January 20, 2014

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POLITICAL PULSE: Legislative Events Focus on Medicaid; MMA Press Event Jan. 23

ACA Medicaid expansion, Medicaid managed care, single payer health care reform, Medicaid coverage of smoking cessation products, and the impact of a so-called "religious freedom" bill on the health care delivery system are highlights of a Second Regular Session that is moving very quickly towards an anticipated adjournment in mid-April.

Health and Human Services Committee Takes up Medicaid Coverage 

LD 1578, the bill that would allow Maine to accept federal funding to provide health care via MaineCare to more low-income Maine residents, received a public hearing last Wednesday, January 15th.  Members of the public wishing to testify on the bill filled both the Committee and an overflow room.  Proponents included hospitals, law enforcement, health centers, mental health providers, individuals standing to gain coverage and others.  Dr. Amy Madden, the Chair of the Association's Legislative Committee and a family physician at Belgrade Regional Health Center delivered the MMA's testimony in favor of the bill.  Steve Feder, D.O. also submitted testimony on behalf of the Maine Chapter of the American Academy of Pediatrics and Janis Petzel, M.D. submitted testimony on behalf of the Maine Association of Psychiatric Physicians (MAPP).  The Committee has scheduled a work session on the bill for this Wednesday.  The Medical Association has planned a press event in favor of the MaineCare proposal for Thursday, January 23rd from 10 am - 12 pm at the Welcome Center of the State House.  Please contact Jessa Barnard at jbarnard@mainemed.com for more information or if you are interested in participating in the event. 

The HHS Committee also invited Gary Alexander of the Alexander Group to present his well-publicized study on the feasibility of a Medicaid expansion, commissioned by the Maine Department of Health and Human Services, last Tuesday.  Mr. Alexander and Commissioner Mary Mayhew presented the report and responded to questions for around an hour.  Jeff Austin of the Maine Hospital Association and Sara Gagne-Holmes of Maine Equal Justice Partners were then invited to comment.  Both expressed disappointment that the report was incomplete and did not take into account savings that could be attributed to the expansion.  

On Thursday, the Committee moved on to consider several carry over bills, including LD 1247, which would require the state to seek additional federal matching funds for family planning services, and LD 1487, Senator Roger Katz's bill to transition Medicaid coverage to managed care.  LD 1487 was tabled for further discussion while a majority of the committee voted in favor of LD 1247.  The Committee also rejected LD 968, a bill that would have required the Commissioner of Human Services to make psychiatric hospitalization available to a person with mental illness who is experiencing a psychiatric crisis and is determined to be in need of hospitalization either in a state or community psychiatric facility or out-of-state.

Governor Vetoes Tobacco Cessation Coverage Provision - Contact your Senator Today

Last session, the legislature overwhelmingly passed LD 386, a bill to restore coverage of smoking cessation benefits to the MaineCare program.  Two weeks ago, the Governor vetoed the bill, stating that because beneficiaries would not be charged co-payments for the services, the bill "expands welfare unchecked."   However, since 2011, CMS has recommended to states that they cover smoking cessation services with no copays or deductibles, citing the fact that "several peer reviewed studies have found that reductions in patient out-of-pocket costs increase both the use of cessation services and overall tobacco quit rates."  The bill would have a negligible financial cost.  Last week, the House voted to override the Governor's veto in a 131-10 vote.  A vote of whether to override the veto is expected in the Senate tomorrow.  Please contact your Senator today to urge them to support the measure.  You can find your senator here

Insurance Committee Holds Work Session on Single Payer Bill 

Dozens of health care providers, patients and others filled the Insurance and Financial Services Committee two weeks ago to testify on LD 1345, a bill that would transition Maine to a single-payer health insurance system in the model of Vermont.  A number of individual physicians testified in favor of the proposal, including Dr. Jim Maier, Dr. Julie Pease and Dr. Janis Petzel.   The Medical Association submitted testimony neither for nor against the bill, highlighting the Association's policy in favor of universal access to health care and a poll conducted in 2008 that showed its membership closely split on the issue.  The Association is re-polling members on their position on a single payer system this month.  The Insurance Committee held a work session on the bill last week and tabled it for further discussion. 

