December 31, 2012

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All Eyes on Washington D.C. as Negotiations Continue into New Year's Eve

Holding its first session between Christmas and New Year's Day in nearly fifty years, the United States Congress continues to look for a compromise between the major parties which would allow for at least a stop-gap measure to pass prior to Wednesday in order to avoid going over what has become popularly known as the fiscal cliff.  Without some type of legislation passing and being signed into law by the President within the next couple days, not only do taxes rise on most Americans but Medicare payments to Maine physicians also are reduced by approximately 30%, representing well over $100 million on an annual basis.  While the House of Representatives will not be voting on any bill tonight, the negotiations seem to be going well enough to expect a vote by tomorrow or Wednesday.

While the new Congress being sworn in on Wednesday (Jan. 2, 2013) could act immediately if Congressional leaders and President come to an agreement, there is no assurance that the new Congress will be any better prepared to deal with the crisis than the existing Congress.   But while the prospect for fixing the Medicare payment problem is largely tied to year-end federal budget negotiations that would prevent the tax increases and the across the board cuts brought on by sequestration, if no year-end deal is reached, Congress could pass a stand-alone physician pay fix if it chose to do so.

With no action in sight at that point, CMS announced two weeks ago that claims would be processed in 2013 under the lower rate (conversion factor would be approximately $25 instead of the current $34) for services provided in 2013. 

Republicans in the House had proposed a solution that would kick the can down the road for another year, but would pay for some of that delay by eliminating provider-based reimbursement in hospital outpatient departments and eliminate or postpone the primary care rate increase effective Jan. 1 because of provisions in the Affordable Care Act.   Both of these "pay-fors" are very unpopular with many Democrats and with hospitals and primary care physicians.  In previous issues of the Update we have noted the strong opposition of Maine's hospitals to elimination of provider-based reimbursement.  With respect to the primary care fee increase, MaineCare announced just last week that it would be bumping up MaineCare payments to primary care physicians to Medicare levels for 2013 and 2014, effective Jan. 1, 2013.  

MMA continues to be in touch with the members of our Congressional delegation urging them in the strongest possible terms to at least delay the nearly 30% reduction in Medicare fees. The following talking points from the AMA provide a sense of the impact of the impending SGR cut in Maine.

  • Maine seniors face significant challenges obtaining access to physicians.  These challenges will get much worse unless Congress acts very soon to permanently prevent steep cuts in Medicare payment rates.  At just 14 practicing physicians per 1000 Medicare beneficiaries, Maine is well below the national average.  Twenty-nine percent of Maine's Medicare beneficiaries are living below 150% of the federal poverty level.  Maine is also one of 29 states and the District of Columbia that have imposed cuts in services for low-income elderly, such as home care and rehabilitation.
  • Congress needs to avert the SGR cut and eliminate the formula that leads to this annual crisis.  SGR legislation would prevent a loss of $100 million annually for the care of elderly and disabled patients in Maine.  On average, a cut of this magnitude will reduce 2013 practice revenues by $21,000 per Maine physician, which will worsen access problems and make it extremely difficult to pay for office space and other expenses and avoid staff layoffs.  
  • 14,935 employees of medical practices, 262,290 Medicare patients and 42,524 Tricare patients in Maine will be helped by the legislation that averts these cuts.
  • Compared to the rest of the country, Maine, at 20%, has an above-average proportion of Medicare patients.
  • Almost 50% of Maine's practicing physicians are older than 50, an age at which surveys have shown many physicians consider reducing their patient care activities.
With Congress having failed to address the pending cut, physicians may wish to check out the AMA Medical Participation Options Kit.  For questions about Par, Non-Par, and opting out/private contracting, go to

MMA Welcomes 2013: Important Dates and Fee Changes Announced

The leadership and staff of the Maine Medical Association welcome a new year and look forward to an array of events and programs celebrating the Association's 160th Anniversary.  Founded on April 28, 1853 at a meeting at the Tontine Hotel in Brunswick, the Association has been a continuous advocate for physicians, patients and the health of the public for 160 years.  An anniversary Gala will be held on Saturday, Oct. 5, 2013 as part of the Association's 2013 Annual Meeting.  The location is the Holiday Inn by the Bay in downtown Portland.  Please mark the date on your 2013 calender.  More information will be available throughout the year.

The Association also wishes to announce a modest change in the fees charged for reviewing contracts for members.  We have held to the existing price of $250 for several years and now find it necessary to increase the charge to $350, effective Jan. 1, 2013.  We still believe that this charge for a legal review of the provisions of a contract and all available appendices and exhibits is a bargain. An increasing number of members are utilizing the service for review of their employment agreements.  But we will also review other types of contracts such as managed care or ACO agreements.

