February 27, 2012

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POLITICAL PULSE: 2012 Supplemental Budget Finalized; Committees Continue Work

After more than two months of discussion, negotiation, and a fair amount of acrimony, the 125th Maine Legislature completed its work on the first portion of the Governor's DHHS supplemental budget last Thursday and sent the bill on to Governor LePage who signed it into law on the same day.  The Appropriations & Financial Affairs Committee begins today its discussions on the next phase of the Governor's proposal which is intended to cut another $80 to $90 million dollars from the MaineCare budget - these cuts to impact the fiscal year beginning on June 30, 2012.  Budget process observers speculate whether Republicans will use a procedural tactic employed by Democrats in the past and pass the second portion of the supplemental budget by a simple majority.  If Republicans can enact the second round of cuts by March 30, 2012, they would not need a two-thirds vote to become law.  They would adjourn the Second Regular Session, starting the clock running for a 90-day post-adjournment effective date that would occur before the start of the next fiscal year, July 1, 2012.


After a week of negotiations, including a commitment to address the health care needs of veterans who may lose health care coverage because of the MaineCare cuts, the Senate achieved a 2/3 vote on L.D. 1816 on Thursday, February 23, 2012.  The 2/3 vote is necessary to permit this portion of the budget to take effect immediately upon the Governor's signature.  The Governor signed the bill the same day.

Two important changes to the package were achieved in a floor amendment 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.

As mentioned in the Update last week, the legislature has divided the supplemental budget into two parts.  The first part 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.  The Appropriations Committee is expected to return to work sessions on L.D. 1746 this week.

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.

 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 Joint Standing Committee on Criminal Justice and Public Safety gave a 7-6 ought-to-pass recommendation to LD 1603, An Act to Amend the Law Relating to Concealed Firearms Locked in Vehicles.  The bill is likely to head to the full legislature for action shortly.  The bill clarifies that a law that passed last year allowing employees to bring firearms onto employer property also applies to state employees on state property. 

A report from the minority would amend the law to indicate that only in the in the absence of a “no weapons" policy in the workplace is an employee entitled to bring their handgun on the employer’s property.   This would apply to all employers, not just state employers.  Members are encouraged to contact their their legislators tell them to reject the majority report and vote yes on the minority report.  You can find your legislators' contact information by clicking here

The Committee has also held public hearings on three bills dealing with domestic violence.  The MMA testified in favor of two, LD 1711 and 1716.   You can find the MMA's testimony here.   The Committee has postponed further work on the bills to coordinate their efforts with Governor LePage's recently announced initiative on domestic violence, which includes three pieces of legislation that have bipartisan support and are also supported by domestic violence advocates. 


Last Wednesday, the Insurance & Financial Services Committee held work sessions on the two reinsurance bills they are considering:  L.D. 1670, which would extend the reinsurance provisions that passed last year in Public Law 90 from only the individual insurance market to also include small groups with fewer than 5 members, and L.D. 1702, which would make technical and other changes to the provisions governing the reinsurance program.  The Committee tabled both bills to gather more information from the Bureau of Insurance.   

After being tabled several times, the Committee also held a vote on L.D. 1691, An Act Related to Specialty Tiers in Prescription Medication Pricing.  The Committee voted 9-4 to adopt an amended version of the bill that states that if a health insurance policy requires coinsurance for specialty drugs, that coinsurance will be subject to the out of pocket maximum for the policy. The MMA supports this bill, which now heads to the House floor.   

The Committee also gave final approval to amended language for L.D. 882 that states that no insurance plan in Maine can be required to cover additional benefits beyond what will be included in the essential health benefits required by the Affordable Care Act.   Depending on the essential health benefit package, this bill has the potential to undermine health benefit mandates in Maine.  It will now move to the House floor.  Members concerned about the implications of this bill are encouraged to contact their legislators to urge them to vote against it. 


The Judiciary Committee held a public hearing last week on L.D. 1796, An Act Relating to False Claims under the Medicaid Program.  Among other things, this bill would allow private citizens to sue in the name of the State (qui tam actions) for Medicaid fraud.  The MMA and other health care organizations testified against the bill.   The Committee will hold its work session on the bill tomorrow. 