The Committee also held a work session on a number of carry over bills creating new insurance coverage mandates, including requiring coverage for the diagnosis of autism spectrum disorders, hearing aids and chiropractic services.  All of the bills were either tabled for further discussion or voted ought not to pass, with the exception of LD 627, which requires insurance companies to cover orally administered chemotherapy treatments on the same terms as other methods of chemotherapy.  MMA supported LD 627 and it was passed unanimously by the committee.  

Judiciary Committee Considers "Religious Freedom" Bill 

The Judiciary Committee held a public hearing last week on LD 1428, An Act to Protect Religious Freedom.  The bill states that State action may not burden a person’s right to the free exercise of religion, even if the burden results from a rule of general applicability.  MMA testified against the bill from the perspective of the medical community, stating that while the bill may initially sound appealing, it threatens to disrupt access to many medical services.  For example, providers, support staff or institutions could refuse to provide primary care services, prenatal care, treatment for sexually transmitted diseases or any other service if it conflicted with religious views; any individual affiliated with a health care facility could refuse to provide services, such as a receptionist or scheduler refusing to schedule or refer patients for medically necessary services; and the bill would create conflicts with state and federal anti-discrimination laws and EMTALA.   The bill is scheduled for a work session this week. 

MMA Legislative Committee Weekly Conference Call, Tuesday, 1/21/14, 8 p.m.

Tthe next MMA Legislative Committee weekly conference call will take place tomorrow, Tuesday, January 21st at 8:00 p.m. 

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:  1-619-326-2772 

Passcode:  729-7185

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.  The MMA staff lists a suggested position for each bill and any medical specialty particularly affected by the bill.

If you have an opinion about any of these bills, but cannot participate in the call, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or 622-3374, ext. 214.

The MMA staff has been hard at work scheduling Doctor of the Day volunteers for the second session of the 126th Legislature.  This month, we still have openings for January 28th.

If you have any questions regarding the “Doctor of the Day” program, please feel free to contact the MMA at docoftheday@mainemed.com. You can submit your registration on line. We hope to see you at the State House for what is expected to be a very interesting session for the medical community.

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

L.D. 1719An Act To Improve Education about and Awareness of Maine's Health Laws and Resources (support; Public Health Committee; pediatricians)*

L.D. 1720An Act To Improve the Operations of the Office of the Attorney General (monitor)

We also will revisit the following list from last week's call:

L.D. 1428An Act To Protect Religious Freedom (oppose)*

L.D. 1578An Act To Increase Health Security by Expanding Federally Funded Health Care for Maine People (support; Cover Maine Now bill)*

L.D. 1580An Act To Use the Dorothea Dix Psychiatric Center To Provide Inpatient Mental Health Services for Forensic Patients (support; psychiatrists)*

L.D. 1582Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 32: Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders, a Major Substantive Rule of the Department of Health and Human Services (monitor; pediatricians)

L.D. 1583Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 29: Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder, a Major Substantive Rule of the Department of Health and Human Services (monitor; psychiatrists)

L.D. 1584Resolve, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 21: Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder, a Major Substantive Rule of the Department of Health and Human Services (monitor; psychiatrists)

L.D. 1592An Act To Improve and Modernize the Authority of Local Health Inspectors (monitor or support; Public Health Committee)

L.D. 1593Resolve, To Eliminate Financial Inequality in MaineCare Reimbursement for Community-based Behavioral Health Services (monitor; psychiatrists)*

L.D. 1594Resolve, To Improve Access to Emergency Behavioral Health Services and Increase Public Safety (monitor or support; psychiatrists)*

L.D. 1596Resolve, Directing the Department of Health and Human Services To Amend MaineCare Rules as They Pertain to the Delivery of Covered Services via Telecommunications Technology (monitor; psychiatrists)*

L.D. 1598An Act To Improve Hospital-based Behavioral Health Treatment for Persons with Intellectual Disabilities or Autism (monitor or support; psychiatrists)*

L.D. 1599Resolve, Directing the Commissioner of Health and Human Services To Advance the Safe Handling of Hazardous Drugs To Protect Health Care Personnel (monitor)

L.D. 1600An Act To Require Health Insurers To Provide Coverage for Human Leukocyte Antigen Testing To Establish Bone Marrow Donor Transplantation Suitability (monitor)

L.D. 1624An Act Concerning Pricing Disclosure Requirements and Oversight of Pharmacy Benefits Managers (monitor)

