March 5, 2012

 
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Decision of Senator Snowe Sends Political Shockwaves Across the State

The announcement last week by Maine's senior U.S. Senator Olympia J. Snowe that she will not seek re-election to a fourth term in the U.S. Senate created chaos in Maine political circles and was also noted in Washington where the decision could impact which party controls the Senate in 2013.  As of yesterday, eleven Republicans and three Democrats had taken out nomination papers for the Senate and five Republicans and seven Democrats had taken out papers for the first district house seat.  

Senator Snowe has held public office continuously since 1973 when she won a special election to replace her husband Peter Snowe who died in a tragic automobile accident driving home to Auburn from the legislature.  She is the first woman in the nation to have served in both branches of the legislature in a state and in Congress.  She has never lost an election and turned 65 during a birthday last week.

Senator Snowe stated that she was going to retire at the end of her current term because of the difficulty of accomplishing anything in the Congress due to hyper-partisanship and the inability of legislators to compromise.  Her surprise announcement has led to several articles and commentaries on the increasingly toxic climate in the Congress and the punishment  inflicted on moderate officer holders by the more ideological elements of each party.  

The Senator has been a major player in healthcare in the Senate, where she was a member of the Senate Finance Committee which has jurisdiction over Medicare and Medicaid.  She has been seen as a friend of physicians and hospitals and has been endorsed repeatedly by AMPAC and many other specialty medical political action committees.  

Of those candidates taking out papers so far, the favorites would appear to be Congresswoman Chellie Pingree on the Democratic side and current Attorney General William Schneider on the Republican side.  Both Angus King and Eliot Cutler are considering runs as Independents (but would not run against each other).  Regardless of the candidates left in the race after the June primary, it promises to be among the most watched Senate campaigns in the nation.  And the first district house race will be watched with interest as well if, indeed, Congresswoman Pingree gives up her House seat to run for the Senate.

 

 

POLITICAL PULSE: Legislative Highlights of the Week

APPROPRIATIONS COMMITTEE TO WORK ON $5 MILLION 2012 SHORTFALL 

The Appropriations and Financial Services Committee plans to work this week on an emergency bill to fill a $5 million shortfall in the 2012 state fiscal year budget, which ends June 30th.   Representative Patrick Flood, House Chair of the Committee, has stated that the Committee plans to work with Finance Commissioner Sawin Millett to help identify funds that can be used to fill the gap and hopes that there will be enough unexpended funds in certain accounts at the end of the fiscal year to meet the need.  The Committee still has to complete a 2013 Department of Health and Human Services supplemental budget and a supplemental budget that addresses non-DHHS needs.  Committee leaders hope to have work done on the DHHS budget by mid-March and other governmental services by the end of the month. 

INSURANCE COMMITTEE LIKELY TO DELAY ACTION ON HEALTH INSURANCE EXCHANGE 

According to a recent article in the Bangor Daily News (click here), Maine Republicans are planning to delay major action on setting up a health insurance exchange until the Supreme Court rules on the constitutionality of the federal Affordable Care Act in June.  The ACA requires that states set up exchanges -- a way for individuals and small employers to compare and purchase plans and quality for subsidies -- by January 1, 2013. 

HEALTH AND HUMAN SERVICES COMMITTEE CONSIDERS AMENDING CONFIDENTIALITY LAW 

Last Tuesday, the Health and Human Services Committee held a public hearing on LD 1813, a bill which would amend the law regarding confidentiality of health care information to allow health care professionals to report to federal, state or local governmental entities if an alleged crime has been committee on the premises.  The intent of the bill is to align state law with the federal HIPAA privacy law and allow clinicians more freedom to report suspected drug diversion.  The bill was one of three arising out of the 1501 work group on prescription drug abuse and diversion that came before committees over the past week.  It has been scheduled for work session tomorrow. 

