August 20, 2012

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CMS Announces Award to Develop Maine Health Insurance CO-OP

Last Thursday, the Centers for Medicare and Medicaid Services announced $62.1 million in financing to Maine Community Health Options for the development of a non-profit Consumer Operated and Oriented Plan (CO-OP) in Maine.  The award announcement took place in Lewiston, the future home of the CO-OP.

Representatives of Maine Community Health Options (MCHO) and the Centers for Medicare and Medicaid Services announced details of the federal award and the Health Plan at a news conference attended by funders, interested parties and the media.  As noted in a previous edition of the Weekly Update, the new nonprofit health plan will receive up to $62.1 million in financing from the federal government to help it start offering new health insurance options to individuals and small businesses in 2014 through the health insurance exchange that will be set up by either the state or federal government.

Raymond Hurd, acting regional administrator for CMS regions I and II participated in the press conference and stated, "The CO-OP program is part of the broader vision to bring high quality, affordable care to the American people and provide greater choice and accountability.  MCHO will serve as a catalyst for improving care and making the live of the citizens of Maine better by bringing providers, consumers and their communities together."

Jim Davis, MCHO board president and CEO of Pines Health Services in Caribou, stated in his opening remarks, "The high costs of health care are adversely affecting our state's economy. business growth and family security.  The coverage options provided by MCHO will make a big difference to Maine's individuals, families and small businesses."

Of the $62.1 million available, $7.1 million is to develop a subscriber-run plan and $55 million is to meet the plan's reserve requirements under Maine law.  The new health plan must be operated by a board of consumers and meet other requirements in the Affordable Care Act, which included a provision for such plans.  While it was originally hoped that each state would have a CO-OP (consumer owned and operated plan),  only a few states have active CO-OPs being developed currently.

Coverage will be available through the plan in 2014 and it hopes to have 15,000 subscribers in its first year. The application for the plan was put together by the Maine Primary Care Association and some of its members with financial assistance from the Maine Health Access Foundation.  The former Executive Director of the Primary Care Association, Kevin Lewis, left the association to be the CEO of the health plan.

The plan currently has a formation board with four members but will ultimately have a full board controlled by subscribers to the plan.  The development loan must be paid back to the federal government within five years with the reserve loan to be repaid in fifteen years.  The plan will be licensed by the Maine Bureau of Insurance and in many ways will look like any other insurance plan operating in the state, except that the control of the plan will be solely in the hands of the subscribers themselves.

While MMA has not been involved with the development of the CO-OP, MMA representatives did attend the press conference and responded to questions from the media.  CO-OP representatives are expected to be at the MMA Annual Meeting in Bar Harbor in September to answer questions and promote the plan.

Appropriations Committee Takes Stock of State Budget, DHHS

The Maine Appropriations and Financial Affairs Committee (AFA) held a regularly-scheduled meeting today to discuss the State's fiscal health and receive updates on a number of budget issues, including the Department of Health and Human Services and MaineCare.  

Overall, the State ended the 2012 fiscal year in June with a $68 million surplus.  Those funds are distributed to a predetermined "cascade" of priorities, including carrying approximately $42 million forward to balance the state fiscal year 2013 budget and using $9.6 million to pay hospital debt.  

Department of Health and Human Services Commissioner Mary Mayhew updated the Committee on the state's request to CMS to eliminate MaineCare coverage for 19 and 20 year olds, parents under 200% of the federal poverty level and some Drugs for the Elderly beneficiaries. DHHS requested a response from CMS by September 1st and if they do not receive approval will have to submit a supplemental budget request to account for the continued cost of providing MaineCare coverage.  Based on different provisions in the law for approving the cuts, DHHS plans to inform one of the groups (11,780 parents between 200-133% FPL) that their coverage may be ending pending CMS approval, so practices may begin to receive questions from patients.  Legislators stressed that the letter has to be very clear about the fact that coverage is not currently ending.

The Committee also discussed funding cuts to Healthy Maine Partnerships, the MaineCare caseload, recent audit findings from the Office of Inspector General, and implementation of the pain management policy contained in the recent budget (see article below).

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New Laws Take Effect August 30

Many of the bills passed by the Maine Legislature this year go into effect next Thursday, August 30th.  A summary of all of the laws passed by the 125th Legislature that MMA followed can be found here on the MMA website.  

