May 20, 2013

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Battle Heats Up over Medicaid Expansion in Maine

A legislative floor fight over Medicaid expansion has begun, following a committee vote - divided along party lines - over a controversial liquor contract bill. The measure defines the process for re-opening the state's wholesale liquor contract for bids, and directs proceeds from those sales to repay nearly a half-billion in Medicaid debt owed to Maine's hospitals. But over Republican protests, it also now includes a provision added by majority Democrats to expand coverage to 70,000 more Mainers.  The combined bill, LD 1546, received its first vote in the Senate today. The Maine Medical Association supports both the payment of the hospital debt and the expanded coverage and considers both provisions to be priorities and essential to the well-being of the state, the delivery system and our citizens.

The effort by majority Democrats in the Maine Legislature to link expansion of Medicaid as part of the state's next liquor sales contract and hospital debt repayment plan continues to anger many Republicans. 

But majority Democrats on the Veterans and Legal Affairs Committee used their majority status to force a 7 to 5 vote at the end of last week on a bill that will include expanding Medicaid for 70,000 Mainers under the provisions of the federal Affordable Care Act as part of the complex liquor and hospital deal. 

The bill defines the process for putting Maine's liquor sales contract up for bidding, and repaying nearly a half-billion dollars in outstanding Medicaid debt to Maine's hospitals over a 10-year period.  Many Republicans say they don't necessarily object to expanding Medicaid, but they don't like the effort to link it to the so-called hospital bill. 

But Democrats again argue that it only makes sense to tap into health care dollars available under the ACA that will be used to pay the medical expenses of poor Mainers - the same people who formerly wound up as hospital charity cases, as costs were passed along to insured patients. 

Members of the Cover Maine Now Coalition - which includes the Maine Medical Association -  held a press conference this morning to urge the Legislature to vote as soon as possible on the proposal to accept federal funding to provide expanded access to health care for 69,500 Mainers.  The Coalition delivered nearly 3,000 signed petitions urging members of the Legislature to expand access to health care and highlighted results of a new statewide poll released last week that shows 67 percent of respondents support the effort to accept federal dollars to expand access to health care while 23 percent don't. 

Gordon Smith, Esq., Executive Vice President of the MMA, spoke at the press event and stated that MaineCare will be able to put to use millions of dollars in federal funding being received for a State Innovation Model grant to deliver better care at lower cost for MaineCare receipents, "and we want more Mainers to be able to benefit from the transformation of both the delivery and payment systems taking place over the next three years." 

Shortly after the press event the bill, LD 1546, arrived on the Senate floor for debate.  Following passionate statements on both sides of the aisle, the bill passed with a 20-15 vote.  If faces further votes in the Senate and then the House. 

Kevin Flanigan, MD, Name State Innovation Model (SIM) Grant Steering Committee Chair

The Department of Health and Human Services has announced four regional forums in early June to present an overview of the recently announced SIM grant including specific goals, project timelines, the governance structure and the next steps moving forward.  Kevin Flanigan, MD, Medical Director of MaineCare, was recently named by DHHS Commissioner Mary Mayhew to be the chair of the steering committee directing the grant work. 
The dates and locations for the four forums are:
June 3rd, Presque Isle-Hampton Inn
June 4th, Bangor-Dorothea Dix Psychiatric Center
June 10th, Augusta-Augusta Civic Center (Penobscot Room)
June 12,  Portland-Fireside Inn and Suites (Sebago Room)
The forums are all scheduled from 9:00am to noon and more information will be available at the Maine State website. The website will continue to serve as a source of the most recent information regarding the grant.
The purpose of testing the Maine Innovation Model is to work with state partners and the healthcare community to align healthcare payment and delivery system reform in the state across MaineCare, Medicare, and commercial payers to improve quality of care and patient satisfaction, while also achieving and sustaining lower costs.  These goals will be accomplished through public and private collaboration with providers, purchasers, and payers to connect important work that is underway and gaining traction across the state. 
Grant funds will also support the development of new workforce models, the formation of multi-payer Accountable Care Organizations that commit to value and performance based reform and will establish data measures that will be publicly reported.  Some examples of what the initiative will hope to achieve include:
  • Behavioral health providers will have access to needed resources to enable them to securely access and, where appropriate, share both behavioral and physical health information through electronic health records:
  • Care management staff will receive real-time notification for when their highest-utilizing patients use the Emergency Department or are admitted to or discharged from the hospital, so they can follow-up with patients in the most appropriate time; and,
  • There will be further integration of physical and behavioral health services by utilizing the skills of direct service workers who understand the importance of assuring both are taken into consideration during treatment.
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MMA Legislative Committee Conference Call, Tuesday, May 21st, 8 p.m.