 We wish all of the members, practice managers, corporate affiliates and other readers of the Weekly Update all the best for the new year.  We appreciate your continued support of the Association.

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MaineCare Limits on Opioid Based Pain Medication Take Effect Tomorrow

 The limits impact both prescriptions for acute pain and chronic pain and will be effective retroactively.  The  proposal, which is still being put into an emergency rule, is posted on the MMA website at (in Spotlight section).  There are also new limits on methadone and Suboxone prescribed for treatment of addiction and those limits are discussed below in a separate article.

The Work Group, consisting of physicians, mid-level providers, and advocates for MaineCare patients (MMA staff participated as well) met seven times over the summer and fall and received input from a wide variety of sources.  While the final supplemental budget took effect on August 30th, DHHS Commissioner Mary Mayhew agreed to delay the implementation of the limits until January 1, 2013, in order to provide the Work Group with time to receive input and provide recommendations for the emergency rule being drafted.  

The proposal is divided into sections dealing with acute pain (pain expected to be resolved within 60 days) and non-acute or chronic pain.   Exceptions to the limits are made for the following categories:

  1. A MaineCare member who is receiving opioid medications for symptoms related to HIV, AIDS and cancer and other qualifying diseases and conditions, as set forth on the Department's Preferred Drug List.
  2. A MaineCare member who is receiving opioid medications during inpatient treatment in a hospital, in a nursing facility or during hospice care.
  3. A MaineCare member who is receiving 30 milligrams or less of morphine sulfate equivalents on a daily basis.
  4. A MaineCare member for whom MaineCare reimbursement for opioid medications for the treatment of addiction is restricted by limits applicable to methadone and buprenorphine and naloxone combination medications.

While prescribers impacted by the limits are encouraged to review the details of the proposal on the MMA website (in Spotlight section) at, the essence of the proposal is a limit of 15 days of medication for acute pain, with the ability to receive up to three 14 day renewals through prior authorization so long as there is a face to face visit with the patient.  A renewal beyond 57 days would require a treatment plan consisting of incorporation of non pharmacologic treatments and functional assessment of the member by the physician or other prescriber.  In essence, treatment beyond 57 days will move the patient to the non-acute, or chronic pain limits.

For treatment for chronic pain, opioids will be covered by MaineCare only after one or more non-pharmacologic treatment alternatives are attempted.  The proposed rule includes as such alternatives physical therapy, occupational therapy, chiropractic therapy, osteopathic manipulative treatment, cognitive behavioral therapy, and acceptance commitment therapy. Note that the Department may waive the requirement of a non pharmacologic intervention treatment through prior authorization when participation is not feasible and opioid treatment is medically necessary.

Post-surgical pain is treated as acute pain, but a more liberal provision applies as after the first fifteen day script, the surgeon may renew the script for a total of 60 days, in one or multiple prescriptions through prior authorization.  But there is a requirement that the patient be seen by a provider (not necessarily the surgeon).

Efforts are being made to notify patients and prescribers before the limits take effect. MMA staff is available to present CME programs on this topic to medical staffs and other interested groups.  If your practice or staff is interested in a presentation, contact Gordon Smith, Esq., at or by calling 622-3374, ext. 212.  Dr. Flanigan is frequently able to present as well and he can be reached at his MaineCare office at 287-1827.

Finally, physicians are reminded that these limits imposed by the Legislature are limits on the ability of MaineCare to pay for the medication.  The physician is free to write for whatever medication he or she believes is appropriate for the patient and the patient may pay cash for the medication if it is not covered by MaineCare. But in doing so, the prescriber may wish to consider whether these limits will eventually be considered the appropriate standard of care for treatment of pain. [return to top]

Two Year Limit on Suboxone and Methadone for Treatment of Addiction Begins Jan. 1

 The two year limit for MaineCare coverage of methadone and Suboxone, established by the Maine Legislature earlier this year, will take effect tomorrow (Jan. 1, 2013).  The limit on methadone will not apply retroactively so the two year period begins tomorrow.  But the limit on Suboxone will apply retroactively so that a patient who has been on the medication for two years will need a prior authorization from MaineCare to continue the treatment.

Throughout the fall, two different working groups have met several times with MaineCare Medical Director Kevin Flanigan, M.D. to make recommendations on the criteria to be applied to the requests for prior approval.   These recommendations rely heavily on the improved functioning of the patient.  The work of the two groups has been completed and the recommendations are in the hands of MaineCare staff.  It is believed that these recommendations will form the criteria for the PA decisions which will be made by the state's contractor, Goold Health Systems.

