January 7, 2013

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Medicare SGR Cuts Postponed; Medicare Enrollment Period Extended

President Obama signs the American Taxpayer Relief Act of 2012.  The Medicare SGR cuts are postponed through December 2013 and the Medicare enrollment period is extended through February 15th.

On Jan. 2, President Obama signed into law the American Taxpayer Relief Act of 2012. This new law prevents the 26.5 percent cut to Medicare physician payments that was scheduled to take effect on Jan. 1, 2013 and provides for a zero percent update for services through Dec. 31, 2013. While the law only patches the Sustainable Growth Rate issue through the end of 2013, President Obama has said he's committed to a permanent solution and eliminating the SGR methodology. The Administration says it will continue to work with Congress to achieve this goal.

The new law extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012 as well as provisions of the Affordable Care Act. See below for more information from CMS on which Medicare fee-for-service policies have been extended as well as billing and claims processing information associated with the new legislation.

Medicare Physician Payment Update

As indicated above, the new law provides for a zero percent update for claims with dates of service on or after Jan. 1, 2013 through Dec. 31, 2013. CMS is currently revising the 2013 Medicare Physician Fee Schedule to reflect the new law's requirements as well as technical corrections identified since publication of the final rule in November. The 2013 conversion factor is $34.0230. Medicare claims administration contractors will be posting the MPFS payment rates on their websites no later than Jan. 23, 2013.

Extension of Medicare Physician Work Geographic Adjustment Floor

The 2012 1.0 floor on the physician work geographic practice cost index is extended through Dec. 31, 2013. As with the physician payment update, this extension will be reflected in the revised 2013 MPFS.

Potential Hold on Claims 

In order to allow sufficient time to develop, test, and implement the revised MPFS, Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (i.e., through Jan. 15, 2013). CMS expects these claims to be released into processing no later than Jan. 16, 2013, and holds on claims should have minimal impact on physician/practitioner cash flow because clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt under current law. Claims with dates of service prior to Jan. 1, 2013 will be unaffected.

Medicare Open Enrollment Extension - Know your options and update your participation status by Feb. 15

Given the new legislation, CMS is extending the 2013 annual Medicare participation enrollment period through Feb. 15, 2013 to give eligible physicians, practitioners, and suppliers more time to change their participation status. The original enrollment deadline was Dec. 31, 2012.

Whether or not you are thinking about modifying your Medicare status, the MMA and AMA encourage physicians to prepare for this opportunity and review participation options carefully to determine the direction that is right for your practice. The AMA has developed the Know your options: Medicare participation guide, available to all physicians at www.ama-assn.org/go/medicareoptions . The kit contains a detailed explanation of participation options, a revenue calculator and various sample materials for communicating with patients.

Participation elections and withdrawals must be post-marked on or before Feb. 15, 2013; the effective date for any participation status changes elected during the extension remains Jan. 1, 2013.

Other Medicare-Related Extensions in the American Taxpayer Relief Act of 2012

Visit http://go.cms.gov/S7iUo4 for more information from CMS regarding the extension of ambulance add-on payments, Medicare inpatient hospital payment adjustments for low-income hospitals, the Medicare-Dependent Hospital Program and payments to Medicare outpatient therapy services.

Please note that this information does not reflect all of the Medicare provisions in the new law, and more information from CMS may be forthcoming.

MaineCare Limits on Opioid Based Pain Medication Took Effect Jan. 1

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 www.mainemed.com (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 www.mainemed.com, 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 gsmith@mainemed.com 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 Began Jan. 1

The two year limit for MaineCare coverage of methadone and Suboxone, established by the Maine Legislature earlier this year, took effect last week (Jan. 1, 2013).  The limit on methadone will not apply retroactively so the two year period began on January 1st.  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]

Appropriations Committee Convenes to Discuss Curtailment Order

The Appropriations Committee of the newly-sworn in 126th Legislature met for the first time last week to discuss Governor Paul LePage's curtailment order issued December 27th.  The Order 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. 