L.D. 1629An Act To Amend the Laws Governing the Provider Profiling Program (monitor or support)*

L.D. 1636An Act To Provide a More Efficient and Reliable System of Nonemergency Transportation for MaineCare Members (monitor)

L.D. 1640An Act To Enhance the Stability and Predictability of Health Care Costs for Returning Veterans and Others by Addressing the Issues Associated with Hospital Charity Care and Bad Debt (monitor)

L.D. 1641An Act To Amend the Workers' Compensation Laws as They Pertain to Employee Representation (monitor; physical medicine & rehab specialists)

L.D. 1642An Act To Clarify the Law Governing Public Disclosure of Health Care Prices (support)*

L.D. 1656An Act To Increase Safety for Victims of Domestic Violence (support; Public Health Committee)

L.D. 1659An Act To Amend the Uniform Deceptive Trade Practices Act (monitor)

L.D. 1663Resolve, To Terminate a MaineCare Transportation Contract (monitor)

L.D. 1664An Act To Encourage Charitable Contributions to Nonprofit Organizations (monitor)

L.D. 1669An Act To Standardize and Simplify the Process for Employers To Provide a Drug-free Workplace (monitor; physical medicine and rehab specialists)

L.D. 1676An Act To Strengthen Access Requirements and Review Standards for Health Insurance Plans (support)*

L.D. 1682An Act To Preserve Head Start and Child Care Services (support; pediatricians)

L.D. 1685An Act To Ensure That All Maine Children Are Protected from Abuse and Neglect (monitor or support; pediatricians)*

L.D. 1686An Act To Address Preventable Deaths from Drug Overdose (support)*

L.D. 1699An Act To Fund the Maine HIV Prevention Education Program within the Department of Education (support; Public Health Committee)

L.D. 1704An Act To Increase the Use of Dental Services by MaineCare-eligible Children (monitor or support; pediatricians)* [return to top]

MMA Board Retreats to Samoset this Weekend for Strategic Discussion

The Association's 25 member Board of Directors will meet this weekend at the Samoset Resort in Rockport for its annual President's Retreat.  Following a two-hour business meeting on Friday beginning at 4:00pm, the Board will meet on Saturday and Sunday mornings to conduct professionally facilitated discussions intended to better focus the association's resources in areas of high value to the membership.  By necessity, this means also reducing the resources currently spent on services and products that the membership has indicated in recent surveys they do not value or, at least, do not highly value.  On Sunday morning, the Board will look at its own structure and effectiveness in a self-assessment exercise.  

Over the past several years, the Board has worked hard at restructuring the governance of the organization and to transition the Board to the position of being a knowledge-based decision-maker.  The Board has generally followed the principles set forth in two association-management texts, The Race for Relevance and the Road to Relevance by co-authors Harrison Coerver and Mary Byers, CAE.  These books are published by and made available through ASAE, the Center for Association Leadership.

The President's retreat will be led by current President Guy Raymond, M.D. of Fort Kent. Brian Pierce, M.D., a family physician practicing in Rockport will chair the Board meeting on Friday. [return to top]

U.S. House Passes FY14 Omnibus Appropriations Bill

On January 15th, the U.S. House of Representatives passed a $1.1 trillion appropriations bill (H.R. 3547) that would fund the government through September and avoid most of the cuts to federal health programs and agencies required by the "sequester."  The bill would fund federal health programs and agencies at $156.8 billion, just $100 million below the FY 2013 level.  The Senate was expected to pass the bill by January 18th when current government funding expires.  President Obama has indicated that he will sign H.R. 3547.  The bill does not include new appropriations for the ACA (funded by money dedicated in the bill), but it does increase funding for the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), community health centers, and mental health programs.  

The bill represents the conclusion of a Congressional budget fight that has gone on for months, including a 16-day government shutdown that began October 1, 2013. [return to top]

PMP Enrollment Becomes Mandatory for all Prescribers in Maine

The Office of Substance Abuse and Mental Health sent a communication last week to all physicians, dentists, physician assistants, podiatrists and advance practice registered nurses licensed in the State of Maine stating that because fewer than 90% of practitioners were participating in the Prescription Monitoring Program (PMP) as of January 1, 2014, all licensed individuals in the above disciplines are now required  by state law to register with the Prescription Monitoring Program by March 1, 2014. See 22 M.R.S. § 7249(5).  In addition, Chapter 21 of the Joint Rules of the Maine Boards recommends the utilization of the PMP (§III.1 Principles of Proper Pain Management: Evaluation of the Patient).