**PLEASE TAKE NOTICE - THE CALL IN NUMBER HAS CHANGED (due to technical difficulties)**

The MMA Legislative Committee weekly phone calls will continue tomorrow, Tuesday, May 21st at 8 p.m..  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:  1-877-668-4493  NOTE THAT THIS IS A NEW CALL IN NUMBER

Passcode:  23045263

The following are bills of interest to the physician community printed last week.  We will discuss the priority bills marked with an asterisk (*) first:

LD 1531, An Act To Maintain Access to Safe Medical Marijuana (monitor; Public Health Committee)

LD 1546, An Act To Strengthen Maine's Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract (support)*

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POLITICAL PULSE: Legislative Highlights from the Week

Here are some highlights of what MMA's advocacy team followed at the State House the week of May 13th.   It was a busy and at times emotionally-charged week as committees scrambled to hold public hearings and work sessions on all of their bills by Friday, and had left some of the most controversial for the end.  There was lots of talk about the hospital debt payment and the bill to accept federal funds for MaineCare coverage - see the stand alone article on that topic.  


The Judiciary Committee held hearings on five bills closely followed by the MMA.  They first took up two bills with major implications for mandatory reporters, LD 1024 and LD 1523.   MMA opposed both. LD 1024 received a hearing in HHS several weeks ago but was re-referred to the Judiciary Committee.  It would have required the Department of Health and Human Services to report to the appropriate licensing board a mandatory reporter who "appears" to have failed to make a mandatory report.  The Committee voted unanimously to approve a modified version of the bill that will still require reporting to the licensing board but makes the minor clarification that  reporting is required when it "appears from the record or relevant circumstances" that the reporter failed to make the report.   LD 1523 is a Governor's bill that would have required mandatory education for all mandatory reporters, made it a class E crime to fail to make a report, and listed several examples of injuries in infants under 6 months of age that would require reporting.  The Committee approved a modified version of the bill that removed all provisions except the requirement that in infants under 6 months all fractures of a bone; substantial bruising or multiple bruises; subdural hematoma; burns; poisoning; and injury resulting in substantial bleeding, soft tissue swelling or impairment of an organ be reported to DHHS.

The Committee also held a public hearing on three bills opposed by the MMA that would reduce access to abortions, LD 760, 1339 and 1193.   LD 760 would increase the amount and type of information that is required to be provided to a woman prior to an abortion; LD 1339 would institute parental notification in Maine; and LD 1193 would create a wrongful death cause of action for any fetus beyond 12 weeks gestation.   The Committee held a work session on all three bills last Friday and a majority of Committee members voted "ought not to pass" on all bills.  


The Insurance and Financial Services Committee was last week holding a number of work sessions to finalize their position on bills.  The Committee held a final work session on LD 727, the MMA-proposed bill that would ensure that patients receive accurate health care information by prohibiting deceptive or misleading advertising or misrepresentation in the provision of health care services, requiring the identification and level of licensure of health care practitioners with patient contact and clarifying disciplinary actions that may be taken for failure to comply with these consumer information requirements.  The Committee voted unanimously that the bill ought to pass with minor amendments.  The Committee clarified the size of the badge and amount of information required to identify a practitioner and rejected proposed changes to carve out sole practitioners or optometrists. 