Last Thursday, the Committee also held a public hearing on LD 1804, a bill that incorporates recommendations of the Right to Know Advisory Committee -- a group that reviews exceptions to Maine's public records laws on a regular basis.  Several provisions were of interest to the MMA, including one that gives the Chief Medical Examiner the discretion to release confidential information and materials about a missing person, one which removes language related to confidentiality of data held by the former Maine Health Care Finance Commission,  and a clarification that the confidentiality provisions of the Maine Health Security Act govern the confidentiality of reports to appropriate medical licensing boards.  The MMA supports these changes.  Assistant Attorney General Linda Pistner explained the provisions and no one testified against the bill.  The Committee moved immediately into work session and unanimously passed the bill, which now goes to the full legislature for approval. 



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 28th 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. 1829An Act To Require Photographic Identification for Prescriptions for Certain Controlled Substances (monitor)

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2012 First Friday Education Series Begins Friday, March 2 with Program on Preventing Drug Diversion

MMA's popular First Fridays seminar series begins a new year with a program offered this coming Friday addressing prescription drug abuse and treatment for chronic pain.  The faculty consists of Noel Genova, PA-C,  Patricia Lapera, MPH, Rebecca Morin, MPH, and Andrew MacLean, Esq.  The new MaineCare limits on opiate medication will also be discussed.  These limits take effect on April 1, 2012 and Sept. 1, 2012, depending upon how long a patient has been on the opiate medication.

Noel Genova, PA-C has been performing chronic pain consultations across the state for the past two years through a project funded by the Board of Licensure in Medicine.   She is also the author of the CME Home Study course on this topic which is currently being revised and updated.  Patricia Lapera, MPH is the coordinator of the state's Prescription Monitoring Program and Rebecca Morin, MPH oversees quality improvement activities for the Maine Primary Care Association.  The Clinical Care Committee of the MPCA recently released a White Paper on this topic which contains a number of helpful suggestions regarding the treatment of patients with chronic or acute pain.  Mr. MacLean, the Association's Deputy EVP and General Counsel, will discuss the medical-legal implications of the topic and review the instances in which prescribers can feel comfortable in reporting suspected diversion or abuse to law enforcement authorities.

The program is available live from 9:00 a.m. to noon on this coming Friday, March 2nd and refreshments are available for those attending at the MMA office.  Participation is also available through Webex.  A $65 registration fee is charged.  Registration is available via the MMA website at www.mainemed.com or by calling the MMA office at 622-3374 (press 0 for reception).  

The April First Friday program consists of the annual coding seminar, presented by the Learning Center at Baker, Newman and Noyes.  The program will be held on Friday, April 6, 2012. [return to top]

MaineCare Physician Advisory Committee Meeting, March 8th

The Physician Advisory Committee (PAC) is a core group of six MaineCare physicians facilitated by the MaineCare Medical Director.  Presently this group meets on a quarterly basis.  During the first half of the PAC meeting, current MaineCare initiatives are presented.  The MaineCare topics for this meeting will be Private Duty Nursing  policy for 2012 and the Fair Hearing process.  For the second half of the meeting, MaineCare providers are invited to present issues in the community they would like MaineCare to address.

MaineCare would like to open its Physician Advisory Committee meeting to wider participation.  Any provider interested in MaineCare initiatives may attend the meeting in person or by phone. 

The next meeting will be held on Thursday, March 8, 2012 from 3:15-5:15 p.m. in the second floor conference room at the Maine Medical Association located at 30 Association Drive in Manchester, Maine.  Please be advised that the conference room is not handicapped-accessible but the meeting may also be attended by conference call.    

The conference call line is 1-800-394-6604, with passcode 959468#.  If planning to attend in person, please reply to Diane Jensen at 207-287-1091 or diane.r.jensen@maine.gov .  

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MMA Welcomes Dianna Poulin as Coordinator of Peer Review & Quality Improvement Activities

Dianna Poulin of Jay began a position at the Maine Medical Association on February 13, 2012 as Coordinator of Peer Review and Quality Improvement Activities.  She also will provide administrative services to the Maine Association of Psychiatric Physicians (MAPP), through a contract between MMA and MAPP..

