone limits;  Part I Review of physician assistant prescribing; Part J Participation in the Prescription Monitoring Program; Part K Limits on opioid coverage

The following is the summary of the House Amendment D modifications to L.D. 1816:

This amendment:

1. Reduces from $7,210,000 to $2,397,939 the amount of the one-time transfer required by Dirigo Health in fiscal year 2012-13 to the Medical Care - Payments to Providers, Other Special Revenue Funds account in the Department of Health and Human Services for the purpose of providing a state match for federal Medicaid services;

2. Corrects the stated effective date of the eligibility reduction for Medicaid services for parents with a maximum income of 200% to a maximum income of 133% of the nonfarm income official poverty line in the Part M initiative reducing the funding in the Medical Care - Payments to Providers account as a result of the one-time transfer. The amendment maintains the amount of the funding reduction in the Part M initiative at $7,210,000;

3. Eliminates the provision that extends the 1.87% access payment to support the cost of Dirigo Health through June 30, 2013 and allows the rate to decrease to 1.64% on July 1, 2012 as scheduled;

4. Requires the Department of Health and Human Services to submit a plan by June 30, 2013 to transition categorically eligible individuals who are enrolled in the MaineCare childless adult waiver program to available MaineCare coverage options by December 31, 2013;

5. Increases from $102,000,000 to $103,500,000 the interfund advance from Other Special Revenue Funds to the General Fund unappropriated surplus required for one day at the end of fiscal year 2011-12;

6. Eliminates the proposed reductions in MaineCare payments to hospitals; and

7. Imposes on each hospital in the State a temporary assessment beginning July 1, 2012 equal to 0.39% of net operating revenue as identified on the hospital's audited financial statement.



The HHS Committee had no public hearings or work sessions of note last week.




Last Wednesday, the Insurance & Financial Services Committee held a public hearing on two reinsurance bills:  L.D. 1670, An Act to Extend the Scope of the Maine Guaranteed Access Reinsurance Association and L.D. 1702, An Act to Correct Inconsistencies and Ambiguities in the Maine Guaranteed Reinsurance Association Act.  The MMA monitored these hearings.  The Committee also continued a work session on, but still has not resolved L.D. 1691, An Act Related to Specialty Tiers in Prescription Medication Pricing.


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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]

Nominations Sought for Access to Health Care Award

The Maine Public Health Association is pleased to announce the call for Phoebe Conrey King Access to Health Care Award nominations. Nominations are simple to submit and are due March 2, 2012.

The Phoebe Conrey King Access to Healthcare Award recognizes an individual or individuals who have made a significant contribution to improving access to healthcare in Maine. The individual(s) will have demonstrated leadership abilities in promoting increased access to healthcare by all Maine residents. He or she will have made a significant contribution toward meeting the needs of the uninsured and medically underserved. The nominee need not be a member of the Maine Public Health Association. Programs are not eligible as MPHA has previously established an award to recognize exemplary programs. 

This prestigious award will be given out at the Quality Counts 2012 conference at the Augusta Civic Center on April 4th.  

For a pdf of the application, please go to http://www.mainepublichealth.org/news.php [return to top]

A Public Forum on the Legality of the Affordable Care Act

 A Public Forum on the Affordable Care Act 

What is it, What will the Supreme Court review & 

What does it all mean for Maine?


   Join us for a timely public discussion of

the Affordable Care Act featuring:


Prof. Joseph Reisert, Colby College

Prof. Cabanne Howard, University of Maine Law School 
 Prof. Amy Lischko, Tufts University
Prof. John McDonough, Harvard School of Public Health

Wednesday February 29, 2012 

3:30 PM Reception, 4:00 - 6:00 PM  Public Forum

Lee Hall, Muskie School, 34 Bedford Street, Portland

Free & Open to the Public 

Register here 

The Patient Protection and Affordable Care Act (ACA) enacted by the Congress on March 23, 2010, made comprehensive health reform the law of the land. The law touches all of us - consumers, providers, and payers of health care, often in very different ways. But that law is not widely understood and its future depends upon the results of a constitutional challenge to be heard by the U.S Supreme Court on March 26, 27, and 28. This Forum will provide a brief overview of the ACA, a thoughtful analysis of the constitutional issues to be argued to the Supreme Court, and a discussion of the policy implications of potential court actions. [return to top]

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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Cancer in the Family: Primary Care Matters, JAX, April 13

The free half day CME event will be held in conjunction with the annual meeting of the Maine Academy of Family Physicians (MAFP) on Friday, April 13, 2012 in Bar Harbor at The Jackson Lab, and is open to all health care providers.  The event will also be webcast. The goal of the session is to enhance Maine health care providers' understanding of the various aspects of detecting and managing individuals with familial cancer syndromes. 

April 13, 2012 


The Jackson Laboratory 


600 Main Street

Bar Harbor, ME

For more information or to register, click here.

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Muskie School’s Master of Public Health Now Accepting Applications

The Muskie School’s Master of Public Health (MPH) degree program prepares students with the practical knowledge and skills to address today’s complex population health and health services challenges. Multi-disciplinary in nature, the MPH program delivers a broad public health and health systems perspective, with two specialized concentrations: Policy & Practice and a nationally accredited Health Management track. Students can also pursue advanced coursework in epidemiology, biostatistics, research methods, and environmental health. Graduates serve in the public and private sectors to apply evidence-based practices and state-of-the-art knowledge and skills to 

improve health and prevent disease.


Applications are accepted and considered on a rolling basis for the fall and spring semesters. Apply now for fall 2012!


Visit: http://usm.maine.edu/graduateadmissions or http://muskie.usm.maine.edu/academics/mph.jsp 

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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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CMS To Delay ICD-10 Implementation Schedule

The Centers for Medicare & Medicaid Services will postpone implementation of a new disease coding system, acting CMS Administrator Marilyn Tavenner said February 14th, but she did not state a timeline for doing so.

“I'm committed to re-examining the pace of implementation,” she told the American Medical Association's National Federal Advocacy Conference.

However, “in order to re-examine the time frame we need to go through a rulemaking process,” she told reporters following her keynote address.

She said that a notice would be coming out in the next few days to start that process.

The International Classification of Diseases, 10th Revision (ICD-10) coding system is intended to be used for classifying health care diagnoses and procedures. All Health Insurance Portability and Accountability Act-covered transactions, including outpatient and inpatient claims, would have been required to use the ICD-10 codes by Oct. 1, 2013. [return to top]

Report on Maine Quality Forum Advisory Council Meeting, Feb. 10

The Maine Quality Forum Advisory Council held its bi-monthly meeting on Feb. 10 at the offices of the Dirigo Health Agency in Augusta.  Following a report of Agency activities by Director Karynlee Harrington, Council members received updates on the following projects:

Healthcare Associated Infections Report

Consumer Experience Survey (project may be compromised by lack of state funding)

Physician Database

Update on CMMI Grant

Shared Decision-Making Project

Legislative action on the Governor's first budget last year phased out DHA's primary funding mechanism (assessment on paid claims) with an end date of the Agency scheduled for 12/31/2013, at which time federal financing of subsidies for individuals under 400% of the federal poverty level takes over through the health insurance exchanges.

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