Therefore, if you have not done so already, please take a moment right now to go to the PMP website  for registration  forms and further information.  Any questions or inquiries can be directed to the  Substance Abuse and Mental Health Services/PMP office at  207-287-2595 or  osa.ircosa@maine.gov.   For technical and registration questions please contact the PMP Help Desk  directly at 1-866-792-3149 or email mepmpinfo@hidinc.com.

As shared in prior editions of the Weekly Update, the MMA is also working with the licensing boards to make registration an automatic part of the license renewal process. 

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Massachusetts Dermatology Practice Pays $150,000 Breach Notification Settlement

In late December 2013, Adult & Pediatric Dermatology, P.C. of Concord, Massachusetts agreed to pay a settlement of $150,000 for failure to have adequate policies and procedures to address the breach notification provisions of the HITECH Act.  This is the first such settlement with a HIPAA covered entity for a violation of this type.  In addition to the fine, the practice is required to develop a corrective action plan.  The HHS Office of Civil Rights (OCR) began its investigation in October 2011 when the practice reported that an unencrypted thumb drive containing the electronic protected health information (ePHI) of approximately 2200 patients was stolen from a staff member's vehicle.  The thumb drive was never recovered. [return to top]

ONC Posts New Quality Data Model

The Office of the National Coordinator for Health Information Technology recently published a new version of the Quality Data Model, a set of standards used in quality measurement to automatically capture data in electronic health records.  The National Quality Forum updates the Quality Data Model annually.  The ONC refers to the Quality Data Model as "the backbone for representation of quality criteria used in clinical guidelines, quality measurement, and clinical decision support."  The model is used by health IT developers and informatics experts to capture data and by federal agencies for data reporting, including the ONC for the meaningful use program. [return to top]

LAST CHANCE TO REGISTER - Payment Reform Readiness Webinar: Connecting to HealthInfoNet, Jan 21

Payment Reform Readiness Webinar Series: Connecting to HealthInfoNet for Better Care Coordination and Outcomes

January 21, 2014, 12-1pm

Shaun Alfreds, MBA, COO, HealthInfoNet

David Hallbert, MD,  & Molly Stevens, RN, Martin’s Point Health Care

Data is at the heart of payment reform efforts intended to reward outcomes rather than volume. Practices preparing for payment reform are making improvements to their systems for data collection, exchange and analytics. Within this spectrum, HealthInfoNet is a valuable tool for exchanging data necessary for informed decision-making, care coordination and improved outcomes.

Shaun Alfreds, MBA, COO of HealthInfoNet will give an overview of HealthInfoNet, emphasizing its practical value for primary care.

David Hallbert, MD and Molly Stevens, RN will explain how they put HealthInfoNet into practice at their work site, Martin’s Point Health Care, Bangor.

To join this webinar, please email Jennifer Reck at jreck@mainemed.com.  This webinar was made possible through a generous grant from the Maine Health Access Foundation. Other payment reform related resources are available at: http://www.mainemed.com/cme-education-info/payment-reform-resources [return to top]

Member Survey Ongoing: Let us Know Your Thoughts on Payment Reform and Single-Payer Health Care

Last week MMA members received a short, confidential survey on payment reform including a question on single payer health care.  MMA members only please are requested to respond by January 29. One randomly drawn member participant will be able to designate a charity to receive a $500 donation in appreciation for your time. Click here to link to the survey. [return to top]

Job Openings

Department of Psychiatry Faculty Position

The Geisel School of Medicine at Dartmouth, Department of Psychiatry, in a productive collaboration with the State of Maine, is seeking a psychiatrist to join our faculty for inpatient responsibilities at the Riverview Psychiatric Center.

Riverview Psychiatric Center is a 92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient treatment center for Maine’s public mental health system.  Psychiatrists with expertise in general inpatient psychiatry or forensic psychiatry are encouraged to apply.

Academic duties can include teaching and supervision of medical students and residents. Research opportunities available and encouraged.

Candidates should be board certified or eligible in Psychiatry. This position will include a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank and salary commensurate with experience. Curriculum vitae and three letters of reference, addressed to Dr. William Torrey, Search Chair, should be e-mailed to psychiatry.jobs@dartmouth.edu.  Please reference search number PS1013D.