CRIMINAL JUSTICE COMMITTEE KILLS BILL THAT WOULD PROVIDE IMMUNITY FOR CALLING 911 

The Joint Standing Committee on Criminal Justice and Public Safety held a public hearing this morning on LD 1827.  The bill would have provided immunity from prosecution for individuals found in possession of a controlled substance if the evidence for the charge was gained as a result of the person's seeking medical assistance for themselves or someone else who is experiencing a drug-related overdose.  The bill came out of the 1501 work group with the intent to reduce a barrier - the fear of being arrested for drugs found on the premises - for individuals calling 911 for someone experiencing an overdose.   After hearing testimony, the Committee moved immediately into work session and voted that the bill ought not to pass.  Committee members stated that they wanted more information about how a similar law has worked in Washington State and were concerned the bill would have the unintended consequence of encouraging drug use. 

JUDICIARY COMMITTEE VOTES AGAINST PROTECTIONS FOR NALOXONE USE, TABLES BILL ON MEDICAID FRAUD

The Judiciary Committee held a public hearing and work session on LD 1824, a bill which would have provided limited immunity for health care professionals and persons who assist a person who experiences or is likely to experience an opiate-related drug overdose with intranasal naloxone.   The bill came out of the 1501 work group and the MMA testified in favor of the proposal.  After hearing concerns voiced by the Committee about the scope of the immunity proposed, the MMA presented a modified proposal at the work session, however the Committee voted unanimously that the bill ought not to pass.  Committee members stated that while they supported reducing drug overdose deaths they were not convinced that immunity was needed to encourage prescribers to participate in naloxone programs.  

The Committee also held a work session 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 Committee considered comments from Maine Equal Justice Partners and the Maine Attorney's General Office debating whether allowing such actions would recover additional dollars for the State.  The Committee tabled further action until next week when the Assistant Attorney General who is an expert in the area will be available to speak to the Committee.  

 

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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 tomorrow night, Tuesday, March 6th 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 one bill below, we will cover the ongoing supplemental budget negotiations, 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. 1837An Act To Authorize the Establishment of Pilot Projects for Community Paramedicine (monitor; emergency physicians)

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MMA Board of Directors to Meet on Wednesday, March 7th

The 24-member Board of Directors of MMA will meet this coming Wednesday, March 7, from 4:00 to 6:00pm at the Association offices in the Frank O. Stred Building in Manchester.  Any MMA member is invited to attend.  The agenda for Wednesday includes a discussion of the new MaineCare limits on opioid medication, a grant application filed jointly by MMA and the state medical societies in Vermont and New Hampshire to the Physicians Foundation, and the upcoming survey of physicians nationwide by the Foundation.  With the grant request, the medical societies are applying for financial support for the offering of an educational program across the three state region regarding prescription drug abuse.  Grants of up to $100,000 over two years are being offered on a competitive basis.

The Board will also consider a proposed policy for its consideration of Resolutions approved at the Annual Meeting.  Bylaws amendments approved last September make such Resolutions only advisory on the Board so a policy needs to be established regarding how the Resolutions can become MMA policy through the approval of the Board.

The Board will also approve a slate of members for the new Nominating Committee established under the bylaw amendments last September.

The Board is chaired by Kenneth Christian, M.D., an emergency physician practicing at Maine Coast Memorial Hospital in Ellsworth. [return to top]

45-Day Limit on MaineCare Coverage for Certain Opioid Treatments Now Final Law

Although MMA has been reporting on the measures the Appropriations Committee has taken aimed at addressing prescription drug diversion included as part of the 2012 supplemental budget, this week we are highlighting the limit on MaineCare coverage of opioid treatment so that physician practices are prepared if this provision remains in effect.  

As of April 1, 2012 MaineCare coverage of opioids for members newly prescribed these drugs will be limited to a total of 45 days (an initial 15-day prescription, followed by 2 additional 15-day prescriptions with prior authorization).  This is intended to be a lifetime limit.  For patients who have been treated for chronic pain with opioids for one year or more, the 45-day limit becomes effective on September 1, 2012 to allow more transition time.  This means their 45 days would run out mid-October if they are taking the medication continuously.  The law exempts HIV/AIDS patients, those with cancer, in hospice care or receiving in-patient treatment from the limit.  

