May 28, 2012

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Annual HIPAA Privacy Staff Training Offered this Friday, June 1

The Annual HIPAA Update is traditionally MMA's most popular First Fridays program and this year it will be presented this Friday, June 1st from 9:00 a.m. to noon.  Regular staff training is required under the HIPAA regulations and this program offers an inexpensive but comprehensive training.  It is an ideal program for newly hired staff not yet trained in the nuances of state and federal patient confidentiality laws. The training is offered both at the MMA office in Manchester and through webinar and registrations will be taken until noon on Thursday.

The Annual HIPAA Update is traditionally MMA's most popular First Fridays program and this year it will be presented on Friday, June 1st from 9:00 am to noon.  The faculty this year includes Stacey Mondschein Katz, J.D., of SMK Consulting Services, LLC, and MMA's three in-house attorneys, Andrew MacLean, Jessa Barnard and Gordon Smith.

The agenda for the morning follows:

8:30 am   Breakfast and Networking

9:00 am    Welcome, Introduction and Overview of State and Federal Privacy Law and HIPAA Regulations, Gordon Smith, JD

9:30 am    HITECH Regulations, Mental Health Rules and Preparing for an HHS Audit, Stacey Mondschein Katz, JD

10:30 am  Break

10:45 am  Special Privacy Rules:  Minors and HIV, Jessa Barnard, JD and Andrew MacLean, JD

11:30 am   Summation and Q & A,  All presenters, moderated by Mr. MacLean

MMA's sample Notice of Privacy Practices document, consent forms and release forms are currently being updated to comply with the HITECH regulations and will be made available to program participants or shared with registrants following publication of the final rules in June.

This program is ideal for your annual HIPAA staff education or for training new staff.  There is a $65 fee and registration is available on the MMA website at  A HIPAA Training Certificate will be presented to each participant and CME has been applied for.

Members and practice managers are also reminded that MMA attorneys are available to come to the practice site to provide a similar program.  Normally, a $200 fee is charged for an on-site program which can be one hour or more if the practice is able to commit that much time to the education.

Any questions about the MMA's educational offerings can be directed to either Gordon Smith, EVP at or Gail Begin via e-mail to

Political Pulse: Legislature Schedules Veto Session, Approves Cuts to DHHS Services in Budget

In its most recent action, the Maine legislature has scheduled to return to Augusta this Thursday, May 31st, to consider several bills vetoed by Governor LePage.  Most notably, the Governor vetoed a $20 million research and development bond that had been unanimously approved by the legislature.  LePage will allow four other bond measures to proceed to the voters without his signature.  No other bills vetoed by the Governor have a direct impact on health care. 

Two weeks ago, voting 75-61 in the House and 19-14 in the Senate, largely along party lines, the legislature approved a Fiscal Year 2013 budget change package for the Department of Health and Human Services.  The approved budget fills a $78.5 million budget gap for DHHS by, among other things, ending MaineCare coverage for young adults and some parents; reducing or ending Fund for a Healthy Maine dollars and MaineCare coverage for certain preventive services; and redesigning MaineCare coverage for opiates.  It also finds some savings in other areas of government outside of the DHHS and includes several spending initiatives as well as income tax reductions.  The changes go into effect August 14, 2012. 

Of most interest to physicians the budget includes: 

  • Eliminating MaineCare Coverage for children age 19-20 (7000 people) and for parents from 100-133% of the federal poverty level (14,500 people).  Note that these cuts are unlikely to go into effect as these categories of coverage are protected by the Affordable Care Act and the federal government would need to approve a waiver request before the cuts are made. 
  • Eliminating MaineCare Coverage for Ambulatory Surgical Centers.
  • Eliminating MaineCare Coverage for Services provided at Maine's three STD Screening Clinics and for smoking cessation products.
  • Raising income limits for participation in the Medicare Savings Plan & Drugs for the Elderly programs.  Note that the reductions to the Medicare Savings Program are also unlikely to go into effect due to the Affordable Care Act. 
  • Reducing or eliminating Fund for a Healthy Maine funding for oral health, home visiting, family planning, child care services, and community school grants (Healthy Maine Partnerships and school based health clinics).
  • DHHS reorganization.
  • Imposing a 2 year limit on Methadone without prior authorization.
  • Creating a Medicaid Stabilization Plan or 9 member task force to create a Medicaid program redesign.
  • Primary Care - Mental Health integration through case managers at hospitals.
  • Opiate Benefit Redesign - no additional savings budgeted but replaces the savings estimated in the 1st supplemental budget - please see more information on this proposal in the article immediately following. 

