March 26, 2012

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POLITICAL PULSE: April 1st Opioid Prescribing Limit on Hold & Other Legislative Highlights of the Week

MMA has been carrying articles for several weeks outlining the initiative in the Department of Health and Human Services Supplemental Budget limiting new opioid prescriptions to 45 days for some MaineCare members who are ages 21 and over.  DHHS announced last Tuesday that due to legal questions about this initiative the Department does not plan to implement this limit on April 1, 2012.

The Department added that they are working with the Attorney General’s office and Maine State Legislature on the details involved with this change in policy and will provide more information when it is available. 

The MMA asks that you please share this information with your colleagues in your practice sites and your medical staffs, as practices have already been making changes in management of MaineCare patients in anticipation of the April 1st limits.  Watch the Weekly Update for further information.

If you have questions or comments about the opioid limits, please contact MMA EVP Gordon Smith at or 622-3374, ext. 212.  MaineCare members who have questions about this initiative can call the MaineCare Member Services help desk at: 1-800-977-6740.


The Appropriations & Financial Services Committee continued work last week on a supplemental budget bill to address funding for 2012-2013.  While it does not focus on Department of Health & Human Services or MaineCare funding (and there is a separate bill to deal with 2013 DHHS funding), the bill still does contain a number of changes to DHHS.   The Committee held a public hearing on the DHHS aspects of the bill last Thursday and the MMA Public Health Committee submitted testimony in opposition of a plan to sweep over $4 million of Fund for a Health Maine dollars into the General Fund.  

The complete budget documents can be found on the web here:

 On Friday, the Committee heard an update from Commissioner of DHHS Mary Mayhew regarding the fiscal impact of not ending coverage for over 19,000 individuals who had been determined ineligible for MaineCare.  The Commissioner explained that she hoped to have data from Molina Healthcare about the expense of services provided to the individuals by April 3rd and would then need to compare the spending to the projected budget.  After the meeting, Democrats expressed concern to the press about being able to finalize a DHHS budget before the legislature is scheduled to adjourn April 18th. 


Last week, the Health & Human Services Committee held a public hearing and work session on an after-deadline bill on communication of breast density information to patients.  Sponsored by Assistant House Democratic Leader Terry Hayes (D-Buckfield), L.D. 1886, An Act Requiring Communication of Mammographic Breast Density Information to Patients, is similar to legislation enacted in Connecticut, Texas, and Virginia and being considered in several other states this year generated by patient advocacy groups.  The primary proponent of the bill is Barbara Deschenes, a patient and constituent of Representative Hayes.  The Maine Medical Association, Maine Radiological Society, and Spectrum Medical Group opposed the bill.  You can find the testimony of the MMA and the MRS on the MMA web site.

MRS President Jeffrey Young, M.D. represented radiologists at the hearing.  Following the hearing, the parties who testified at the hearing met with Representative Hayes and negotiated a compromise that would change the bill to a Resolve directing DHHS to convene a stakeholders' group to review breast imaging standards; review the federal Mammography Quality Standards Act; review the current breast imaging results protocol; and recommend strategies to improve the dialogue between patients and physicians regarding breast density and breast imaging options.  At a committee work session last Thursday, the Committee voted 11-1 "ought to pass as amended" on the compromise version of the bill.  The only dissenting vote was Senator Nicchi Farnum (R-Penobscot) who opposed the original bill, but also felt that this could be adequately addressed by the medical community without legislation.

A bill to carry out the the Maine Department of Health & Human Services restructuring plan announced last Wednesday also came before the Committee last week.  Under the proposal, the Offices of Substance Abuse and Adult Mental Health Services will merge to become the Office of Substance Abuse and Mental Health Services (SAMHS).  The Offices of Elder Services and Cognitive and Physical Disabilities Services will become the Office of Aging and Disability Services (OADS).  Finally, the Office of Child & Family Services will reorganize.  Programs and consumers testified both for and against the proposal.  The Committee continues it discussion of the proposal this afternoon.  

After an over 3-hour work session, the Committee voted last week 8-2 in favor of passing L.D. 1840, An Act To Limit MaineCare Reimbursement for Methadone Treatment, which limits methadone treatment to 24 months without prior authorization.  The bill was amended to require DHHS to include experts in the field of addiction and recovery in crafting the prior authorization criteria.   The Committee also approved L.D. 1848, which requires that additional notice be given in the service area of a health care facility that may be negatively affected by a certificate of need application and LD 1855, a bill that requires spending on obesity programs within the Fund for a Healthy Maine to be tracked separately. 