The Geisel School of Medicine at Dartmouth is an Equal Opportunity/Affirmative Action Employer and encourages applications from women and members of minority groups.


ED Provider Jobs

Challenging, Lucrative, ED Provider jobs in central Maine - honoring and serving Veterans.  ED Physicians are needed in Augusta. Must-have an unrestricted medical license (from any U.S. state), and current ACLS certification. This is your opportunity to use and develop your skills of diagnosing, treating, and managing patients according to standard, usual, and acceptable methods and techniques.

B/C or B/E specializing in EM, IM, or FP by the appropriate accrediting agencies (EM preferred).

This is the opportunity for you to receive a competitive salary, a generous leave package, excellent health & life insurance benefits, and retirement benefits. You'd be eligible to participate in a pension program as well as a matching Thrift Savings Plan which is similar to a 401K. If you are a veteran, you may be able to combine accrued military retirement credit with VA pension benefits.

Your salary will be determined by local Physician/Dentist Compensation Panel (commensurate with education, experience and qualifications). By law, U.S. Citizens will be given 1st preference but non-citizens will be considered in the absence of qualified citizens. A signing bonus may be available.  Equal Opportunity Employer. Disabled persons and/or veterans are encouraged to apply.

FMI, call John Poulin at (877) 421-8263 x6913, or email him at john.poulin@va.gov

To apply, go to https://www.usajobs.gov/GetJob/ViewDetails/328066200


Psychiatrist, Psychiatric Nurse Practitioner and/or Physician’s Assistant 

Assistance Plus is seeking a full time psychiatrist, psychiatric nurse practitioner and/or physician assistant for the Medication Management Program in 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.  This position is Monday through Friday and no on call coverage is required.

Please submit resume and cover letter to Kelly Negm 453-4708 ext 303 or email knegm@assistanceplus.com


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Upcoming Events

Medical Group Management Association of Maine

2014 Third Party Payer Seminars

January 21, 2014 (Storm Date January 22, 2014) 
Fireside Inn & Suites, 81 Riverside Street, Portland, ME 


January 28, 2014 (Storm Date January 30, 2014) 
Waterville Elks Club, 76 Industrial Street, Waterville, ME

8:30 am - 4 pm 

Plan to join us for our most popular program of the year, our annual Third Party Payer Seminar.  Payer representatives from the major plans will be speaking at this seminar and providing updates that affect your practice.  Come learn about the new products offered on the Health Care Exchange and how they can help your patients.

For questions or more information, contact Linda Tardif, Education Chair, (207) 783-1449, LTardif@CentralMaineKidneys.com 


The Maine Public Health Association (MPHA) Tobacco Webinar Series  

The Answers Are Out There: Best Practice Strategies to Reduce Tobacco Use

February 27th, 2014 at 2:00 pm 

Register Now 

Speakers: American Cancer Society Cancer Action Network and American Heart Association

Consider the Source: The Intersection Between the
Fund for a Healthy Maine and Tobacco Prevention and Control

March 20, 2014, 2:00 pm 

Register Now 

Speakers: Friends of the Fund for a Healthy Maine and MPHA

Sex Sells: the Wild, Wild East—Emerging Tobacco Trends

May 15, 2014, 2:00 pm 

Register Now  


CODEquest 2014 - Conquering ICD-10

Sponsored by the American Academy of Ophthalmic Executives, a division of the American Academy of Ophthalmology, and the Maine Society of Eye Physicians and Surgeons.

Friday, March 7, 2014

11:00am - 4:15pm

Harraseeket Inn, Freeport, ME

Details and Registration are available at:  http://www.aao.org/aaoe/coding/codequest-maine.cfm or contact Peggy Coakley at pcoakley@aao.org or 415-561-8561.


Save the Date!   

Quality Counts 2014 Annual Conference 

Wednesday, April 2, 2014

Registration materials and information will be available in February at www.mainequalitycounts.org or by calling QC at 207.620.8526, ext. 1004. 


Maine Society of Eye Physicians and Surgeons Spring Educational Program and Business Meeting

Friday, May 2, 2014

12:00pm - 4:45pm

Harraseeket Inn, Freeport, ME

For more information, please contact Shirley Goggin at sgoggin@mainemed.com or 207-445-2260.


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