 The Committee also held a work session on LD 1466, a bill that would apply additional standards to entities engaged in the secondary sale of physician networks, also known as "rental network PPOs" or "silent PPOs."  After much discussion among the interested parties including the MMA, physical therapists and insurance carriers, the Committee voted unanimously to approve the bill with modifications that were acceptable to the MMA.    The Committee considered an amended version of Senator Geoffrey Gratwick's bill, LD 1453, An Act to Increase the Transparency of Charges and Expenses of Hospitals that Receive State Funds, and voted 9-1 to turn the bill into a joint order that creates a Commission to study transparency, costs and accountability of health system financing.  


The Health and Human Services Committee continued its busy pace with a number of hearings and work sessions last week.  The following were of particular interest to MMA: 

  • LD 802, 908 and 951 related to access to Suboxone and methadone treatment.  The Committee held a public hearing on all three bills on Monday and the MMA and Maine Association of Psychiatric Physicians commented in opposition to further restrictions on access to opiate replacement therapy.  The Committee voted "ought not to pass" on LD 802 and 908 and a majority voted in favor of a modified version of LD 951, which will allow additional MaineCare patients to continue Suboxone and methadone therapy beyond the 2 year limit in current law without needing a prior authorization (pregnant women, those with chronic mental illness and those receiving below a threshold amount).  It also restores some reimbursement to methadone clinics. 
  • On Tuesday, the Committee held an afternoon and evening of hearings on bills related to various aspects of the State's medical marijuana program.  MMA weighed in opposing LD 1062, which would have allowed physicians to write certificates for PTSD, opiate addiction and "any other medical condition or its treatment as determined by a physician."  After a day of negotiations, the proponents agreed to a modified version that adds the ability to write certificates only for PTSD, inflammatory bowel disorders and dyskinetic and spastic movement disorder but drops opiate addiction and any other conditions.  The Committee voted 12-1 in favor of the amended bill.  
  • LD 1014, a bill that would increase law enforcement access to the Prescription Monitoring Program.  This was a bill introduced by the Attorney General's Office and was modified to propose increased access to law enforcement conducting a criminal investigation involving a prescription drug offense. The Committee vote on the bill was split. 
  • LD 1487, An Act to Implement Managed Care in the MaineCare program.  This bill was introduced by Senator Roger Katz and proponents included several companies and consultants who work with managed care companies.  The Department of Health and Human Services opposed the bill stating that they prefer to achieve savings and improved care using local community initiatives such as Health Homes.  MMA testified neither for nor against the bill.  In a work session later in the week, the Committee expressed interest in the concept but voted 13-1 that the bill ought not to pass at this time. 
  • LD 1486, a proposal that would provide additional MaineCare-covered dental services for those referred by a primary care provider or hospital emergency room and need services to prevent further acute oral health care.  An amended version of the bill was approved by a majority of the Committee in a 9-5 vote. 


The Taxation Committee held work sessions last week on LD 1326, a bill that would equalize the tax on "other tobacco products" (roll your own tobacco, snuff, little cigars, etc) with cigarettes, and LD 1406, a bill that would increase the tax on cigarettes by $1.50 per pack.  The Committee voted unanimously that both bills ought not to pass, and it is expected that these items may be moved into the budget if they are to proceed this session.  The Committee also held a work session on LD 1496, the proposal from the bipartisan group of lawmakers - the "Gang of Eleven" - to make major change to Maine's tax code, such as reducing the income tax and increasing sales and excise taxes.   MMA opposed the aspect of the proposal that would institute a tax on elective cosmetic medical procedures.  Members of the Committee questioned whether it was appropriate for them to be taking an in-depth look at the bill given the timing of the session and number of questions that remain about the impact.  After a several-hour work session, the Committee tabled the bill and has received approval to continue work on the bill past the May 17th deadline for other bills. 