The opioid coverage limit is Part O of the first supplemental budget, L.D. 1816:

PART O

Sec. O-1.  22 MRSA §3174-TT  is enacted to read:

§ 3174-TT. Limitation on reimbursement for opioids

1 Limitation.    Except as provided in subsection 3, beginning April 1, 2012, the maximum time period for reimbursement under the MaineCare program for opioids is set forth in this subsection.

AFor a MaineCare member who is receiving treatment for HIV or AIDS or for cancer or who is in hospice care, reimbursement must be provided for the duration of the treatment or care.

BFor a MaineCare member who is receiving inpatient treatment in a hospital, reimbursement must be provided for the duration of the inpatient hospitalization.

CExcept as provided in subsection 2, for a MaineCare member who is receiving any treatment other than the treatments or care described in paragraph A or B, the maximum time period for reimbursement is 15 consecutive days.

2 Authorization for reimbursement for longer than 15 consecutive days.     For a MaineCare member who is receiving treatment under subsection 1, paragraph C, the department may authorize reimbursement for a period longer than 15 consecutive days in accordance with this subsection.

AThe department may authorize reimbursement after the first 15 consecutive days for an initial extension period of an additional 15 consecutive days.

BThe department may authorize reimbursement after the initial extension period authorized in paragraph A for a final extension period of 15 consecutive days.

The department may not authorize an extension beyond the final extension period authorized in paragraph B.

The department shall adopt rules to implement this subsection. Rules adopted under this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

3 Exception; treatment of chronic pain for one year or longer.     For a MaineCare member who on April 1, 2012 has been receiving opioids for the treatment of chronic pain for one year or longer continuously, the limitation on the maximum time periods for reimbursement under the MaineCare program for opioids set forth in subsection 1 takes effect September 1, 2012.

Because of concerns expressed by the medical community about this proposal throughout the budget debate, MaineCare Medical Director Kevin Flanigan, M.D. is looking for possible alternatives to this approach that might be included in another supplemental budget bill enacted before the April 1, 2012 initial effective date.  Dr. Flanigan has been reaching out to the physician community for input on this proposal through the MMA, the Maine Osteopathic Association, the MaineCare Physician Advisory Committee and other avenues.  

Please keep in mind that this is a coverage decision by the legislature for the MaineCare program.  It is not a limit on physicians' prescribing rights.  Patients would still be able to fill prescriptions and pay cash.  While acknowledging the likely negative results of this decision, not just for the health of the individual patient but also the social costs, feedback on this policy decision received by the MMA has been mixed.  

Please share this information with your colleagues in your practice sites and your medical staffs, so that you can plan for management of these MaineCare patients should this policy remain in effect as of April 1, 2012.

If you have further questions or comments about this matter, please contact MMA EVP Gordon Smith at gsmith@mainemed.com or 622-3374, ext. 212.


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Alan Prysunka to Step Down as Executive Director of Maine Health Data Organization

The Chair and Vice-Chair of the Maine Health Data Organization (MHDO) announced last week that Alan Prysunka, the only Executive Director the organization has even known, will resign his position later this month. Al was the first employee hired for the organization when it was created in the mid-1990's following the demise of the Maine Health Finance Commission (MHFC).  Among his legacies at the agency is the establishment of the first all-payer database in the country.  He is considered one of the nation's leading experts on such databases and his informal advice has helped establish similar databases in a number of states including New Hampshire, Vermont and Wisconsin.

MMA wishes him well in whatever the future may hold for him. [return to top]

Maine Vaccine Board Announces Provider Transitional Loss Mitigation Program

If you are a Maine Provider who administered vaccines to minors between January 1, 2012 and April 30, 2012, and reimbursement was denied by an insurer, then you may be eligible for reimbursement by the Maine Vaccine Board under its Provider Transitional Loss Mitigation Program (PTLMP).