Laws going into effect next week that practices should be aware of include: 

  • L.D. 806, An Act to Increase Public Access to Information Regarding Health Care Facility & Practitioner Payments: Requires MHDO to post data semiannually and to ensure the data are current within 12 months
  • L.D. 1628, An Act to Limit Payment for Care & Treatment of Residents of State Institutions: Practices will be reimbursed at Medicare fee schedule rates when providing care for residents of state institutions 
  • L.D. 1715, An Act to Allow for Timely Access to & Enhanced Administration of All Vaccines: Permits qualified pharmacists to administer any federally-approved vaccine to an adult
  • L.D. 1813, An Act to Amend the Laws Governing Confidentiality of Health Care Information: Makes Maine’s confidentiality law consistent with federal law regarding reports to law enforcement of potential criminal conduct on the provider’s premises
  • L.D. 1837, An Act to Authorize the Establishment of Pilot Projects for Community Paramedicine: Permits the Maine EMS Board to approve up to 12 pilot projects of no more than 3 years in duration for “community paramedicine," allowing EMS providers to care for patients in the community 

Other laws going into effect include changes to insurance regulation (LD 1497, LD 1670 and LD 1702), policies on bullying in schools (LD 1237), study groups on the All Payer Claims Database (LD 1818) and breast density (LD 1886), and administrative changes to the Fund for a Healthy Maine (LD 1855 and LD 1884). 

For questions about any of these provisions, contact Andrew MacLean at or Jessa Barnard at  

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Prescription Drug Abuse Task Force to Hold Fourth Meeting Tomorrow

The Prescription Drug Abuse Task Force appointed by Governor LePage and Attorney General Schneider will meet for the fourth time tomorrow (Tuesday) from 3:00pm to 5:00pm in Room 208 in the Cross Office Building in Augusta.  Highlights of the meeting will include presentations by Kevin Flanigan, M.D., Medical Director of MaineCare, and Noel Genova, PA-C.  Dr. Flanigan will discuss the work MaineCare officials are doing to limit the amount of opiate medication being prescribed to MaineCare patients and Ms. Genova will discuss the work of the Chronic Pain Project funded by the Maine Board of Licensure in Medicine and offered to all prescribers through the Maine Medical Association.
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Caring for Our Elders the Theme of MMA's 159th Annual Session, Sept. 7-9

Registration materials for the Association's 159th Annual Meeting were recently mailed to all members.  The meeting will be held in Bar Harbor again this year, at the Harboside Hotel and Marina, September 7-9th.  The Friday afternoon educational program will be held at the Jackson Laboratory.  

The room block at the Harborside Hotel and Marina expired on August 10th.  However, rooms may still be available and the MMA does maintain a list of alternative accommodations in the Bar Harbor area and members and guests are asked to contact Diane McMahon at MMA for the list ( or call 622-3374 ext. 216.)

The theme of this year's CME program is Caring for Our Elders and the keynote speaker is well-known author and geriatrician Dennis McCullough, M.D.  Dr. McCullough is the author of the best-selling book entitled, My Mother, Your Mother, Embracing Slow Medicine (2008). He is also the co-author of The Little Black Book of Geriatrics.  Dr. McCullough is associated with Dartmouth Medical School and resides in Norwich, Vermont.

On Saturday evening, MMA President Nancy M. Cummings, M.D. will  present the Presidential gavel and medallion to in-coming President Dieter Kreckel, M.D.  Dr. Kreckel is a family physician practicing in Rumford. He is a former President of the Maine Academy of Family Physicians.

Interested members may also register on the Association's website.

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Join MMA in Phasing out BPA from Baby and Toddler Food Packaging

The Maine Medical Association is working with other health professional associations in Maine and the Alliance for a Clean and Healthy Maine to support a proposed rule to phase out BPA from baby and toddler food packaging sold in Maine.  Maine designated BPA as a priority chemical in 2010, and banned the sale of baby bottles, sippy cups, and other reusable plastic bottles with BPA.  This next step seeks to ban the use of BPA in infant and toddler food or beverage packaging in Maine. A summary of the proposed rule and a science update on BPA by Dr. Laura Vandenberg of Tufts University are linked here.

Please CLICK HERE to join fellow health professionals from around the state in a sign-on letter that will be delivered to the Maine Board of Environmental Protection at a public hearing in September. (The letter is included in the link.  Please email Emma Halas-O’Connor to sign on if you have any trouble with the link:

The sign-on deadline is September 4, and it only takes a minute! If you have any questions, please contact Emma Halas-O’Connor at the Environmental Health Strategy Center ( or 207-699-5799).

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Effective Date of MaineCare Opiate Limits to be Delayed

MaineCare has not yet released final details of their plan to implement  changes to the MaineCare opioid coverage and other pain management issues contained in the supplemental budget that passed the legislature in May, but an advisory committee to provide input on how the State should implement the changes has met twice.  Kevin Flanigan, MD, Medical Director of MaineCare Services, convened the group and has stated that the limits for patients and prior authorization requirements will not be put into effect until the advisory group settles on criteria for a prior authorization process and the changes go through the rulemaking process.  A realistic date for any limits or prior authorizations being in place for patients is January 1, 2013.  The State is planning to begin generating reports comparing clinicians' opioid prescribing to peers sooner, ideally by the August 30th effective date of the budget.  