Five amendments to the budget were proposed on the House floor, all by Democrats.  Dr. Linda Sanborn introduced an amendment to restore the Fund for a Healthy Maine programs; other amendments would have restored cuts to MaineCare, Drugs for the Elderly and Home Visiting.  After debate, the bill passed in both the House and Senate and Governor LePage signed the legislation May 16th.  

For the final votes and language of the budget click here.  For a summary of the Republican proposal as passed out of the Appropriations Committee click here.   A more detailed summary of the budget is posted on the MMA website here.  

NOTE:  MMA LEGISLATIVE COMMITTEE CONFERENCE CALLS HAVE ENDED FOR THIS SESSION.  The calls were quite well attended and we are very grateful to the physicians and specialty society staff who took time out of their busy evenings to review proposed legislation and share their comments with us.  The MMA advocacy team could not be effective without your input.  We hope you have a restful summer and fall and we look forward to our in-person meeting before the 2013 session begins.  

For more information about our advocacy activities, please contact Andrew MacLean at or 622-3374 x 214.
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Changes to MaineCare Opioid Coverage Become Law

The budget approved by the Maine legislature and signed by Governor LePage on May 16th (see article above) contains a redesign of the MaineCare opiate benefit.  The changes are made in response to the concern that proposals to restrict opiate coverage contained in the first supplemental budget were in conflict with federal law. The Department of Health and Human services does not expect additional savings from the new law but did book savings in the first supplemental budget that the Department still expects to achieve. 

The new benefit design, which goes into effect August 14, 2012, includes: 

A prescription for opioids for acute pain can now only provide for 15 days of medication. Then a face-to-face visit with the prescriber is required in order to get prior authorization for another 15-day prescription. After 45 days, if the opioid drugs are still medically necessary, a person may qualify for opioid drugs for long-term chronic pain with prior authorization. Note: 60-day prescriptions are allowed following surgery.

To get opioid drugs for chronic pain, the person must have: 

  • Failed to respond well to a prescribed alternative treatment; or
  • Completed the prescribed alternative treatment and the pain is getting worse; or 
  • Completed at least half of the prescribed alternative treatment, and the prescriber determines that the alternative treatment is not adequately controlling the pain.

MaineCare will establish through rulemaking acceptable alternative interventions, such as Cognitive Behavioral Therapy, Physical Therapy (up to 6 visits) or Osteopathic Manipulation Treatment.  The department will also impose limits on the total amount of opioids allowed for a member who fails to have an adequate response to the prescribed treatment, subject to exception based upon medical necessity. 

These new limits do not apply if the drugs are prescribed:

  • For symptoms related to HIV, AIDS, cancer and certain other qualifying diseases and conditions;
  • During inpatient treatment in a hospital or during hospice care;
  • At certain qualifying low doses;
  • For treatment of addiction, in which case the limits applicable to methadone and buprenorphine and naloxone combination drugs apply;
  • To people on the Medicare Savings Program (MSP) who are covered by Part D; or
  • To current users (MaineCare patients who have been on opiates consistently for six months prior to the effective date) until January 1, 2013.  Prior to that time, it is hoped that MaineCare will develop rules that would exempt patients on small daily doses of the medication and exempt others by diagnosis or condition. 

Second opinion: Prior to prescribing an opioid drug as part of a treatment plan for a member who suffers from one of the medical diagnoses known to typically have a poor response to opioid drugs, a prescriber shall obtain an evaluation from a physician from outside the practice of the prescriber.

Treatment pattern data: There is language in the budget that will allow the Prescription Monitoring Program to provide to prescribers their own prescribing information, compared to a peer group.  If the prescriber is an outlier, he or she will be given an opportunity over time to bring their prescribing pattern into conformance with the peer group.  If that is not achieved, the Department could take actions against the prescriber such as limiting their ability to participate in the MaineCare program. 

The department will have to go through rule making to implement many of these provisions.  For questions or to express an interest in participating in the rule making process, please contact Gordon Smith, MMA Executive Vice President at or 622-3374 x 212. 

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Trial Continues in Case Compelling Disclosure of Peer Review Materials

The trial in a case followed closely by the MMA continues this week with final arguments in Cumberland County Superior Court.  The Defendant Mr. Weidul is charged with manslaughter in connection with the beating and subsequent death of Roger Downs in December of 2011.  After being beaten, later awoke and called 911.  He was transported to Mercy Hospital and was eventually admitted to the inpatient unit where he stayed overnight and died the following evening.  The state has alleged that Mr. Downs died from laryngeal edema caused by trauma sustained during the fight with Mr. Weidul.  The edema manifested approximately 48 hours after the fight and, according to the state medical examiner, caused the death.