The Criminal Justice Committee held a public hearing last week on LD 1491, An Act To Strengthen the Laws Regarding Certain Crimes Committed by a Person in a Position of Authority.  The bill as introduced was opposed by the MMA and would have eliminated the statute of limitations that applies to civil cases brought against mental health professionals for sexual acts with a patient, and would change the statue of limitations for criminal cases to 10 years.  In the end, a majority of the Committee approved a much narrower version of the bill which would only extend the statute of limitations in felony criminal cases to 8 years and eliminated any change to the civil statute of limitations.  The change to the criminal statue of limitations will apply to all cases, not just those involving a licensed professional.   [return to top]

Friday, June 7, Let MMA Train Your Staff on HIPAA/HITECH Provisions

The June 7 First Friday educational session, offered both on site and through webex features the Annual HIPAA Update.  This year's Update is particularly important as the final HITECH rules are enforceable as of Sept. 23, 2013.  Registration is available at

The program runs from 9:00am to noon and the faculty includes Stacey Mondshein Katz,Esq. and MMA attorneys Gordon Smith, Andrew MacLean and Jessa Barnard.

MMA's updated model forms, including the Notice of Privacy Practices and the Business Associate Agreement will be distributed at the program.

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Brunswick Physician Honored with National Award for Outstanding Service

Thomas J. Keating, MD, MS, MA, FACP, a medical oncologist with Maine Center for Cancer Medicine and a resident of Brunswick, was honored with a 2012 American Cancer Society St. George National Award for his outstanding service to the community in support of the Society's mission. Keating was one of 26 inspirational individuals nationwide who received the award, conceived in 1949 by Dr. Charles S. Cameron, former Society medical and scientific director. Recipients were chosen based on ongoing leadership, time commitment, and dedication to areas such as mission delivery, patient support, legislative advocacy, fundraising and event engagement. All nominees for this award have dedicated at least six years of their time to the fight against cancer and for more birthdays, and have significantly contributed to advancing the Society’s mission.

Dr. Keating first became a Society volunteer 35 years ago when he was a college student who had just learned that his brother had been diagnosed with cancer. Throughout his successful career as a medical oncologist in Massachusetts and Maine, Dr. Keating has been an essential member of the American Cancer Society team. In 1979, he served on the organizing committee for the first Living With Cancer Conference in Augusta, the longest running survivor conference of its type in the United States. He also held several key leadership positions with the Society: a Board of Directors member for the Maine unit for seven years, including three years as President; and was the Medical Delegate for the New England Division Board from 2003-2004.

Dr. Keating’s personal experience as a caregiver, his chosen career in medicine, and his compassion for people during their cancer journey epitomizes an exemplary American Cancer Society volunteer.  He works tirelessly to promote American Cancer Society patient services and reduce the burden of cancer on families.

Pictured in the center is 2012 St. George Award winner, Thomas Keating, MD, MS, MA, FACP, with (left) Andrew MacLean, JD, Chair of the American Cancer Society Board of Directors, New England; and (right) Randy Schwartz, MPH, American Cancer Society Senior Vice President of Strategic Health Initiative [return to top]

Upcoming Funding Opportunities for Maine Practices

The Maine Health Access Foundation (MeHAF) will be releasing two RFPs of interest to Maine practices next month. 

Improving Access to Quality Care for Uninsured Individuals (A2QC)

MeHAF will release an RFP entitled Improving Access to Quality Care for Uninsured Individuals (A2QC) next month.  The A2QC will provide grants to promote a more proactive, coordinated and population-based approach to care delivery for uninsured and underinsured individuals to improve their health. The program will provide funding to support innovations that achieve the 'Triple Aim' outcomes of reduced cost, improved quality and experience of care, and improved health of populations- in this instance, for those who are low income and uninsured. Successful proposals will emphasize inclusion, collaboration and shared ownership of the responsibility of care for all community members. Grants will support the development of collaborative partnerships made up of a broad group of stakeholders representing health care, social services, and low income patients/consumers who will work together to identify needs and develop a sustainable plan to coordinate delivery of health care service to the uninsured population within a common service area.  We will encourage these collaborative partnerships to be built upon current community networks where they may exist, rather than forming new ones. 

Continuum of Care: Thriving in Place (TiP)

The TiP program will also be announced in June. TiP is part of our Promoting Patient-Centered Care strategic priority.  The TiP program will give health care providers and their community partners opportunities to develop and implement solutions to allow adults (including elders and persons with disabilities) with chronic conditions to remain healthy in their homes and communities and out of in-patient or institutional care.  

Watch MeHAF's funding opportunity webpage for the release of these two RFPs.

MeHAF is an independent private nonprofit health foundation funded following the sale of Blue Cross Blue Shield of Maine to Anthem in 2000.  [return to top]

Deadline for Avoiding 2014 E-Prescribing Penalty is June 30

In 2014, a Medicare payment penalty of 2 percent will be applied to individual eligible professionals or group practices participating in the Electronic Prescribing Group Practice Reporting Option (GPRO) if they are not successful electronic prescribers. CMS will automatically exclude from the penalty those professionals and group practices who meet the criteria listed in the Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet. Individual eligible professionals and groups participating in eRx GPRO who were not successful electronic prescribers in 2012 can avoid the 2014 payment adjustment by meeting the specified reporting requirements between January 1 and June 30, 2013. 

Clinicians also can apply for hardship exemptions, which include: (1) practicing in a rural area without sufficient high-speed Internet access; and (2) being barred by local, state, or federal law from e-prescribing. The deadline for hardship exemption applications, accomplished by including a G-code on a Medicare claim, is also June 30. Significant hardships associated with a G-code may be submitted via the Communication Support Page or on at least one claim during the 6-month 2014 eRx reporting period (January 1 – June 30, 2013). If submitting a significant hardship G-code via claims, it is not necessary to request the same hardship through the Communication Support Page. Please note that the hardship exemptions for achieving Meaningful Use or demonstrating intent to participate by registering in the Medicare or Medicaid Electronic Health Record (EHR) Program by June 30, 2013, will be automatically processed by CMS. Therefore, entering a hardship exemption request through the Communication Support Page will not be necessary. 

More information about avoiding the Medicare e-prescribing penalty is available on the CMS Web site.

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MMC Oncology Symposium May 29

The Maine Medical Center Cancer Institute will host its annual oncology symposium at Maine Medical Center in Portland on Wednesday, May 29, from 7 a.m. to 12:30 p.m. Let’s Get Personal: Applications of Personalized Medicine in Oncology will focus on emerging cancer treatments that are tailored to the individual. Learn about the science behind these new treatments and what the future holds for your patients. Keynote speakers are Dr. Neal Goodwin, Program Director, JAX Cancer Services, Jackson Labs West, and Dr. Gregory Feero, Research Director, Maine-Dartmouth Family Residency Program.

There is no fee for the symposium, and 4.75 CMEs are available. Please register online by clicking here. For further information, contact Jill Domingos at 396-7697. [return to top]

Accountable Care Organizations Educational Forum for Primary Care, June 10

June 10, 2013

Accountable Care Organizations Educational Forum

Guest speaker: John Freedman, MD, MBA

 Hilton Garden Inn, Freeport

6:00 buffet dinner, 6:30-8:30 presentation and discussion

With generous support from the Maine Health Access Foundation, the Maine Medical Association is pleased to offer an educational forum with John Freedman, MD, MBA. He will be discussing the emerging role of accountable care organizations (ACOs).  This event will be targeted toward primary care providers, particularly those in independent practice seeking to better understand the potential impacts of payment reform models such as ACOs.          

John Freedman is Principal at Freedman HealthCare in Newton, MA and has 20 years' experience in systems management, managed care, health care quality measurement and quality improvement, clinical laboratory development, health economics, and medical informatics. His experience comes from leadership roles at nationally recognized organizations, such as Kaiser Permanente, Tufts Health Plan, MA Health Quality Partners, Focused Medical Analytics, and the MA Quality and Cost Council.

If you are a physician and would like to participate in this event, please reply to Jennifer Reck at, including notice of any dietary restrictions, by June 3.  There is no cost to attend. [return to top]

Upcoming Events

Webinar: Introduction to Lesbian, Gay, Bisexual & Transgender (LGBT) Health

Tuesday, May 21, 2013

12:00 PM - 1:00 PM EDT



Looking to improve care for your patients who are lesbian, gay, bisexual or transgender? The Maine Primary Care Association is excited to bring you this webinar training on health care for lesbian, gay, bisexual and transgender populations (LGBT), featuring Harvey J. Makadon, MD, Director of the National LGBT Health Education Center, Fenway Institute.


Advancing Change:  Healthcare System Transformation in Northern New England 

Keynote Speaker:  Jay Want, MD, Center for Improving Value in Health Care

May 21, 2013

8:00 am - 5:00 pm

University of New Hampshire, 75 Main Street, Durham, NH

For more information or to register, click here


Maine Center for Cancer Medicine Presents Educational Lecture Series:  Screening & Treatment

4th Wednesday of Each Month (with exceptions), 6 pm – 7 pm

100 Campus Drive, Conference Room, Scarborough, Maine

Note: To attend the live presentation or join a lecture via Webex, contact Betsy Chase

at 207-396-7634 or

FREE CME Credit Available

May 22, 2013:  Prostate, Treatment Update  Dr. Aronson

June 26, 2013:  Lung, Screening & Treatment Update  Dr. Thomas

July 24, 2013:  Breast, Screening Update  Dr. Weisberg

August 28, 2013:  Breast, Treatment Update  Dr. Weisberg

September 18, 2013:  GI, Screening Update   Dr. Benton

October 23, 2013:  GI, Treatment Update   Dr. Dugan

November 13, 2013:  Melanoma Review and Update for the PCP   Dr. Aronson

December 18, 2013:  Palliative Care Review  Dr. Keating

January 22, 2014:  Brain, Screening and Treatment Dr. Evans

February 26, 2014:  Clinical Research Overview  Dr. Thomas

March 26, 2014:  Hematologic, Treatment Update  Dr. Ryan


Save the Date: 

Maine Public Health Association 29th Annual Meeting 

October 22, 2013 

8:30 am - 4 pm 

Augusta Civic Center 

For more information, click here. 

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Job Openings

Behavioral Health Consultant

Sacopee Valley Health Center is seeking a full time LCSW to join our Medical Team as the Behavioral Health Consultant.  This position involves working with patients in a busy integrated primary care setting to more effectively manage the behavioral aspects of their physical/mental illnesses and/or chronic medical conditions.

Applicant must possess valid State of Maine license or be license eligible.  Experience in a health care setting preferred.  Anticipated start date for this position:  June 3, 2013.

Send resume to or mail to:  Human Resources Coordinator, Sacopee Valley Health Center, P.O. Box 777, Parsonsfield, ME 04047.  Sacopee Valley Health Center is an equal opportunity provider and employer.


Psychiatrist, Psychiatric Nurse Practitioner and/or Physician Assistant

Assistance Plus is seeking two (2) full time psychiatrists, psychiatric nurse practitioners and/or physician assistants for the Medication Management Program in Benton and Wilton. The professional team is overseen by Robert Gordon, medical director. Our primary focus is to assist those with behavioral health disorders.

Applicant must be a graduate of an accredited degree program and licensed to practice in the State-of-Maine. A minimum of three years experience required.

We offer a generous benefit package of full coverage for health, dental, and 401K along with a sign on bonus of $5,000.  This position is Monday through Friday and no on call coverage is required.

Please submit resume and cover letter to Jillian Jolicoeur 453-4708 ext 408 or email  


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 and Patten 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.


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