As a reminder, a summary of the provisions in the budget can be found on the MMA website, here, and include limits on prescriptions of opioid medication for acute pain, requirements for patients to participate in alternative interventions before receiving prescriptions for chronic pain, prior authorizations before patients with certain diagnoses can receive opioid medications, and generating reports for prescribers showing how their prescribing patterns compare to their peers.  [return to top]

Maine Department of Labor Issues Report on 2011 Violence Against Caregivers

In 2011, more than 1,300 workers in healthcare or rehabilitation settings were hurt on the job by a patient or client, a report issued last week by the Research and Statistics Unit of the Maine Department of Labor indicates. Aggressive acts that resulted in worker injuries include hitting, biting and kicking; workers also sustained injuries while trying to restrain a patient or client.

The Research and Statistics Unit, part of the Bureau of Labor Standards, compiled the data from the First Reports of Injury of the Workers' Compensation Board 2011 database. 

Research regarding violent or aggressive actions by recipients of mental health care, residential care, health care and social assistance and disability rehabilitation services found that a significant number of violent or aggressive acts target caregivers and social assistance providers. 

In 2011, about 100,000 people in Maine were employed in the healthcare occupations covered in this report, and 9,965 cases related to those occupations were filed with the Maine's Workers' Compensation Board. A review of those cases identified that 13.4 percent included injuries caused by violent/aggressive actions of care and social-assistance recipients. These recipients included mental healthcare, substance abuse and general healthcare patients as well as residential clients, disability rehabilitation students and others.

The report reviews such case factors as the numbers of incidents per organizational setting, the occupations of the injured and the types and prevalence of injuries. Due to the high number of bite incidents, a specific section focuses on bite injuries and references information from the Federal Bureau of Prisons' 2009 Clinical Guidelines regarding viral and bacterial exposures.

This report is located on the Department of Labor's website at

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Showing of The Healthcare Movie Marks Start of Midcoast Chapter, Maine AllCare

Maine AllCare invites Maine physicians and health care providers to the first gathering of the Midcoast Chapter of Maine AllCare at 6:30 p.m. on Wednesday, August 29, at the Bath City Hall auditorium.  

The speaker for the evening will be Dr. Julie Pease from Brunswick, president of Maine All Care, who will guide attendees through a film called The Healthcare Movie.

The mission of the Midcoast AllCare chapter, an all-volunteer, non-profit organization, is to promote quality, affordable, equitable and universal health care for Maine people through research, education and advocacy.  Maine AllCare is a chapter of the national Physicians for a National Health Program

There will be refreshments and a social after the film.

Contact:  Karen Johnson, Chapter leader,  263-4815 or

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Successful ACOs Based on More Than Medicare Shared Savings Model, Report Says

The components of successful accountable care organizations (ACOs) go well beyond what is detailed in the health reform law or the Medicare Shared Savings Program (MSSP), according to a report released Aug. 10 by a national alliance of hospitals and health care systems.

The report, Accountable Care Strategies: Lessons from the Premier Health Care Alliance's Accountable Care Collaborative, by the Premier healthcare alliance, a provider-owned performance improvement alliance of 2,600 hospitals and 84,000 other care organizations, lists components needed to implement an effective ACO, including:

  • a “health home” approach to providing comprehensive primary care;
  • population health and data management;
  • a provider network that delivers top outcomes at reduced cost;
  • an established governance structure; and
  • payer partnerships with value-based payments.

The report was sponsored by the Commonwealth Fund, a private foundation that aims to promote a high performing health care system. The report is available by clicking here.

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Upcoming Events & Conferences


2012 New England Clinical Symposium & Workforce Summit 

August 23, 2012 

Holiday Inn By the Bay, Portland

Maine Primary Care Association and the Maine Office of Rural Health and Primary Care will host their first Summit  featuring two prominent keynote addresses, an 'Ask the Expert' Roundtable/World Café, a clinical track on caring for aging New England and a workforce development track. Target audience includes the clinicians and administrators of New England's critical access hospitals, community health centers, rural clinics and tribal health centers.

For more information or to register, click here


3rd Annual Patient Safety Academy

September 7, 2012

USM Portland Campus, Abromson Center 

Join colleagues and other health care professionals this September in an engaging and thought-provoking day of presentations, workshops, and skill-building activities designed to advance patient safety throughout the state and region.

For more information or to register, click here


17th Annual Northern New England Conference on Child Maltreatment 

September 13 & 14, 2012

University of New England Campus Center, Biddeford, ME 

The goal of this conference is to provide multi-disciplinary training to increase professional skills and knowledge of professionals who are involved in child abuse prevention, recognition, evaluation, reporting, investigation, treatment and all forms of child maltreatment. 

For more information, email or call 207-321-6080 x 3311. 


First Annual Let's Go 5210 Childhood Obesity Conference 

September 27 & 28, 2012

Maine Health Conference Center, 110 Free Street, Portland 

For anyone who works 1:1 with patients and families.  Learn how to build capacity in your practice, in your community and for your patients. 

For more information, click here.


11th Annual Downeast Ophthalmology Symposium

September 28-30, 2012

Harborside Hotel & Marina, Bar Harbor, Maine

The Maine Society of Eye Physicians and Surgeons will host the 11th Annual Downeast Ophthalmology Symposium in beautiful Bar Harbor, Maine once again this year.  Offering 15.25 AMA PRA Category 1 Credits to ophthalmologists across the country.  

For more information and registration information, click here


Making Strides Against Breast Cancer Fundraising Walk 

October 14, 2012

Monument Square, Portland 

The annual American Cancer Society Making Strides Against Breast Cancer® three-mile fundraising walk will unite the community to honor and celebrate breast cancer survivors, educate women about the importance of early detection, raise funds for the fight to end breast cancer, and commemorate two decades of making a difference in the fight to end breast cancer. 

For more information or to register, click here.


Maine Public Health Association 2012 Annual Conference 

Community Connections: Building Creative Partnerships for the Health of All Mainers

October 17, 2012

Civic Center, Augusta 

Join us at Maine's premier Professional Public Health event, the 28th MPHA Annual Meeting. We will be partnering with many organizations across the State to bring the highest quality of education, innovation and inspiration to those that work in and around the field of public health.

For for information or to register, click here


Maine CDC Infectious Disease Conference 

November 13, 12012

Augusta Civic Center, Augusta, Maine

Presenting a review of emerging issues in the field of infectious diseases, particularly as they impact the Maine medical community. 

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

Job Openings

Medical Director/Family Practice Physician

Katahdin Valley Health Center, established in 1974, is a high performing FQHC with a continuous track record of growth and stability.   KVHC seeks a Medical Director/Family Practice Physician to join our team and pursue our mission to provide community accessible, quality healthcare with compassion and dignity.   The Medical Director at KVHC will begin by providing patient primary care 3 days per week and performing administrative Medical Director Duties the other 2 days of the week.  This position will progressively move to a Full Time Medical Director Administrative role.  KVHC offers state of the art facilities and technology, electronic medical records, as well as a competitive salary and benefits package which include sign on bonus, generous amounts of paid time off, health insurance, life and disability insurance as well as Federal Torts Claims Act (FTCA) malpractice coverage. No nights, no weekends, either limited or no inpatient care and limited call coverage.  

KVHC has site locations in Houlton, Island Falls, Patten and Millinocket.  The Medical Director will work between the Houlton and Patten site, or the Millinocket and Patten Site.  Interested applicants should contact Michelle LeFay at or visit our website at  KVHC is an equal opportunity employer.


Family Practice Physicians - Millinocket & Houlton, Maine Locations

Katahdin Valley Health Center is recruiting dedicated Family Practice Physicians that are committed to providing quality health care services to the people in Central/Northern Maine.  Join our practice in one of the newly expanded facilities.  We are seeking physicians for our Millinocket and Houlton locations.  KVHC is a fully electronic medical record site and offers a competitive salary and benefits package which includes sign on bonus, generous amounts of paid time off, health insurance, life and disability insurance as well as Federal Torts Claims Act (FTCA) malpractice coverage.  No nights, no weekends, either limited or no inpatient care and limited call coverage.  Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.

Physicians that join KVHC will be providing quality care in a dynamic, cutting edge environment, within a patient focused team of 11 Providers and 90 Staff Members.  As one of New England’s highest performing Federally Qualified Health Centers (FQHC), KVHC has a mission to provide community accessible, quality healthcare with compassion and dignity. 

To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at or visit our website at  KVHC is an equal opportunity employer.


Exceptional Internal Medicine Opportunity in Kennebunk, Maine 

SMMC PrimeCare Internal Medicine Kennebunk is seeking a BC/BE internal medicine physician for their busy outpatient office located in downtown Kennebunk on the beautiful southern coast of Maine.  This well-established, highly desirable practice has current providers leaving clinical practice and is a unique opportunity for a motivated and creative individual interested in ensuring the healthcare needs of patients is delivered with highest level of quality.  For more information, please contact Katie Wechter at (207)294-8404.


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