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Attestation Form for MaineCare Primary Care Payment Bump Available; Must be Completed

As reported in previous issues of the Update, the Office MaineCare Services (OMS) is implementing Section 1202 of the Affordable Care Act, effective January 1, 2013 which requires Medicaid programs to pay “for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor.” 

In order to receive the increased rate, providers must fill out and submit a Self Attestation form. By completing the form, providers attest that s/he meets the criteria established by the ACA – specifically, that:

  • they are appropriately Board certified; OR 
  • that 60 percent of their Medicaid claims are for evaluation and management (E&M) and vaccine administration codes as specified in the federal rule.  

The Self-Attestation form can be found here (downloadable Word document) and provides detail on each of the above criteria.

Provider files will be updated once OMS has approved your form, and OMS will send you a confirmation via email. Please note that the increase will not occur until OMS has approved your form, and that payments will be retroactive to 1/01/13. 

If you have any questions, please contact Donna Sutter at OMS at (207) 629-4280. [return to top]

Governor LePage Releases Curtailment Order Impacting DHHS

Governor Paul LePage issued a curtailment order December 27th that proposes to cut $35.5 in state spending in order to help balance the 2012-2013 State Fiscal Year budget that ends June 30th. 

The Department of Health and Human Services would have to reduce spending by $13.43 million. The DHHS cuts affect programs throughout the agency, including the Bureau of Mental Health, independent living services for people with disabilities, the Office of Substance Abuse, and Maine’s two psychiatric centers.  It cuts $1.5 million in funding to mental health and substance abuse providers, $1.4 million in child adoption services and $1.9 million in foster care services.

The other big cuts are to K-12 education and Maine’s public higher education institutions. 

The state Constitution authorizes the governor to make temporary, across-the-board spending reductions to bring the state budget into balance. The cuts must be relatively equitable among departments.  Some of the cuts wouldn't take effect for several months and the Legislature will have a chance to consider them as part of a supplemental budget package that the LePage Administration is preparing.  

The supplemental budget will also have to close a DHHS shortfall of over than $100 million in the state’s Medicaid program.  Finally, the Governor is preparing to introduce a budget for the two-year period beginning July 1, 2013 that has to address a structural shortfall in excess of $750 million, a significant portion of which can be attributed to an income tax cut passed by the legislature last session.

The new Legislature’s Appropriations Committee is meeting this Friday, January 4th and will begin considering the elements of the curtailment order. The full Legislature reconvenes January 8th for the new session. 

The order is available by clicking here[return to top]

MMA Legislative Committee to Hold First Conference Call Next Tuesday, Jan. 8

The MMA Legislative Committee weekly phone calls will begin next week, Tuesday, January 8th.  They will be held every Tuesday at 8 pm through the session. 

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.  

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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Free First Friday Education Program on MaineCare Opiate Limits and Prescription Drug Abuse, Feb. 1

The MMA's First Fridays Educational Series for 2013 begins on Friday, Feb. 1 from 9:00am to 1:00pm and includes an unusual feature.  THERE IS NO COST to attend, either in person at the MMA offices in Manchester or via webex from a laptop or desktop.  Because of grant funding by the state Office of Substance Abuse and Adult Mental Health Services, we are able to present the program without charge.

Faculty for the program includes Tamas Peredy, M.D. of the Northern New England Poison Control Center, John Lipovsky, the new coordinator of the Prescription Monitoring Program, Noel Genova, PA-C of the Chronic Pain Consultation Program, Stephen Kelleher,  and Gordon Smith, Esq. of MMA.  MaineCare Medical Director Kevin Flanigan will also be available to describe the MaineCare limits on opiate medication, effective Jan. 1, 2013.

Registration is available on the MMA website at  Although the registration form notes that a fee is charged, just complete your registration form without including that portion.  A new form with a full agenda and goals and objectives will be available shortly and will be distributed electronically to all of the e-mail addresses we have available for members and their staffs.

Only twenty five remote sites are available so sign up as soon as possible if you know that your facility or practice would like to attend.

A complete list of all the 2013 First Friday programs is also on the website and was included with your Fall issue of Maine Medicine. [return to top]

New Medical Marijuana Rules Take Effect Jan. 1, 2013

By communication dated Dec. 21, the Department of Health and Human Services has announced that a 76 page rule containing requirements for providers, patients, care-givers, growers and dispensaries will be effective Jan. 1, 2013.  The rule provides a lot of detail that had previously been lacking on issues such as disposing of excess marijuana and DHHS consideration of petitions to add diseases and conditions to the list provided in the law passed by the voters in 2009.