The Insurance and Financial Services Committee last week gave approval to changes to Bureau of Insurance Rule Chapter 850. The final rule allows health insurance carriers to provide incentives for patients to travel to "designated" providers and eliminates geographic network requirements including a maximum of 30 minutes travel time to primary care from an enrollee's residence and a maximum of 60 minute travel time to specialty care and hospital services.   The MMA worked closely with the Maine Hospital Association in an attempt to improve the transparency of the data and methodologies relied on by carriers to designate providers but insurance carriers opposed such changes and the Committee ultimately decided not to make any substantial change to the rule. The MMA plans to take this issue back up next session.  The rule now moves to the full legislature for approval. 


The Senate today sent L.D. 882, An Act to Limit Health Care Mandates back to the Insurance and Financial Services Committee.  The bill states that insurance companies cannot be required to offer plans that go beyond the minimum benefits required by the ACA.  MMA opposes the bill.   

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 27th at 8:00 p.m.  Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-669-3239

Passcode:  23045263

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.  There have been no new bills introduced since the last call, so we will cover the ongoing 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 or 622-3374, ext. 214.

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Events Around the State Recognize ACA Two-Year Anniversary; Benefits Available Under the ACA

A number of press events around Maine last week highlighted the two-year anniversary of the Affordable Care Act and benefits available to patients under the law.  

The U.S. Surgeon General, Dr. Regina Benjamin, spoke as part of a panel last Monday at Central Maine Medical Center (CMCC) to talk with women in Maine and other interested community members about the benefits of the health care law and the many ways that it is already working to help women.  Along with the Surgeon General, the panel included women sharing their stories about how the law has helped them and  Dr. Ned Claxton, from Central Maine Medical Group, who discussed their "Saving Lives" program and the initiatives providers are engaged in to encourage preventive care and screenings.

On Thursday, several health leaders and consumers gathered to announce an unprecedented outreach and education campaign in the greater Bangor area aimed at informing people about new health care benefits that are available under the ACA.   In addition to "door knocking", the project will also hold community meetings, educational trainings, and use TV and radio segments to educate Bangor residents.  Some benefits under the health reform law include the ability for young adults to stay on their parents' health insurance until they turn 26, no out-of-pocket costs for most preventive care for people with insurance, improved Medicare Part D prescription benefits for seniors, and a new insurance option for people with pre-existing health care conditions. 

Also making big headlines was the beginning of Supreme Court oral argument today in the case to determine the Constitutionality of the Affordable Care Act. The hearing this morning focused on whether the Anti-Injunction Act should prevent a challenge to the individual mandate before it goes into effect.  Argument will continue tomorrow on whether it was within Congress' power to enact the individual mandate and on Wednesday with whether the individual mandate can be severed from the rest of the law. You can listen to the arguments on C-SPAN3.


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US House Passes Bill to Repeal Medicare Board, Impose Limits on Medical Malpractice Cases

By a vote of 223 to 181, the House March 22 approved repeal of the Independent Payment Advisory Board, created in the health reform law to control Medicare costs, with seven Democrats joining 216 Republicans voting in favor of the bill (H.R. 5).

To help offset the costs of repealing IPAB, the measure was combined with a bill that would place major limitations on medical malpractice cases brought in state court. The limitations would preempt existing state laws.

The combined legislation is not likely to be approved in the Democratic-controlled Senate. The addition of the malpractice measure is considered to be a “poison pill” that will doom even the slimmest chances the legislation may have had in the Senate.

Sen. John D. Rockefeller IV (D-W.Va.), chairman of the Senate Finance Subcommittee on Health Care, said the measure “will take us in exactly the wrong direction, and every senior in America should be outraged.”

The House bill repealing IPAB, originally introduced as H.R. 452, had as many as 20 Democratic supporters in the House before it was joined with the medical malpractice measure (H.R. 5).

You can read the AMA's statement in support of the IPAB repeal legislation on the web at:

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Take Charge of Your Physician Data with New AMA Resources

Public and private health insurers are increasingly using physician data to drive their decision-making processes on new payment methodologies, network design, patient education, and health services availability and delivery.  In addition, health insurers are using performance data to rate the quality and efficiency of physicians. A suite of new resources from the AMA can help physicians access these data and strategically use them to improve practice efficiency and delivery of care, as well as ensure that payers and other reporting bodies are not misusing the information.   

