January 5, 2015

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127th Legislature to Re-Convene Wednesday for Governor LePage Inauguration

The 127th Maine Legislature will reconvene at 10:00 am Wednesday, January 7th with the second inauguration of Paul LePage as the major event of the day.  On Thursday, the three constitutional officers, Janet Mills (Attorney General), Matthew Dunlap (Secretary of State), and Terry Hayes (State Treasurer) will be sworn in.  The Governor will present his proposed biennial budget on Friday.  

The Legislature is expected to be in session until late June.  The cloture date for all bills to be pre-filed was last Friday, January 2nd.  MMA filed several bills on behalf of legislators, including those with the following titles:

  • An Act to Improve Childhood Vaccination Rates in Maine (Rep. Linda Sanborn, M.D.)
  • An Act to Ensure Comprehensive Medical, Educational, and Behavioral Assessment of Children Entering State Custody  (Sen. Geoffrey Gratwick, M.D.)
  • An Act to Ensure Appropriate Health Insurance Coverage for Prescription Eye Drops (Rep. Henry Beck)
  • An Act to Clarify the Use of "M.D." to Represent Achievement of a Graduate Degree by an Individual not Licensed to Practice Medicine in Maine (Rep. Patricia Hymanson, M.D.)
  • An Act to Amend the Law Requiring the Reporting of Injuries to Children Under Six Months of Age or Otherwise Nonambulatory (Rep. Dillon Bates)
  • An Act to Eliminate the Dual Licensing of Physician Assistants (concept draft) (Rep.Anne-Marie Mastraccio)
  • An Act to Amend the Health Care Practitioner Transparency Requirements (Sen. Geoffrey Gratwick, M.D.}

 MMA was also involved in the drafting of a concept draft entitled, An Act to Decrease Uncompensated Care, Reduce Medical Debt and Improve Health Outcomes and a concept draft dealing with home births and the potential licensing of certified professional midwives.  Sen. Anne Haskell is sponsoring the first bill and Sen. Amy Volk the second.

 Finally, Sen. Gratwick has resubmitted on behalf of the Maine Chapter of the American Academy of Pediatrics, legislation known as L.D. 272 in the 126th Legislature that would prohibit minors from using indoor tanning facilities.  The bill passed last year but was vetoed by Governor LePage.

 Weekly conference calls for the MMA Legislative Committee will begin on Tuesday evening, January 13th at 8:00 pm.  Watch the Weekly Update next week for the call-in number.

Physicians wishing to serve as Doctor of the Day during one of the days the House and Senate is in session should communicate with Ashley Bernier at MMA (abernier@mainemed.com).

Physician's Day at the Legislature will be held on Thursday, March 12th and all medical specialties and any individual physicians are welcome to participate.  For more information, contact Dianna Poulin at dpoulin@mainemed.com or call her at 622-3374, ext. 223.


State Laws Taking Effect January 1, 2015

A small number of laws enacted by the 126th Legislature took effect on January 1, 2015.  As most state laws take effect 90 days after adjournment of the legislative session,  a new year usually brings forth only a handful of new laws which specifically included an effective date of January 1st. Of particular interest this year are the following:

  1. A law requiring health plans to cover cancer medication taken orally if the plan covers the equivalent medication administered intravenously.  Supported by the American Cancer Society, MMA, and other health organizations, the legislation is vitally important for those patients for whom an oral medication was appropriate but their health plan included the oral version of the medication in their pharmacy plan, subjecting it to high co-payments that could reach thousands of dollars.  The MMA extends a special "thank you" to New England Cancer Specialists for its critical work on this bill.
  2. A second new law effective January 1st increases the age for mandated health plan coverage of assessment and treatment of autism spectrum disorders.  The previous law covered children ages 5 and under the and new law covers children up to 10 years of age.  The legislation originally presented would have covered children up to the age of majority but in a legislative compromise between supporters and opponents of the bill, the age of 10 was arrived at. This bill was an important initiative of the Autism Society of Maine.  It was also supported by MMA and the Maine Association of Psychiatric Physicians.
  3. A third bill requires health insurers to cover up to $150 of a laboratory fee to test an individual for the human leukocyte antigen to determine whether the person would be a suitable bone marrow donor.
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U.S. Supreme Court Sets Date for Oral Argument in ACA Subsidy Case