Dianna comes to us from her previous position as Medical Staff Support Manager at Franklin Memorial Hospital in Farmington.  Dianna will remain active in the Maine Association of Medical Staff Support Services which she has served most recently as editor of the newsletter.

Dianna is a graduate of the University of Maine, Farmington, where she received a Bachelor of Science Degree in Community Health Education. 

 Dianna can be reached at MMA at 622-3374, ext. 223 or via e-mail to dpoulin@mainemed.com.


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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 Health Care Award recognizes an individual or individuals who have made a significant contribution to improving access to health care in Maine.  The individual(s) will have demonstrated leadership abilities in promoting increased access to health care 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 this Wednesday

 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; and
  • 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]

Maine Maritime Academy Seeks Physician for 2012 Training Cruise

Each year the Maine Maritime Academy conducts training on a two-month cruise on its training ship, the State of Maine.  A physician is recruited each year to join the trip and provide medical services.  Modest compensation is offered.  If you or a colleague are in a position to be gone on such a cruise for that period of time and are interested in the position, please contact Gordon Smith, Esq. at MMA at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com who will forward your name to the Academy.  This year's cruise includes stops in Galveston, Curacao, and Bermuda, among other destinations.

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Call For Nominations: Hanley Center Advanced Program For Maine Physician Leaders

The Hanley Center is looking for 150 experienced physician leaders to participate in a unique five-year initiative aimed at building Maine’s physician leadership capacity and helping individual physicians position themselves to take on roles of greater influence and authority.  This program has been developed in close cooperation with MMA, MOA and a highly committed group of physician leaders from throughout Maine.

Beginning this May, about 30 physician leaders from across the state will be brought together each year an intensive one year Advanced Leadership Program that will feature national faculty from the Heller School at Brandeis University as well as a distinguished faculty of physician  and other leaders from Maine.  The Advanced Program and a Foundational Program (launched last fall) have been developed by the Hanley Center’s Physician Executive Leadership Institute Steering Committee, co-chaired by former MMA President David McDermott, MD, of Mayo Regional Hospital and Jackie Cawley, D.O. at MaineHealth.

The Advanced Program curriculum has been designed to meet high priority needs within practices, health centers and hospitals.  Sessions will build competencies in strategic thinking, leading change, conflict negotiation, business skills and financial literacy, performance management and learning from outliers.  We’ll also do in-depth work in both inter- and intra personal communication skills, team building and negotiating internal politics. 

Nominations are now being accepted for the Advanced Program.  Physicians are encouraged to nominate colleagues—or nominate themselves. 

Deadline for nominations is March 16. 

Every individual who is nominated will be invited to enroll in one of the annual one-year courses that begin this spring.  Given the time commitment (six two-day sessions every other month for a year in Brunswick and Freeport) and the tuition ($7,500, which includes CME, food, overnight accommodations and instructional materials), not everyone who may want to be in the first year’s class will be available for the inaugural class that begins in May.  That’s why the Hanley Center is opening enrollment in all five annual classes right now.

The Advanced Program is for physicians who:

  • Have leadership/management experience (suggested five years minimum)

  • Are focused on developing higher level expertise in key leadership competencies including strategic thinking; business/management skills; systems awareness; self-awareness; teamwork & collaboration; inter- and intra-personal communication skills and understanding of emerging models of healthcare delivery

  • Have an outstanding professional reputation

  • Are passionate about improving systems and transforming health and healthcare in Maine

  • Are committed to building physician leadership capacity in practices, hospitals and other settings in Maine

  • Bring a strong desire to be challenged and energized as part of a positive and supportive cohort of other physician leaders.

Please visit www.hanleyleadership.org to learn more.  Or, you can use the links below to quickly get specific information.