Take Charge of Your Data is a guidebook designed to help physicians understand and verify the accuracy of complex physician data reports used to profile physicians. The guidebook is best used in tandem with the AMA’s Standardized Physician Data Report, which provides a uniform format for displaying physician data. Used together, these resources provide you with a road map to understanding how to use your own payer-provided data to verify the accuracy of your profiles and assist you in providing exemplary care to your patients. Additionally, through the creation of the Guidelines for Reporting Physician Data, the AMA is working to improve the quality and utility of physician data reports.   

Visit to access these new resources and find additional information on how to use these exciting new tools.

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Health Risk Assessment Now Part of Medicare Annual Wellness Visit

This year, the CY2012 Medicare Physician Fee Schedule Final Rule added a Health Risk Assessment requirement to the Medicare Initial Preventive Visit and the Annual Wellness Visit.  The purpose of the Health Risk Assessment, according to CMS, is to help physicians identify the behaviors and risk factors such as tobacco use and nutrition that the physician can discuss with the patient in an effort to reduce those risk factors and related diseases.  CMS has not required a specific HRA form but has published a "framework" for the HRA and a sample form you can have patients fill out in advance of their visit:   Family Practice Medicine has also published a sample form

To learn more, on March 28, 2012, Medicare Preventive Services is hosting a National Provider Call on The Initial Preventive Physical Exam and the Annual Wellness Visit.

This is an opportunity to get the information you need about the Initial Preventive Physical Exam (IPPE—also known as the "Welcome to Medicare" Preventive Visit) and the Annual Wellness Visit (AWV). CMS experts will be on hand to discuss both the IPPE and AWV, when to perform them, who can perform each service, who is eligible and how to code and bill for each service, followed by a question and answer session.  For more details, including instructions on registering for the call, please visit .

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MMA and the Learning Center at Baker, Newman & Noyes Annual Coding Seminar Friday, April 6

The Maine Medical Association and the Learning Center of Baker, Newman & Noyes present the Annual Coding Seminar as part of MMA's First Friday CME series on April 6, 2012 from 9:00am to noon.  The seminar is available either live at the MMA office in Manchester or via webex.  There is a charge of $65 per person.

Faculty for the seminar includes Laurie Desjardins, CPC, PCS, Jana Purrell, CPC-I, CEMC, and Gordon H. Smith, Esq.

More information and an agenda are available on the MMA website at  You may also register for the program on the website.

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DHHS Announces Director of Licensing and Regulatory Services

Kenneth (Ken) Albert III recently joined the Maine Department of Health and Human Services as the Director of the Division of Licensing and Regulatory Services.

Prior to joining DHHS, Albert practiced law for several years, specializing in health law, professional licensing and regulatory and compliance law. He has also directed compliance efforts in a large health care organization, developing a new compliance program for several business lines.  Albert has served as the Manager of Emergency Services at Central Maine Medical Center, as the Administrator of the Health Center at CMMC, and as the Lewiston Site Manager for LifeFlight of Maine. He spent five years as a traveling nurse. 

A graduate of the CMMC School of Nursing, Albert moved on to earn a Bachelor of Science in Nursing at the University of Southern Maine and a law degree at the University of Maine School of Law.

Albert said his immediate goals are to strengthen relationships and communications with health care providers and to engage them in developing best practices for consistency in regulatory enforcement.  He resides in Lewiston with his wife and two children.   [return to top]

Maine PCMH Pilot Phase 2 Expansion Applications Due March 31st

Maine PCMH Pilot Phase 2 Expansion & MaineCare Health Homes Initiative


Conveners of the multi-payer Maine Patient Centered Medical Home (PCMH), the Dirigo Health Agency’s Maine Quality Forum, Maine Quality Countsand the Maine Health Management Coalition, have announced plans to expand the Pilot to include an additional 20 adult practices inJanuary 2013, and have opened an online application process.  Interested practices must complete the online application by March 31, 2012

Interested practice sites are encouraged to read more information, including a newly developed “FAQ,” and review eligibility requirements, and the online application posted on the Maine Quality Counts website (  The PCMH Pilot application is available online at and must be completed 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 or  Practices interested in applying for participation in the MaineCare Health Homes initiative should complete the same online application being used for the Pilot expansion by March 31, 2012. It is available at

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 applications for both the Pilot expansion and MaineCare Health Homes Initiative
  • 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
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MMA Annual Golf Tournament, June 4th

Save the Date

 The Annual MMA Benefit Golf Tournament will be held this year on Monday, June 4, 2012 at the Augusta Country Club.  The net proceeds this year will benefit the scholarship fund within the Maine Medical Education Trust.  Lunch will be at 11:00am followed by a shot-gun start at noon. A traditional scramble format will be used.  