Just prior to the Christmas holiday, the U.S. Supreme Court set March 4th as the date for oral arguments in the case (King v. Burwell, No. 14-114) that will determine whether individuals purchasing health insurance coverage through an exchange operated by the federal government will be able to take advantage of the federal tax credits or subsidies available under the ACA.  In 2015, 37 states are using a federally facilitated marketplace (FFM) for ACA enrollments.  The U.S. Courts of Appeals for the Fourth Circuit and D.C. Circuit had reached different conclusions in their rulings on the question. [return to top]

MMA Advocacy on ACA Primary Care Increase for MaineCare

MMA has been working for several months to advocate for continuation of the MaineCare primary care fee increase funded in 2013 and 2014 by the federal government through the ACA.  The 100% federal funding ended on December 31st and many states have reverted back to previous fee schedules.  But, MaineCare continues to pay for the select set of primary care services at Medicare rates and MMA is advocating for continuation of the increase at the State House.  Approximately $1.5 million dollars is needed in the current fiscal year to continue the payment and $3 million will be needed for the fiscal year beginning July 1, 2015.  There is every indication that the LePage administration is supportive of primary care and understands the significance of the enhanced payments to the independent primary care practices which completed the process to be eligible to receive the higher payments.

Watch the Weekly Update for regular reports on what is happening on this issue.  MMA is still encouraging the private practices to complete a brief survey indicating the impact of the enhanced payment on their practices.  To receive the link to the survey, contact Dee deHaas at ddehaas@mainemed.com.

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From MMA Archives 150 Years Ago

From the Records of the 13th Annual Meeting of the Maine Medical Association in 1865:

  •  "It was voted that the President and the Secretary be authorized to petition the Legislature in behalf of the Association that vaccination be made compulsory."  The petition was presented but no action was taken upon it "that was of any benefit."  Two years later, at the 15th Annual Meeting, the President Dr. S.H. Tewksbury, called upon the Legislature to again address the subject of vaccination, as follows:
  • "The attention of the Legislature should be again drawn to this subject, and be furnished with such an array of facts that will convince them that stringent legislation is necessary to prevent the spread of this loathsome and dangerous disease.  Small-pox is almost constantly in existence in some portion of our State, more so than in any other of the New England or Middle States, and the present law gives no adequate power to prevent its spreading over the land.  It must also be remembered by those engaged in preparing legislative measures concerning vaccination, that it is as necessary for the extinction of small-pox, that re-vaccination should be compulsory as that vaccination should be required in the first instance; for it is a well recognized fact that a first vaccination is ineffectual in warding off small-pox, after a certain period.  Here is an evident blot in our sanitary legislation.  It will therefore be a good and useful work to fill the void by a simple and sensible enactment."  Dr. Tewksbury then went on to discuss the need for a General Hospital to be constructed in the State.  That battle was won within a reasonable time.  We are still working on vaccinations (see lst article above).

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ACA Enrollment Update: More than 36,000 Mainers Enroll in First Month of Open Enrollment

A press release December 30th from the federal Department of Health & Human Services stated that more the 36,000 Mainers have signed up for health insurance coverage through the federal marketplace exchange in the first month of open enrollment which began Nov. 15, 2014.  Sixty-one percent of these individuals re-enrolled while 39% used the exchange for the first time.  Of these enrollees, 89% were eligible for a federal subsidy, very close to the 90% eligibility last year.

During the open enrollment period last year, approximately 44,000 individuals signed up for health insurance and that number will very likely be exceeded this year as the automatic re-enrollments did not begin until Dec. 16th after the date of this report.  ACA advocates in the state have predicted that enrollments could increase to about 60,000 before open enrollment closes on Feb. 15th.  

Last year, Maine enrollees paid an average monthly premium of just $99, which was more than the national average of $82, both of these figures being after the subsidy is applied.