The defendant, through his attorney Thomas Connolly, claims that Mr. Downs in fact suffered from streptococcal pneumonia in both lungs and that it was this undiagnosed pneumonia that caused the victim's death. Attorney Connolly sought internal documents from the hospital that would normally be privileged pursuant to two Maine statutory privileges:  22 MRSA Section 8754 (3), concerning sentinel event notification and reports, and 24 MRSA Section 2510-A, concerning professional competence review records.  The provision in title 24 states that all professional competence review records are privileged and confidential and not subject to discovery, subpoena or other means of legal compulsion for their release to any person or entity and are not admissible as evidence in any civil, judicial or administrative proceeding. Attorney's for Mercy Hospital argued what MMA's position has been for years, that the reference to judicial proceedings includes a criminal trial.

Unfortunately, Justice Wheeler disagreed and found that the defendant's Sixth Amendment right guaranteeing a criminal defendant the right "to have compulsory process for obtaining witnesses in his favor" took priority over the peer review privilege.  She wrote in her pre-trial order, Mr. Weidul's right to confrontation is implicated in Mercy's request because Mr. Downs was treated and died while a patient at Mercy Hospital and Mercy Hospital conducted reviews because of his apparently "unanticipated death."

The attorneys for the hospital appealed the ruling to the state's highest court on an interlocatory basis, but the law court refused to make overturn the order, stating that not all the requirements of an exception to the rule that appeals are only heard after a final judgment were met.

Given that the hospital is not a party to the case, it is not clear whether there will be an additional opportunity to appeal the ruling.  If there is no further opportunity to get the case before the law court, the only recourse may be to go to the legislature in January to clarify the statute.

Following the preliminary ruling on the peer review issue,  MMA and the Maine Hospital Association released a statement to the media criticizing the breach of the peer review protections and supporting Mercy Hospital's work in connection with protecting the statute.  The statement can be read in its entirety on the MMA website by clicking here.

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Increase in Pertussis Cases in Maine - Guidance for Clinicians

Maine, like many other states, has been experiencing an increasing number of pertussis cases over the past year.  According to the MeCDC, there have been a total of 72 pertussis cases reported statewide through May 24, 2012, compared to 47 reported cases in 2011 during the same period. Clusters of pertussis have occurred in schools, child care centers, camps, sport teams and workplaces.

The MeCDC has released recommendations to guide clinical management of suspect cases and persons reporting exposure to pertussis.  Click here for more information. 

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Upcoming Events & Conferences

Integrating Mental Health with Medical Practice 

Friday, June 1, 2012

9:00 am - 4:30 pm 

Viles Arboretum, 153 Hospital Street, Augusta, ME 

 This day-long conference includes presentations, panel discussions and work groups to help attendees understand key questions underlying integration of care. 

For more information, or to register, click here.


22nd Annual Maine GERIATRICS Conference

June 7-8, 2012 

Harborside Hotel & Marina, Bar Harbor, ME

Registration Open.  CME Available. 

 For more information or to register visit


Medical Mutual Practice Manager Seminar: 

Caring for our Seniors - Complex medical & liability issues

June 13, 2012

DoubleTree by Hilton Hotel, South Portland, ME 


MaineCare Physician Advisory Committee

Thursday, June 14, 2012, 3:00-5:00pm

Conference Room 103A, Cross State Office Building, Augusta, Maine or 1-800-394-6604, with passcode 959468#

MaineCare topics on the agenda for this meeting will be follow-up to March’s Opioid discussion and Health Homes. MaineCare providers are also invited to present issues in the community they would like MaineCare to address.

RSVP to Charyl Malik at 207-287-3320 or


Save the Date: 

CMS Region 1 National Medicare Training Program 2012

August 7-9, 2012

Sheraton Framingham Hotel and Conference Center, Framingham, MA

Information about key aspects of Medicare, Medicaid, Children's Health Insurance Program (CHIP), and pertinent legislation

More information to be distributed via CMS later in May


Maine Immunization Program Regional Trainings 

July 27, 2012 – Houlton Regional Hospital – Houlton

August 3, 2012 – Hilton Garden Inn – Bangor

August 9, 2012 – Fireside Inn – Portland

Augusta 10, 2012 – Maine Principals Association – Augusta

Open to all health professionals responsible for managing and supporting childhood vaccine programs including physicians, nurse practitioners, physician assistants, and practice managers.

For more information or to register, click here[return to top]

Free In-Office Atypical Antipsychotic Education Available Through MMA's Academic Detailing Program

Request a free educational session on the topic of your choice: 

atrial fibrillation, chronic pain management & (coming soon) atypical antipsychotics

The Maine Independent Clinical Information Service (MICIS) is an innovative service that provides independent, evidence-based prescribing information directly to health care providers in the convenience of their own practice setting (also called "academic detailing").

CME is available at no cost.