The Maine Vaccine Board (MVB) recognizes that as the new universal vaccine program begins providers may have unused vaccine which they previously purchased for use in children under the age of 19. The MVB is concerned about transitional costs borne by providers as this new program is implemented.  Many insurers will continue to reimburse providers for use of purchased vaccine, but some may not.  To lessen the potential financial burden on providers, the Board has established a process to reimburse providers at least a portion of the cost of purchased vaccine if reimbursement is denied by an insurance carrier.  This applies only to vaccines administered to children from January 1, 2012 and through April 30, 2012.

The PTLMP is administered by the following special claims serving agent. All questions related to the PTLMP should be addressed as follows:

Attention: Steven Hoxie

Maine Worker’s Compensation Residual Market Pool

207-885-9755

For more information on the Universal Vaccination Program, see the Maine Vaccine Board webpage.  The Program was established by 2009 Public Law 595 to provide all children from birth until 19 years of age in the State with access to a uniform set of vaccines as determined and periodically updated by the Maine Vaccine Board. Vaccine purchase is funded by an assessment on health insurance carriers and 3rd-party administrators.

 
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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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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:

www.readytalk.com

Participant Code:  5231501#

Call in Number:  1-866-740-1260

Access Code:  5231501#

Links For Specific Information

Overview of the Advanced Program

http://www.hanleyleadership.org/leadership-programs/physicians-executive-leadership/

Meet The National Faculty

http://www.hanleyleadership.org/leadership-programs/physicians-executive-leadership/Advanced-Course/Faculty/

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

http://www.hanleyleadership.org/uploads/PELI%20Forms/PELI%20Advanced%20Program%20Dates.pdf

Nomination Forms

http://www.hanleyleadership.org/leadership-programs/physicians-executive-leadership/Advanced-Course/

 Frequently Asked Questions

http://www.hanleyleadership.org/leadership-programs/physicians-executive-leadership/Advanced-Course/Advanced-FAQ/

Which Program Is Right For Me?

http://www.hanleyleadership.org/leadership-programs/which-program-is-right-for-me/


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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 .   [return to top]

AMA Offers Free Practice Management Alerts

Have you signed up to receive the AMA’s free Practice Management Alerts?

You can empower your practice to save time and money with free AMA Practice Management Alerts. Let us bring important practice management and payer news to you.

Sign up today to receive free, timely e-mail alerts from the AMA:

  • Increase efficiency and ensure accurate payment by staying on top of problematic payer practices, as well as the appropriate, effective ways you can address these problems.
  • Save time and money with AMA practice management resources that can help streamline your practice’s internal claims process.
  • Take action on unfair payer practices—easily invite friends within the profession to join the online community and share practice management experiences.

Anyone can subscribe for free: An unlimited number of physicians and staff from your practice can subscribe to the AMA Practice Management Alerts—including practice managers, coders and billers. Save time and paper—instead of printing an alert to give to someone else in your practice, invite them to sign up and receive the Practice Management Alerts directly to their inbox.

If you aren't already an AMA member, visit www.ama-assn.org/go/membership to join today and learn more about AMA membership benefits. 


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Maine Law Court Upholds Limits to Anthem Rate Increases

Consumer groups applauded a Maine Supreme Judicial Court unanimous ruling last week upholding a May 2011 decision by then-Bureau of Insurance Superintendent Mila Kofman to limit the 2011 Anthem rate request to an increase of 5.2% in the individual market.  Anthem had requested an increase of 9.7%. 

This is the second consecutive year Anthem has appealed its case to the Court. In May 2011, the Court dismissed a 2010 rate appeal as "moot" because the rate review increase they sought was for the previous year and had already been eclipsed by a new rate

"This decision is a tremendous victory for Maine consumers and for the state regulators whose decision saved Anthem's 11,000 individual policyholders over $3 million," said Consumers for Affordable Health Care Executive (CAHC) Director Joe Ditré. "The Court clearly said that nothing in state law or its constitution entitles Anthem or any health insurer to a guaranteed 3 percent profit margin." 

CAHC points out that the insurance law that passed last year, called Chapter 90, removes the ability of regulators to review rates if the company asks for less than a 10 percent rate increase.

To read the Court's opinion click here. 

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