Beginning this week, we will hold two  Informational webinars.  You and your physician leaders are encouraged to take part in any of these one-hour sessions:

1. 7:30 a.m. Tuesday, February 28

2. 5:30 p.m. Thursday, March 8

The webinar access for both sessions will be:


Participant Code:  5231501#

Call in Number:  1-866-740-1260

Access Code:  5231501#

Links For Specific Information

Overview of the Advanced Program


Meet The National Faculty


Program Dates and Session Titles (for first class beginning in May, 2012)


Nomination Forms


 Frequently Asked Questions


Which Program Is Right For Me?


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Maine Association Medical Staff Services Biennial Education Conference: May 9-11 in Portland

The Maine Association Medical Staff Services will hold its Biennial Education Conference on May 9-11, 2012 at the Residence Inn Hotel and Conference Center in Portland.  Entitled, "The Many Spokes of the Wheel," the conference welcomes physicians and other health professionals with an interest in medical staff activities, including credentialing and quality improvement.  Category I CME is offered for physicians, through The Aroostook Medical Center.  

A complete agenda and registration materials are available on the MEAMSS website at www.meamss.org.

Any questions on the conference can be directed to Debra Carter, MS. CPMSM, CPCS at Synernet CVO (207-771-3489, ext. 7).


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President Obama Signs 10-Month Patch on Medicare SGR Issue

On February 22, 2012, President Obama signed the Middle Class Tax Relief & Job Creation Act of 2011 (H.R. 3630).  Most significant for Medicare beneficiaries and physicians, the legislation averts the scheduled 27.4% reduction in Medicare payments called for by the sustainable growth rate (SGR) by extending current payment rates through the end of the year.  It also continues the current payroll tax reduction of 2% through 2012, and it extends and reforms unemployment insurance for the long-term unemployed.  

While negotiators added the nearly $100 billion cost of extending the payroll tax holiday to the federal deficit, budget offsets were required for the other provisions.  Negotiators also insisted that offsets for the $18 billion cost of extending the current Medicare physician payment rates be achieved through cuts in health care programs.  These included:

  • $6.9 billion from reducing the amount of bad debt that is reimbursed to hospitals, critical access hospitals, dialysis clinics, skilled nursing facilities, federally qualified health centers, community mental health centers and rural health clinics;

  • $4.1 billion from reduced  disproportionate share payments to hospitals;

  • $2.5 billion from the disaster-recovery Medicaid funding match for Louisiana provided by the ACA;

  • $2.7 billion from reduced clinical lab payments; and

  • $5 billion from the Prevention and Public Health Fund created under the ACA.

Additionally, the bill addressed a number of health care "extenders" through the end of the year:

  • Hospital geographic reclassifications under Section 508 of the Medicare Modernization Act;

  • Work geographic adjustment floor for physician payments;

  • Exceptions process for Medicare therapy caps;

  • Payment for the technical component of certain physician pathology services (through June 30)

  • Ambulance add-on payments in rural areas;

  • Outpatient hold-harmless provisions, except for sole community hospitals with more than 100 beds;

  • QI program for low-income Medicare beneficiaries; and

  • Transitional Medical Assistance program.

Finally, two provisions that have typically been included with health care extenders were eliminated as of March 1st:

  • Add-on payments for certain mental health services, which disproportionately affect non-physician mental health providers; and

  • Increased payments for bone density tests (DXA).

Because Congress once again failed to repeal the SGR, the AMA projects that the next cut, scheduled to occur on January 1, 2013, will be approximately 32% and the cost to repeal the SGR will be $25 billion higher.

Maine has more than 260,000 Medicare patients and more than 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.

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CMS Announces Rule on Stage 2 Criteria for EHR Incentive Programs

On Friday, February 24, 2012, US DHHS Secretary Kathleen Sebelius issued a press release announcing a proposed rule scheduled for publication in the March 7th Federal Register detailing Stage 2 requirements for the Medicare and Medicaid EHR incentive programs.  Comments on the rule are due 60 days following publication.  CMS says that the Stage 2 meaningful use criteria come primarily from recommendations of the Office of the National Coordinator for Health Information Technology's HIT Policy Committee based on Stage 1 provider experiences.  You can find the press release along with links to technical fact sheets and the proposed rule on the US DHHS web site at:  http://www.cms.gov/apps/media/press/release.asp?Counter=4291&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=dat.

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