 While the obligations on physicians who prepare a certificate are not significantly enhanced from those in the statute, there is an explicit reference to physicians abiding by the provisions of Joint Rule Chapter 21 promulgated by the five licensing boards for prescribers.

The entire rule can be found at   You may also call 287-9300 and ask for a paper copy of the rule. [return to top]

Job Openings

Physician Assistant or Family Nurse Practitioner

Full-time physician assistant or family nurse practitioner wanted for multi-service, progressive, rural community health center in a medically underserved area. Services include family practice, mental health counseling, pediatric psychiatry, integrated behavioral health and radiology. EMR. Practice is outpatient only. Located in Porter, ME, between Portland and the White Mountains.  Please submit your resume to or mail to: 

Human Resources Coordinator

Sacopee Valley Health Center

PO Box 777

Parsonsfield, ME 04047

Sacopee Valley Health Center is an
Equal Opportunity Organization.


MEDICAL DIRECTOR/PHYSICIAN - Health Access Network - Lincoln, Maine

Health Access Network (HAN), a Federally Qualified Health Center (FQHC) in Lincoln, Maine, is seeking a dynamic physician leader to serve in the role of Medical Director to provide overall direction and oversight of our clinical team, as well as provide part-time direct patient care. The Medical Director will join the health center’s leadership team in meeting the goals and objectives of the health center’s mission. Responsibilities include, but are not limited to administrative and clinical leadership of medical staff, quality improvement, credentialing & privileging, peer review, strategic planning, budgeting, provider recruitment and assist with the development of clinical policies and procedures. Position is two days a week administrative and three days providing direct patient care.

Qualifications: Board Certified in family medicine, Maine License, and have at least five years primary care and leadership experience. A practicing physician wishing to transition to a part time medical-administrative/management role is encouraged to apply. Community health center experience a plus. Familiarity with disease registries and electronic medical records is required. Must have exceptional verbal and written communication skills, and possess compassion, innovation, integrity, and excellence which are the health center’s values.

For more information or to forward your curriculum vitae' contact:  Sonia Maxwell, HR Director/Compliance Officer, P.O. Box 99, Lincoln, ME  04455, 207-794-6700,


DFD Russell Medical Centers seeking NURSE PRACTITIONER

The DFD Russell Medical Centers (DFDRMC) operates three community health centers in central Maine.  We are looking for a full-time NP for immediate placement.  A current unencumbered Maine license and proficiency with electronic medical records are required.

Excellent benefits, including medical, dental and life insurance, 403(b) retirement plan, flexible spending accounts, a generous paid time off plan and incentive plan.  Salary is commensurate with experience.
We are an equal opportunity employer committed to diversity in the workplace. 

To submit your resume, please email or fax Laurie Kane-Lewis, CEO or fax 207-524-2549.     


HOSPITALIST - Belfast, Maine

Multi-specialty community hospital on the coast of Maine seeks full-time BC/BE Hospitalist to join an established group and provide full medical oversight of hospital inpatient and critical care activities. Belfast offers beautiful views of Penobscot Bay and is ideal for outdoor enthusiasts. Exceptional family environment with excellent schools.

Send CV to Dan Bennett, Director of Operations, Waldo County General Hospital, P.O. Box 287, Belfast, Maine 04915. Tel. (207) 930-6741, Fax (207) 338-6207, e-mail:


Medical Director- Mercy Recovery Center, Westbrook, Maine

The Mercy Recovery Center offers the largest substance abuse treatment center in Maine for adults treating the entire spectrum of substance abuse from alcoholism to drug addiction. Treatment services include detoxification, group therapy, treatment of withdrawal symptoms, and long term therapies.

We are seeking a Psychiatrist specializing in addiction medicine to serve as Medical Director for the Recovery Center. Suboxone certification is required. Previous experience running an addiction clinic is strongly desired. This position oversees four physicians and 8 physician extenders. Direct care responsibilities include a combination of office visits, inpatient, and partial hospitalization coverage. Mercy offers a competitive compensation and benefits package.

Mercy is the Greater Portland regional health care system representing the highest standards of clinical excellence and compassionate care. Because of a commitment to excellence, the nursing, clinical and support services have consistently achieved superior patient satisfaction ratings, and remain committed to providing the highest quality healthcare for all.

FMI and to apply online, please visit our website: 

Please send your CV to Alison Salerno, Provider Recruiter, at, or Mercy Hospital, 144 State St., Portland, ME 04101. 207-879-3804 E.O.E.

 1/28/13 [return to top]

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