Members of the Appropriations Committee asked quesitons about a number of the cuts, focusing on the impact of the cuts on clients, especially holding a large number of positions vacent and reducing contracts for substance abuse providers.  The Committee will meet again several times this week and have an opportunity to ask more detailed questions of the Commissioner of Health and Human Services. On Friday, the LePage Administration will also be introducing a supplemental budget for the current fiscal year and a budget for the two-year period beginning July 1, 2013 that has to address a structural shortfall in excess of $750 million.  

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

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

The MMA Legislative Committee weekly phone calls will begin tomorrow, 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 amaclean@mainemed.com 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 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 www.mainemed.com.  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 Took 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 that became 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 http://www.maine.gov/dhhs/dlrs/rulemaking/adopted.shtml.   You may also call 287-9300 and ask for a paper copy of the rule. [return to top]

Fund for a Healthy Maine Webinar, Jan. 11

Maine Public Health Association and the University of New England are
pleased to bring you the first webinar in their winter series.

The Fund for Healthy Maine: Understanding and Protecting our Largest Source of Prevention Funds in Maine

January 11, 10:00am


  • Dennise Whitley, Friends of the Fund for a Healthy Maine and Maine Public Health Association
  • Ed Miller, American Lung Association of New England
  • Steve Rowe, Former Maine Attorney General and Speaker of the House
Join us to learn why and how the Fund for Healthy Maine (FHM) was created and the intent of the fund according to the 1999 legislative body. Participants will gain knowledge on which funds have been diverted from the FHM since its inception and data gathered on fund programs that highlight the return on investment.  In addition, we will share practical steps around what you can do to advocate for the FHM and why it’s important to protect it.

Registration is required. 
REGISTER NOW: http://events.r20.constantcontact.com/register/event?oeidk=a07e6rqv94if28450e1&llr=7lbhmrfab>
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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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AMA State Legislative Strategy Conference Addresses Timely Topics

The MMA recently sent representatives to the AMA's annual State Legislative Strategy Conference held near Miami from January 3-5, 2013.  The conference opened last Thursday evening with a keynote address by Major Garrett, chief White House correspondent for CBS News and a correspondent at large for National Journal.  The meeting agenda included the following relevant topics:

  • the AMA's state legislative advocacy vision for 2013;

  • Health care issues facing the states in 2013;

  • Medicaid expansion:  What will your state decide?;

  • Health insurance exchanges;  Coming to a state near you;

  • Reducing the costs of interactions between physician practices and health plans;

  • an overview of the AMA strategic plan;

  • Will states, buckling under surging health care costs, be scared straight by the fiscal cliff?;

  • Hot topic:  Drug diversion and abuse;

  • the 2013 federal landscape;

  • State-based delivery and payment reform:  One size does not fit all; and

  • Hot topic:  Dealing with the avalanche of medical innovation and data.

The MMA staff would be happy to share the meeting materials with any interested member.  FMI, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com.

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Job Openings

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  laurie.kane-lewis@dfdrussell.org or fax 207-524-2549.     


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: www.Mercyhospital.org 

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


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: dbennett@wcgh.org.


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 on 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, smaxwell@hanfqhc.org.



Sebasticook Family Doctors is a Federally Qualified Health Care Center currently accepting applications for a Full Time Nurse Practitioner for our  Dexter location.  Ideal candidate will have two or more years experience with exceptional clinical, interpersonal and EMR skills.    Maine License and DEA registration required.  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, mknowles@sfdchc.org.  


MD/DO Position Available - 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!

Interested 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 mknowles@sfdchc.org.


PSYCHIATRIC NURSE PRACTITIONER Position Available - Dexter, Maine

Sebasticook Family Doctors is a Federally Qualified Health Care Center currently accepting applications for a Full Time Psychiatric Nurse Practitioner for our Dexter location. Position includes assessment, medical management, therapy and group work. Ideal candidate 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 at mknowles@sfdchc.org.



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