First Circuit Dismisses LePage Administration Lawsuit over MaineCare
On Thursday, September 14th, a three-judge panel from the First Circuit Court of Appeals in Boston denied the request by the State of Maine to force federal health officials to expedite the approval of the Medicaid State Plan Amendment (SPA) request to make approximately $20 million in MaineCare reductions impacting more than 36,000 Mainers.
The First Circuit U.S. Court of Appeals dismissed the State's lawsuit seeking to force the Centers for Medicare & Medicaid Services (CMS) to decide whether the LePage Administration could cut MaineCare eligibility in accordance with the Governor's supplemental budget proposal approved by majority Republicans in the legislature during the last session.
The one-page decision by the court said that “the facts do not warrant” the state’s request to have an expedited review of its request for a Medicaid State Plan Amendment that would have allowed the state to make the cuts, which would affect coverage for about 36,000 low-income residents.
CMS had not denied the State's request, but had stated that it needed more time to make a decision and could not give an answer by the State's requested September 1st deadline. By law, CMS has 90 days, or until November 1st, to make a decision. A MaineCare representative speaking to the MaineCare Provider Advisory Group earlier in the day Thursday stated that MaineCare beneficiaries will not be cut before the State has an answer from CMS, and it will likely take at least 30 days after a response to actually put the changes in place.
MaineCare Provider Advisory Group Meets, MIHMS Portal Scheduled Downtime
Last Thursday, September 13th, the MaineCare Technical Advisory Group and Provider Advisory Group held its regular monthly meeting. Among the topics discussed were:
[return to top]
MaineCare eligibility and the request to CMS to cut eligibility for parents from 100-200% of the federal poverty level, young adults age 19-20, and some seniors. Stefanie Nadeau explained that no cuts would be made until the State received approval from CMS. CMS has 90 days from when the request was filed, or until November 1st, to make a decision, though the State filed a lawsuit to expedite the decision (see accompanying article).
The limit on brand name drugs passed by the legislature. As directed by the Legislature in the budget process, MaineCare Services is now imposing a mandatory substitution for a brand-name drug of a generic and therapeutically equivalent drug, with certain exceptions. The Department had promulgated another emergency rule, effective 4/1/12, that limited the number of brand-name drugs members may receive per month without Prior Authorization. However, after further legal analysis, the Department concluded that the budgetary requirement to substitute generic drugs precluded a specified limit on brand-name medications, and the Department will not be implementing a new limit on brand-name drugs.
Claims system down. Due to testing of the data disaster recovery system, the MIHMS Health PAS Online Portal will be unavailable from 8 p.m. on Friday, October 12th through 3 a.m. Monday, October 15th. This will not impact the regular weekly schedule for provider payments; however, payments for the week ending October 19th will include six days of claims rather than a full week. Claims must be submitted by noon on Thursday, October 11th, to be included in that week’s processing cycle. Electronic Fund Transfer (EFT), PDF Remittance Advices (RAs), and 835s will be unaffected, and paper Remittance Advices (RAs) and checks will be on schedule.
Census Bureau Report Says Uninsured Rate Dropped Nationally in 2011; Maine Bucks Trend
On September 12th, the U.S. Census Bureau released Income, Poverty, and Health Insurance Coverage in the United States: 2011, the Bureau's annual report based on the results of its 2012 Current Population Survey Annual Social and Economic Supplement. The report concludes that in 2011 the uninsured rate in the United States as a whole decreased from 16.3% to 15.7%, though median household income declined by 1.5%. In 2011, the number of people with health insurance coverage increased to 260.2 million, or 84.3% of the population. The rate of people covered by private health insurance was not statistically different from 2010, but it is the first time in ten years that the rate of private health insurance has not decreased. The rate of people covered by government health insurance programs (Medicare, Medicaid, CHIP, and military programs) increased for the fifth consecutive year to 32.2% in 2011.
[return to top]
In contrast, in Maine there was an increase last year in the percentage of residents living without health insurance from 9.3% to 10%. Fewer people were insured by both private and government health care programs.
You can find the report on the web at: http://www.census.gov/hhes/www/hlthins/.
EHR Meaningful Use Audits Are Underway
Audits are underway to assess whether electronic health record (EHR) incentive payments made to physicians and other providers were made correctly. At this time, CMS is not sharing information on how many providers are being audited. Physicians attesting to meeting the meaningful use of EHRs requirements for either Medicare or Medicaid incentive programs should retain all relevant supporting documentation (in either paper or the electronic format used in completing the online attestation) for six years post-attestation. The government has developed guidance material, including a 10-step plan to help physicians navigate this process. CMS also has an extensive list of frequently asked questions on the meaningful use requirements. More information can be found on the CMS web site: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/. The contractor who is overseeing the Meaningful Use audits is Figliozzi and Company. Meaningful use audit questions can be directed to Peter Figliozzi at (516) 745-6400, ext. 302 or by email at firstname.lastname@example.org. [return to top]
New Study Highlights Potential Benefits of Accountable Care
A Medicare pilot program that financially rewarded physicians for meeting cost and quality targets achieved significant savings in the care provided to a patient population that is especially burdened by illness and costly health care needs, according to a study released last Wednesday. The new research, which appears in the Journal of the American Medical Association (September 12th), highlights the promise of new models of delivering health care, including accountable care organizations, that reward providers for coordinating and improving patient care—and that may slow cost growth in treating some of the sickest patients.
The study, conducted by the Dartmouth Institute for Health Policy & Clinical Practice, focused on the Physician Group Practice Demonstration, which ran from 2005 to 2010. Ten physician groups, representing 5,000 physicians and 220,000 Medicare fee-for-service beneficiaries, received bonus payments if they met quality targets and reduced spending on care. The Dartmouth researchers found that participating practices generated particularly large savings in the care of "dual eligibles"—the low-income elderly individuals and people with disabilities who are enrolled in both Medicare and Medicaid.
Funding for the study was provided by the Dartmouth Atlas Project and with support from the National Institute on Aging and The Commonwealth Fund. [return to top]
New York City First to Ban Oversized Sugary Drinks
On Thursday, September 13th, the City of New York passed a ban on over-sized sugary drinks in an attempt to reduce obesity and its complications. By an 8-0 vote with one abstention, the City's Board of Health ratified Mayor Michael Bloomberg's plan to outlaw sugary drinks larger than 16 ounces, except in grocery store and convenience stores. The ban does not include diet sodas, drinks that are more than 70-percent fruit juice, or that contain alcohol.
Violators of the ban, the first of its kind in the country, face a $200 fine. It takes effect in March 2013. Opponents, largely organized by the beverage industry, have threatened court action in an attempt to stop the action.
[return to top]
HHS Releases Interim Final Rule on Electronic Funds Transfer/Remittance Advice
The U.S. Department of Health & Human Services (DHHS) last month released the Interim Final Rule with comment period for the electronic funds transfer (EFT) and electronic remittance advice (ERA) operating rules. The proposal calls for the adoption of Phase III Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, for the health care EFT and ERA transactions, but does not adopt the acknowledgement requirements, which remain under consideration by HHS. This is a tremendous victory for physicians because it will enable them to determine the patient's financial responsibility when care is provided, thus enabling them to settle payment before the patient leaves the office.
The highlights of the EFT and ERA operating rules include the following requirements:
[return to top]
Health plans must provide standardized and streamlined paper-based and online EFT and ERA enrollment forms.
Physicians must work with their banks to ensure all the EFT information sent by the health plans is transmitted to the practice so that the EFT can be re-associated with the ERA.
Health plans must transmit the EFT within three days of the transmission of the ERA.
Health plans that issue proprietary paper claim remittance advice must continue to offer paper remittance advice for a minimum of 31 days from the implementation of ERA to ensure a smooth transition.
Health plans must use standard claims adjustment reason and remark codes for four common business scenarios. The four business scenarios include: Additional Information Required - Missing/Invalid/Incomplete Documentation; Additional Information Required - Missing/Invalid/Incomplete Data from Submitted Claim; Billed Service Not Covered by Health Plan; and Benefit for Billed Service Not Separately Payable.
Health plans must use a standardized and streamlined companion guide to describe any health plan- specific rules associated with the EFT and ERA transactions.
The AMA will be reviewing this interim final rule in detail and will submit comments by the October 9th deadline. The compliance date for operating rules for the health care EFT and ERA transactions is January 1, 2014.
Health Effects of Climate Change Presentation, September 19th
Doctor Wendy Ring, a 56 year old family physician and long time member of Physicians for Social Responsibility, is riding a bicycle across the United States to draw attention to global warming as a public health emergency.
Join Physicians for Social Responsibility as they welcome Dr. Ring to Portland for her presentation:
The Health Effects of Climate Change
Wednesday, September 19, 7:00 PM
Maine Audubon, Gilsland Farm, Falmouth, ME
For more information, contact Karen A D’Andrea, Executive Director, Physicians for Social Responsibility, ME Chapter, email@example.com, 207-210-0084
Learn more about Dr. Ring here. [return to top]
Public Health Association Seeks Award Nominees
The Maine Public Health Association is pleased to announce its fall Call for Award Nominations. The MPHA will be honoring two esteemed colleagues at its fall conference with the Public Health Program of Excellence award and the Ruth Shaper Memorial award.
Nomination forms can be found here, are easy to complete and are due Friday, September 21st. You do not need to be a member of MPHA to submit, or receive, a nomination.
You can register for our conference, to be held October 17th at the Augusta Civic Center, titled Community Connections: Building Creative Partnerships for the Health of All Mainers, here.
Please consider nominating a deserving co-worker or colleague.
The Program of Excellence Award is to increase the visibility of public health initiatives in Maine, to promote adoption of effective public health programs, and to provide recognition to organizations involved in successful collaborative public health initiatives. Past award winners are included on the nomination form.
[return to top]
The Ruth S. Shaper Memorial Award recognizes an individual who has made a significant contribution in the area of public health. The individual will have demonstrated a broad orientation to health promotion and disease prevention that extends beyond his/her specific profession or field of interest. For example, the individual may have made a meaningful impact in health legislation, health education, health policy development, or consumer advocacy at either the community or state level. Professional rank or status in an organization is not an important factor. The nominee need not be a member of the Maine Public Health Association. Past award winners are included on the nomination form.
National Drug Take-Back Day Scheduled for Saturday, 9/29 in Androscoggin County
The U.S. Drug Enforcement Administration (DEA) has scheduled another annual Drug Take-Back Initiative for Saturday, September 29, 2012 at the following 8 locations in Androscoggin County.
Farwell Elementary School, Lewiston
Bedard Pharmacy, Auburn
Poland Town Office parking lot
Greene Town Office
Mechanic Falls Police Department
Livermore Falls Police Department
Sabattus Police Department
Lisbon Police Department
The Take-Back Day sites will be open from 10 a.m. to 2 p.m.
[return to top]
You can find more information about a specific site by calling the local police department or Healthy Androscoggin at 795-2120.
Upcoming Events & Conferences
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.
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 Cardiovascular Summit
Best Practice: Cardiovascular Care in the Field, in the Clinical Practice, and in the Community
November 8, 2012
Samoset Resort, Rockport
National and local cardiovascular health experts will come together to discuss best practice in cardiovascular care.
For more 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]
Chief Medical Officer
Community Health Options (MCHO) is a non-profit consumer operated and oriented
plan (CO-OP) in Maine. The purpose of the CO-OP is to provide affordable
healthcare insurance options that are designed to improve health outcomes.
MCHO seeks a
Chief Medical Officer (CMO) to provide clinical and administrative leadership
for all clinical aspects of MCHO. As the
clinical senior executive leader, the CMO will ensure effective and efficient
delivery of quality care consistent with the mission and vision of Maine
Community Health Options.
The CMO will
provide strategic direction, strategy execution and implementation of clinical
and care management programs.
Specifically, s/he will provide clinical perspective and guidance on
provider credentialing as well as direct, develop and provide oversight of
medical and behavioral treatment policy, utilization review and management,
quality management, disease/care management, and pharmacy initiatives.