MMA, through an enrollment and outreach grant from the Maine Health Access Foundation, has enrollment materials available and continues to work with primary care practices to make information available to patients who are eligible and interested in the exchange.  If your practice is interested in partnering with MMA in distribution of these materials, please contact Susan Kring at skring@mainemed.com or 662-2364.


Consumers can get more information and enrollment help from the following sources:

• Marketplace Call Center at 1-800-318-2596

• Consumers for Affordable Health Care Maine HelpLine at 1-800-965-7476.

• Free in-person enrollment help is available at http://www.enroll207.com


Consumers who already had a 2014 Marketplace plan should update their account during Open Enrollment to make sure they are in the right plan at the right price.  Five Steps to Staying Covered In The Marketplace offers further information.  Consumers who were automatically re-enrolled for 2015 can still review their Marketplace options for 2015 coverage. If they find that another Marketplace plan is a better choice, they can change plans before the end of Open Enrollment on February 15, 2015.


Free brochures to help patients get covered and use their new insurance plans are available at www.enroll207.com/material-order-form/. Marketplace information and links to further resources are available at the Maine Medical Association website


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Cindy Mann, Medicaid Director at CMS, is Leaving Her Post

According to an internal email from CMS Administrator Marilyn Tavenner confirmed by the agency spokesperson, Cindy Mann, CMS deputy administrator and director of the Center for Medicaid and CHIP Services (CMCS), will leave her post at the end of January.  CMCS deputy director Vikki Wachino will serve as acting director until a replacement is identified.  Mann has been leading the Medicaid division of CMS since 2009 and before this appointment she served as director of the Georgetown University Center for Children and Families. [return to top]

MMA Announces Hiring of Peter Michaud, Esq., RN

The Maine Medical Association is pleased to announce the hiring of Peter Michaud, Esq., RN, effective January 1, 2015.  Peter will serve as a staff attorney and handle a variety of responsibilities in the areas of public health, legal and regulatory services, and advocacy.

 Peter is a native of Madawaska, Maine and is a graduate of Harvard College, the University of Maine School of Law, and Central Maine Medical Center College of Nursing and Health Professions.  Most recently, Peter worked as a practicing RN at Memorial Hospital in North Conway, New Hampshire.  He is a former Workers' Compensation Commissioner in Maine and for many years chaired many medical malpractice pre-litigation screening panels while practicing law in Portland.

"We are very fortunate to have recruited Peter back to his home state and back to the practice of law and advocacy,"  said Gordon Smith, Esq., Executive Vice President of MMA.  "Peter comes to us with a unique background involving both law and nursing and he will be able to assist us in our work on behalf of Maine's physicians on day one of his employment.  We welcome him to the MMA team."

Peter can be reached at MMA beginning Jan. 5, 2015 at pmichaud@mainemed.com and 207-622-3374, ext. 211.


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Health Insurance Marketplace 101 Webinars

The Denver Regional Office of the Centers for Medicare & Medicaid Services is offering Health Insurance Marketplace 101 webinars every Tuesday afternoon at 3 pm EST now through the end of Open Enrollment on February 15, 2015.  Registration is not required.  Information about the webinar including dates, topics to be covered, and how to view the webinar is available here [return to top]

Top Ten Predictions for Health Care in Maine and the Nation in 2015

Now that the new year is upon us, MMA staff offers its predictions for what will and will not occur in health care in Maine and the Nation in 2015.
  1. Implementation of ICD-10 will not be subject to further delays and will occur, as presently scheduled, on Oct. 1.  As clinicians have had an additional two years to prepare for the change, the transition will not be the disaster some have predicted, nonetheless, the administrative burdens imposed will be significant.
  2. The ACA will not be repealed by the Congress and any attempt to do so will be vetoed by President Obama.  The law will continue to be unpopular with the public at large. And some significant parts of the law will be repealed, including the tax on medical devices and the Independent Payment Advisory Board (already defunded).
  3. The U.S. Supreme Court, in the infamous King v. