May 28, 2013

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POLITICAL PULSE: Legislature and Governor Now at an Impasse: You Can Help Break It

The Legislature today is expected to sustain the Governor's veto of L.D. 1546, An Act to Strengthen Maine's Hospitals, Increase Access to Health Care and Provide for a new Spirits Contract, a bill combining payment of the hospital MaineCare debt and the MaineCare expansion provided for in the Affordable Care Act.  Following this action, the Legislature and the Governor will have approximately a month left to find a pathway to accomplish these two important goals.

The time has come to communicate with your legislators about the importance of getting these two priority items passed.  You can leave a message for your Senator at 287-1540 or toll free at 1-800-423-6900 and for your State Representative at 287-1400 or toll free at 1-800-423-2900.

If you do not know who your Senator or Representative is, contact Maureen Elwell at MMA at 622-3374 ext. 219 or via e-mail to

It was a busy week on the House and Senate floors last week, where legislators engaged in passionate debates about whether to accept federal funds to provide MaineCare coverage to low income Mainers.  Republicans centered their opposition around linking the expansion to paying hospital debt and questioned the necessity to vote on the bill now when they are seeking more information about the cost and impacts of expansion.  Democrats countered that the Health and Human Services Committee spent weeks considering the bill and has enough information to know that CMS will cover adults without children with 100% federal funds.  As widely reported in the press, the House and Senate both passed the bills along party lines and the Governor issued a veto message within minutes of its final passage in the Senate.   Republican immediately introduced separate bills to pay the hospital debt and create a study committee to review Medicaid options.  The Democrats, meanwhile, will lead an effort to override the veto and are prepared to continue to push LD 1066, the stand-alone Medicaid bill still in the Health & Human Services Committee.  

For more information on the efforts to move the issue forward, visit the Cover Maine Now website. 


A majority of the members of the Criminal Justice Committee have voted in favor of an amended version of LD 1240, a bill that would strengthen background checks for gun purchases.  Under the bill it would remain voluntary for sellers to complete a background check before selling a gun.  However, the seller would be held strictly liable for the crime of selling to a person legally prohibited from purchasing a weapon.   The bill also calls on the Chief of Police to create a work group to study the "blue paper" process as it relates to those prohibited from possessing firearms. The bill will likely hit the House and Senate Floor next week.  Members interested in taking further action to support the legislation are encouraged to contact their legislators and can visit the Coalition for a Safer Maine website


During their last work session of the year, the Environment and Natural Resources Committee voted to strengthen Maine's Kid-Safe Products Act to reduce children’s exposure to BPA and other toxic chemicals in the home.  LD 1181, An Act To Further Protect Pregnant Women and Children from Toxic Chemicals, sponsored by Senate Majority Leader Seth Goodall (D-Richmond) was amended by the committee and now will head to votes in the Senate and House. 

As amended LD 1181 would do three things:

  1. Require the largest food and beverage companies (those with $1 billion or more in gross annual sales), like Campbell’s, Del Monte, and ConAgra to report their use of Priority Chemicals (like BPA) in food packaging.
  2. Allow the Department of Environmental Protection (DEP) to require manufacturers to report on which products contain Maine's 49 Chemicals of High Concern.
  3. Require the DEP to identify the next steps needed to implement the Kid-Safe Products Act and provide a progress report to the Maine Legislature.  
Members interested in learning more and supporting the bill are encouraged to visit the Alliance for a Clean and Healthy Maine website


As reported in earlier issues of the Update, a majority of the Judiciary Committee voted to support LD 1046, a bill regarding the administration of naloxone to those likely to experience an overdose.  Last week, the Committee reviewed updated language of the bill.  In the final version, the bill authorizes a health care professional to prescribe and dispense naloxone to a person at risk of experiencing an opioid-related overdose and also to a person who may be in a position to assist an individual during an opioid-related overdose.  A health care professional will have to provide "opioid overdose information" to the person being prescribed the naloxone - including information on the causes of overdose, how to recognize symptoms of overdose and how to administer naloxone.  The bill now proceeds to votes in the House and Senate. 


While members of  the Health and Human Services Committee spent much of their time on the floor of the House and Senate debating LD 1546, they also continued their work reviewing final language of a number of bills of interest to MMA.  Among the bills they discussed where LD 951, related to providing Suboxone beyond two years, LD 1014, a bill that would increase law enforcement access to the Prescription Monitoring Program., and LD 753, a bill that will create a study group to review the health impacts of food and drinks with added caffeine.  These bills have been covered in previous issues of the Update and none of the language changed substantially during Committee review. 


The Taxation Committee continues to work on LD 1496, An Act to Modernize and Simplify the Tax Code. This is the major tax reform effort that has been formulated by the bi-partisan "Gang of 11." The proposal has been modified since it was originally put forth to provide for staged implementation of reform. Under this new approach, elements of tax reform would be implemented in three stages, with the final stage being implemented January 1, 2015.  On MMA's latest review, the tax on elective cosmetic procedures is no longer in the proposal.  

Last week, the Taxation Committee held another work session on this bill and received new legislative language from the "Gang of 11." This language can be found here. The Taxation Committee has asked Maine Revenue Services to analyze this legislative language and determine the budget implications of this proposal. The Committee will take up this bill and receive Maine Revenue Services' analysis on May 30th at 1:00 p.m.

MMA Legislative Committee Conference Call, Tuesday, May 28th, 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 28th 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

No new bills of interest to MMA were printed last week, but we will update participants on the latest action at the State House.

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Friday, June 7, Let MMA Train Your Staff on NEW 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 WEBEX SITES ARE NOW FULL (25) BUT SPOTS ARE STILL AVAILABLE FOR PEOPLE TO ATTEND AT THE OFFICE IN MANCHESTER.

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. [return to top]

ALERT: Watch for MaineCare Provider Listserve for News on ACA's Enhanced Reimbursement for Primary Care

MMA EVP Gordon Smith participated in a conference call with MaineCare policy staff this afternoon during which he learned some new information about the ACA's enhanced Medicaid reimbursement for primary care practitioners (to match Medicare rates for two years).  The Office of MaineCare Services (OMS) expects to announce this information through the Provider Listserve shortly.  

OMS reports that 541 physicians who are not employed by hospitals or FQHCs have filed the necessary attestation statements to be eligible for the enhanced reimbursement since the program opened in January.  Since that time, the State has paid a total of $2.58 million in enhanced reimbursement based upon the submission of 74,000 claims.  

CMS recently has responded to the OMS State Plan Amendment (SPA) request to take advantage of this new ACA program and the federal response includes several key pieces of information for practitioners:

  1. Based on a misunderstanding between state and federal program managers about the payment methodology, the State has overpaid practices by approximately $250,000 or 10% of the total payments mentioned above.  The State will be announcing its plan to recoup this amount to be repaid to the federal government.

  2. CMS has asked the State to use a different attestation statement, so each practitioner will have to file a new attestation statement by June 30, 2013 in order to continue eligibility for the program.

  3. This program is not available to practitioners in FQHCs or hospitals.  While most institutions were aware of this, apparently a few practitioners based in hospitals filed attestations and received some payments, so the State will be seeking recoupment arrangements with them as well.

Please keep an eye out for the Provider Listserve announcement.  The MMA understands that it will include a link to the new attestation form.


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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]

The Physician Payment Sunshine Act is Here Are you Ready?

The new Physician Payment Sunshine Act (Sunshine Act) was created by Congress to ensure transparency in physicians’ interactions with the pharmaceutical, biologic and medical device industries as well as group purchasing organizations. Physicians elected to the AMA's House of Delegates have developed strong ethical standards and made clear that physicians’ relationships with these industries should be transparent and focused on benefits to patients.

Many interactions between physicians and the pharmaceutical, biologic and medical device industries occur to advance clinical research that is essential to discovering treatments and improving patient care. The Sunshine Act is not meant to stifle these important interactions. The AMA has provided input to the Centers for Medicare and Medicaid Services (CMS) on how to present a meaningful picture of physician-industry interactions and give physicians an easy way to correct any inaccuracies. Our efforts were aimed at ensuring the benefits of transparency and avoiding the burden of incorrect information.

 Research shows that physicians are not yet aware of many of the changes coming from the Sunshine Act. Here is what you need to know right now: Beginning in August, pharmaceutical and medical device companies must begin tracking information on their interactions with physicians, which they will report to CMS from that point forward. CMS is creating a public database on its website that will display the information reported by the pharmaceutical, biologic and medical device companies. This database will go live in September of 2014.

CMS incorporated a number of the AMA's comments in the final rule governing the Sunshine Act. The AMA is pleased that they will not require the reporting of pharmaceutical industry funding to CME providers as long as the CME complies with existing requirements for certification and accreditation. There are other exclusions as well, including product samples and in-kind donations for charity care.

Accuracy is just as important as transparency, so we are also pleased that physicians will have a minimum of 45 days to challenge any information before it is public and can dispute inaccurate reports and seek corrections during a two-year period. Physicians can, and absolutely should, review information submitted about them before it becomes public so they can correct any inaccuracies. This can be done by asking manufacturers and their representatives to provide the information they intend to report, or by registering with CMS (beginning January 1, 2014) to receive a consolidated report on your activities each June for the prior reporting year. 

Now is the time to get up to speed on this major change, and the AMA is offering resources to help. An easy way to get started is by viewing a recent AMA webinar on the topic. This resource provides information on what is happening and when, and what you need to do to be ready. Because this information is critical for all physicians to have, the AMA is providing this webinar free of charge.

The AMA is also developing tools to aid physicians in talking with their patients about the transactions included in the new Sunshine Act database. These and other resources – including answers to frequently asked questions, important dates to remember and information on how to challenge incorrect reports – are available at  The AMA will continue to update this page and offer the latest information and tools to help you prepare for the changes coming from the Sunshine Act.

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Lyme Disease in the Limelight During Lyme Disease Awareness Month

This past week, the Maine Legislature joined others in the nation in recognizing the month of May as Lyme Disease Awareness Month.  In Maine, the number of diagnoses of Lyme disease has increased dramatically over the last five years and the state case rate for Lyme disease in the state reached a record high in 2012 at 83.7 cases per 100,000 persons, with 1,111 Maine residents diagnosed with probable and confirmed cases of the disease.

Across the country, Lyme disease is now the 6th most common notifiable disease but is concentrated heavily in the Northeast and upper Midwest, with 96% of cases being reported from 13 states.  During 2011, there were 33,097 new cases nationally of confirmed and probable cases.

The Legislature also last week gave initially favorable readings to a bill which would mandate that physicians disclose to patients tested for the disease that a negative test does not mean that Lyme disease could not still develop.  If enacted and signed into law by the Governor, the law would become effective 90 days after the session adjourns. 

Further complicating the situation is concern over a shortage of a key medication used to treat the disease.  Last week,  U.S. Senator Susan Collins called on federal drug regulators to take immediate action to alleviate the shortage of doxycycline, an oral antibiotic used to treat Lyme disease and other infectious diseases.  In her letter to regulators, Senator Collins noted that Lyme disease is contracted most frequently in May and June making the shortage even more serious at this time.  The FDA first reported a shortage of doxycycline on Jan. 18.  The Maine Centers for Disease Control and Prevention also tracks the supply of the drug and has not noted a shortage in Maine as of yet, although the state has seen price increases associated with shortage of the drug nationally. [return to top]

Vermont Legalizes Physician-Assisted Suicide

The Vermont House May 13 passed the bill (S. 77) on a 75-65 vote, just a day before the Legislature adjourned for the year. The Senate took its last action on the bill May 7, when it approved the bill, 16-14.

Under the law, any patient 18 or older who has been declared terminally ill, is within six months of death, and is suffering extreme pain, may seek medication from a physician with whom they have a bona fide relationship, to end their own life. The physician must determine that the patient does not have impaired judgment and that he or she has been informed of all available options for palliative care.

The law provides practice guidelines for physicians that are drawn from those in use in Oregon. If followed, they will provide immunity from civil or criminal liability and professional disciplinary action if a physician prescribes a lethal dose of medication to a patient.

In an 11th-hour negotiation, the bill was amended so that the guidelines will expire in three years, in a compromise with lawmakers who feared too much government interference in doctors' practices, Sen. Claire Ayer (D), an author of the legislation, stated. It is expected that physicians will write their own guidelines to replace those that expire in the bill, Ayer said.

Also under the law, physicians cannot be required to write such prescriptions for patients, and health care facilities may ban the use of them for patients on their premises by informing physicians in writing of the policy.

About 200 people in Vermont are terminally ill in any given year and studies estimate that about 15 of them would avail themselves of medicated suicide if that option existed, Ayer said. The law was hard-won, said Ayer, a nurse.

“I'm in my 11th year in the Legislature and it's been introduced every year. Until last year, people wouldn't even talk about it,” Ayer said. A survey of physicians found that a majority wanted the state to not legislate, she said. However, more than 50 percent said that if assisted euthanasia were made legal, they would use it in their practices. About 30 percent had been asked by their patients to hasten death. [return to top]

Early State Filings Show Premium Reductions Under Reform Law

In many cases the Affordable Care Act appears to be reducing health insurance premiums before tax credit subsidies are taken into account, according to an analysis released May 20 by House Energy and Commerce Committee ranking member Henry A. Waxman (D-Calif.).

Waxman released the Analysis of Recent Filings of Proposed Affordable Care Act Insurance Rates in Five States before a hearing scheduled late May 20 by the Energy and Commerce Committee's Oversight and Investigations Subcommittee on insurance premiums under ACA.

Rhode Island, Vermont, Maryland, Oregon, and Washington state have released information on premium rates proposed by insurers seeking to sell plans in the health insurance marketplaces being created under ACA, the Democratic analysis said.

The analysis “does not find evidence of the widespread ‘rate shock’ predicted by Republicans,” it said. In Oregon, rates for people who stay in comparable plans offered by their current insurer are expected to fall by an average of 11 percent, or $470 per year, in “bronze”-level plans that cover 60 percent of claims; and rates are expected to fall by 7 percent, or $350 per year, for “silver”-level plans that cover 70 percent of claims, it said.

The report is consistent with news from California last week, where regulators just unveiled a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace.

It's the first disclosure of prices in the nation's most populous state for individual health insurance that complies with the Affordable Care Act, and the menu of affordable options surprised some consumer advocates and analysts who had been expecting premiums to be much higher.

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Watch Out for Affordable Care Act Scams

Scammers are taking advantage of the launch of the Affordable Care Act to try and get people's personal information. The Better Business Bureau reports that in recent weeks, people across the country have received calls from scammers posing as federal workers, promising to send a new government-issued health insurance card in the mail as soon as they collect personal and financial information.

But don't let your patients be fooled. You can't sign up for coverage through the Affordable Care Act until October 1, 2013, and anyone who says they can sign you up early is lying. 

Here are key facts to remember:

  • No one can sign up until October 1, 2013. This is when the new Health Insurance Marketplace opens for enrollment. If anyone says they can sign you up earlier or pressures you to act right away, they are trying to scam you. Hang up the phone and don't tell them anything.
  • Never give out personal information to unfamiliar callers. The government doesn't typically call, text, or email - and if they do contact you, they should already have your personal information on file.
  • If you or someone you know is the target for one of these scams, report it. Contact the Federal Trade Commission by calling 877-382-4357 or filling out their online form. You can also call the Maine Bureau of Insurance by calling 1-800-300-5000, or the OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477).

If you are unsure about something you hear about the Affordable Care Act or about someone who contacts you, check it out with a trusted source of information, like the Maine Medical Association or Consumers for Affordable Health Care.  CAHC can give your patients factual information about the Health Insurance Marketplace.  Call their toll free HelpLine at 1-800-965-7476 or email your questions to

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Last Chance to Register for CME Progran on Preventing Prescription Drug Abuse, June 8 in Wells
MMA is presenting a three hour CME program on prescription drug abuse on Saturday morning, June 8, 2013 in Wells.  The program begins at 9:00am and is being held at The Coastal House on Rt. 1 in Wells.  Faculty includes Cyrus Jordan, M.D., Noel Genova, PA-C, MaineCare Medical Director Kevin Flanigan, M.D., Enriko Farmsworth of the Prescription Monitoring Program and Gordon Smith, Esq.  

The cost of the program is just $20 and registration is available on the MMA website at or by calling 622-3374.  You may also e-mail your intention to attend to Ashley Bernier at and simply pay at the door.
Breakfast refreshments will be available prior to the program beginning at 8:30am.
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Upcoming Events

SIM Grant Regional Forums
  • June 3rd: Presque Isle,  Hampton Inn


  • June 4th: Bangor, Dorothea Dix


  • June 10th: Augusta, Augusta Civic Center (Penobscot Room) – webinar also available on this date


  • June 12th: Portland, Fireside Inn and Suites (Sebago Room) – webinar also available on this date


The forums are intended to provide an overview of the State Innovation Model (SIM) Grant including specific goals, project timelines, the governance structure and the next steps moving forward.  they are scheduled from 9:00am to noon.


Webinar options are available on two dates for those who are unable to attend in person. Please register for the forums and/or webinars by May 31st through this registration linkindicating your meeting selection.  If you register for a webinar option, the webinar link and conference call information will be sent to you in a separate email.


If you would like more information about this grant, visit the SIM initiative webpage. If you have questions about the forums or webinars, please email the MaineCare Training Unit.


MMC Oncology Symposium May 29

 Wednesday, May 29, 2013

7 a.m. to 12:30 p.m. 

The Maine Medical Center Cancer Institute will host its annual oncology symposium at Maine Medical Center in Portland on Let’s Get Personal: Applications of Personalized Medicine in Oncology. The symposium will focus on emerging cancer treatments that are tailored to the individual. 

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.


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

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


What Health Care Providers Can Do to Address the Needs of Returning Veterans and Their Families 

July 16th, 2013

8:00 am—12:00 pm

Hannaford Lecture Hall, College of Pharmacy. University of New England

Register Online

This training, part of a national educational campaign aimed at civilian healthcare professionals, will enable these community providers to use their current clinical skills to provide culturally appropriate treatment to service members and their families.


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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