The CMO will
analyze data from multiple sources to identify and respond to trends and /or
emerging issues, design clinical interventions and programs to simultaneously
improve overall health outcomes and reduce the costs of care, plan and direct
MCHO's clinical approaches in support of the patient- centered health home
initiative, oversee management of complex cases and direct management of care
coordination with practitioners, oversee and direct MCHO vendor resources in
the coordination of patient care, assist with provider network development ,
chair clinical/quality committee(s) focusing on health care outcomes and
service improvements, provide clinical reports to MCHO executive leadership and
Board, and serve as a liaison to external parties and institutions.
within MCHO are expected to lead with integrity, humility, strategic vision,
curiosity, and discipline. They must be
highly effective and compassionate communicators, effectively manage work and
processes and actively engage in continuous process improvement.
or DO with unrestricted medical license in Maine
of five years of direct clinical experience
of five years of leadership and involvement in medical staff activities
of five years of management experience within a health care delivery
of three years of experience in medical management in a managed care setting or
of applicable National, State and local laws and regulations, JCAHO, NCQA and
other regulatory requirements affecting MCHO clinical operations
Preferred Degrees, Licensure, and/or Certification: Board
certification in medical management
This is a
unique opportunity to join a new and establishing organization in Maine. Please send a resume and letter of
application to firstname.lastname@example.org no later than October 11, 2012.
Director of Care Management
Maine Community Health Options (MCHO) is a non-profit
consumer operated oriented plan (CO-OP) in Maine. The purpose of the CO-OP is
to provide affordable healthcare insurance options that are designed to improve
MCHO seeks a Director of Care Management to serve as the
strategist for care management and to ensure that all resources are effectively
deployed to effect optimal health outcomes.
The Director will collaborate with the Chief Medical Officer.
The Director of Care management will direct, plan, and
supervise activities and priorities within Care Management, ensure compliance
with approved standardized guidelines, government mandated regulations and
contractual agreements, collaborate to ensure processes are in place to
accomplish all defined goals and quality metrics, coordinate personnel to meet
medical management operational program needs, foster open communication between
MCHO and practitioners by acting as care management liaison, monitor and
oversee the reporting of all quality issues and act as a catalyst for change
and enhancement of processes.
Directors within MCHO are expected to lead with integrity,
humility, strategic vision, curiosity, discipline, highly effective and
compassionate communication, effective management of work and processes and
active engagement in process improvement.
- Masters of
Science in Nursing, or Nurse Practitioner
Registered Nurse (RN) license in ME
- Five or more
years of care management experience
- A minimum of
five years of management experience
- Data mining,
analytical and reporting skills
This is a unique opportunity to join a new and establishing
organization in Maine. Please send a
resume and letter of application to email@example.com no later than September 23, 2012.
MD/DO Position Available in Dexter, Maine
Sebasticook Family Doctors is accepting applications for a
MD/DO at our busy Dexter location. Ideal candidate will have two or
more years experience in a busy community health outpatient setting
delivering high quality care. Exceptional clinical, interpersonal and
EMR skills are required. SFD offers excellent compensation, benefits
and working environment. Join our growing team!
applicants should send resume and cover letter to: Melanie Knowles,
Human Resources, Sebasticook Family Doctors, 18 Moosehead Trail, Suite
5, Newport, ME 04953 or at firstname.lastname@example.org.
Family Practice Physicians
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, Patten 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 email@example.com or visit our website at www.kvhc.org. KVHC is an equal opportunity employer.
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 firstname.lastname@example.org or visit our website at www.kvhc.org. KVHC is an equal opportunity employer.
Psychiatric Nurse Practitioner
Sebasticook Family Doctors is a
Federally Qualified Health Care Center currently accepting applications
for a Full Time Psychiatric Nurse Practioner for our Dexter location.
Position includes assessment, medical management, therapy and group
work. Ideal candidtate will have 3 or more years experience in a busy
community health outpatient setting delivering high quality care.
Excellent compensation, benefits and working environment.
Send resume and cover letter to: Melanie Knowles, Human Resources, Sebasticook Family Doctors,
18 Moosehead Trail, Suite 5, Newport, ME 04953 or by email at email@example.com.
10/8/12 [return to top]