For more information, or to schedule a visit with one of our clinician-academic detailers (Erika Pierce, PA-C, and Elisabeth Fowlie Mock, MD), call the Maine Medical Association today at 207-622-3374 x 211 or email Sessions can be tailored to meet your needs and range from one-on-one visits with a prescriber to an entire medical staff and typically last 45 minutes to an hour. 

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Free Online CME, Cancer in the Family: Primary Care Matters

The successful Cancer in the Family: Primary Care Matters CME event was held in conjunction with the annual meeting of the Maine Academy of Family Physicians (MAFP) in April at Jackson Labs.

Now,  for free, you can earn up to 4.75 AMA category 1/AAFP prescribed CME credits by watching the videos of Cancer in the Family: Primary Care Matters.

The goal of the session is to enhance health care providers' understanding of the various aspects of detecting and managing individuals with familial cancer syndromes.

For more information or to access the videos, visit

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Reservations Being Taken for Breast Cancer Motorcycle Plate

An effort is underway to create a Maine Breast Cancer specialty license plate for motorcycles, similar to the specialty plate for automobiles that was first released in 2008. In order to begin a formal legislative process to gain approval for the specialty plate, 500 reservations (along with payment of $25) must be obtained. These reservations guarantee a plate when they become available. 

Proceeds from these license plates will be evenly distributed among the Maine Cancer Foundation; the Maine Breast Cancer Coalition’s Support Service Fund; and Maine CDC’s Breast and Cervical Health Program, which will allocate funds directly to the cost of mammograms received by clients age 40-49.  

For more information or to reserve a plate, visit

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Job Openings - Primary Care Physician, Hospitalist NP/PA, and Family Practitioner

Lifestyle Position/Primary Care Physician - Augusta, Maine

Board Certified Internal Medicine or Family Practice Physician sought for full-time staff Primary Care Physician position based at the Riverview Psychiatric Center in Augusta, Maine.   Responsibilities primarily involve providing basic primary care services to a caseload of approximately 45 patients. Enjoy working regular 40-hour workweeks in a collegial environment. No third party insurance billing, no evenings, no weekends, and no-on call responsibilities.  Offering $170k per year, pay by direct deposit on the 15th of each month, 37 paid days off annually, and paid liability insurance. For additional details contact Ian Castronuovo at (610) 389-7430


Hospitalist Nurse Practitioner/Physician's Assistant Position Openings

Sebasticook Valley Health (SVH) a system of healthcare services including a Joint Commission Accredited 25 bed Critical Access Hospital located in Pittsfield, Maine is looking for two full-time nurse practitioners or physician assistants for our expanding hospitalist program. 

The qualified candidate will feel comfortable responding to ED admissions, managing inpatient medical care including proper documentation, meeting with Care Coordinators and Utilization Review staff on a daily basis and performing procedures, as well as assisting the Emergency Department as appropriate.  The current schedule is 3 to 4 days per week, including weekend rotations, 4PM to 10PM with on-call.

The Hospital serves a population of 30,000 and offers primary care, specialty services and emergency services in addition to inpatient care. SVH is one five rural community hospitals which along with Eastern Maine Medical Center, a level 2 trauma center, comprise Eastern Maine Healthcare System. 

The town of Pittsfield is a safe and pretty community with a good school system. The Maine Central Institute, a prestigious college preparatory school is a prominent part of the landscape. Pittsfield is conveniently located for easy access to the mountains, nearby lakes, rivers and the coast of Maine.

Please contact Terri Vieira, Chief Operating Officer at 1-207-487-4032 or email Terri at


Family Practitioner Position in Jonesport

Busy rural practice located in Jonesport seeking a Family Practitioner to join our successful, well-established practice.  Coverage would include a four day work week, nursing home coverage, and shared call for the practice.  We are currently not looking at any hospital coverage.  We offer a competitive salary and benefits with the possibility of loan repayment through the National Health Service Corps.  This is an excellent opportunity to practice in a gorgeous ocean community.  For more information, please contact Laurie Charbonneau, Administrator at, 207-497-5614.

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Don't Forget Annual MMA Benefit Golf Tournament Monday, June 4 at Augusta Country Club

It is not too late to register to play in the Association's annual golf tournament to be held on Monday, June 4th. This year's tournament will benefit the medical student scholarship fund which supports Maine residents in medical school.  It is a fund within the Maine Medical Education Trust. The tournament chair is Brian Jumper, M.D.

The event begins at the Augusta Country Club with lunch on the deck at 11:00 a.m. and a shotgun start at noon. The format is a traditional scramble.

We welcome golfers, hole sponsors and items to be included in the raffle.  Contact Lisa Martin at 622-3374 ext 221 or for more information.

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