Watch your mail for registration materials or reserve your spot now by contacting Gordon Smith at Registration will also be available in April on the MMA website at 

Sponsorships are welcome and any interested potential sponsors should contact Lisa Martin at at call Lisa at 622-3374 ext. 221.  [return to top]

Save the Date: MMA's 21st Practice Education Seminar Announced for Wednesday, July 25, in Augusta

The Association's 21st Annual Practice Education Seminar will be held on Wednesday, July 25, 2012 at the Augusta Civic Center.  Keynote presenters include Susan Turney, M.D., President of the Medical Group Management Association (MGMA) in Englewood, Colorado and Brian Atchinson, Esq., President of the Physician Insurance Association of America (PIAA).  Mr. Atchison is a former Insurance Superintendent in Maine and a former chair of the National Association of Insurance Commissioners (NAIC).  Dr. Turney is in her first year serving MGMA, having previously served as Executive Vice President of the Wisconsin Medical Society.

The program will be held from 8:30 a.m. to 4:00 p.m. at the Augusta Civic Center.  Watch for registration materials in your next issue of Maine Medicine.  Registration will also be available on the Association's website at

In addition to the keynote presentations, updates will be offered on MaineCare, Medicare, state legislation, Board of Licensure in Medicine activities, HIPAA, the federal Affordable Care Act, HealthInfoNet, the Regional Extension Center, and the recently updated Physician's Guide to Maine Law.

If your firm or company is interested in exhibiting at the program, contact Lisa Martin at or call her at 622-3374, ext. 221.  Sponsorship opportunities are also available through Ms. Martin.



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Upcoming Events & Conferences

Quality Counts 2012 Conference - Last day to register is tomorrow at 5 pm! 

 Partnering with Patients: Finding the Bright Spots to Transform Care

Wednesday, April 4, 2012 

Augusta Civic Center

A “best practice college”, offering participants specific models and tools for working collaboratively within communities to improve health and health care.

For more information or to register, click here.  


Cancer in the Family: Primary Care Matters

April 13, 2012 


The Jackson Laboratory 

 600 Main Street

Bar Harbor, ME

This half day free CME event will be held in conjunction with the annual meeting of the Maine Academy of Family Physicians with the goal of enhancing Maine health care providers' understanding of detecting and managing individuals with familial cancer syndromes.

For more information or to register, click here.


The Maine Gastroenterology Society

Gastroenterology 2012 Update

April 14, 2012 

Harraseeket Inn, Freeport, Maine. 

Expand your knowledge of Gastroenterology  in areas including management of ascites, encephalopathy and dysphagia; hepatocellular cancer screening; treatment of IBS.  Open to Primary Care Physicians, Family Practitioners and Allied Health Professionals that want to broaden their knowledge of Gastroenterology

For more information or to register, contact Gail Begin at or 207-622-3374 ext. 210.


Immunization Annual Conference: Focus on Maine

Monday, April 23, 2012 

8:00 am - 3:45 pm 

Augusta Civic Center

Sponsored by the Maine Center for Disease Control and Prevention

 Dedicated to a review of emerging and existing issues relating to immunization practice, at the federal, state and local levels.

For more information or to register, click here.



11th Annual Obesity Workshop 

Price Matters: Sugar Sweetened Beverages, Taxes & Obesity - The Evidence 

May 3, 2012

8:00 am - 3:00 pm 

Maple Hill Farm, Hallowell

The annual obesity workshop is an event not-to-miss for all people interested in public health and the health of our children.  Three nationally known speakers will present the latest research and information about sugar sweetened beverages, how they impact obesity rates and how purchase price influences our choices.

For more information or to register, click here


Back to School: Pediatric and Adolescent Hot Topics and School Based Health

May 5-6, 2012

Harborside Hotel, Bar Harbor 

Approved for 10.5 Hours of Category 1 CME 

For more information or to register, go to 


Maine Association Medical Staff Services Biennial Education Conference: The Many Spokes of the Wheel

 May 9-11, 2012

 Residence Inn Hotel and Conference Center

Portland, ME

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.

An agenda and registration materials are available at


22nd Annual Maine GERIATRICS Conference - Save the Date

June 7-8, 2012 

Harborside Hotel & Marina

Bar Harbor, ME

Registration Open.  CME Available. 

 For more information or to register visit


Save the Date: 

Emergency Ultrasound Course

October 25-26, 2012

MaineGeneral Medical Center

Waterville, ME 

Primarily geared to emergency and intensivist physicians and mid-levels.  Expected 14 Category 1 CME Credits.  Course Director: John Joseph, MD, FACEP 

To reserve your spot: 626-1303 or

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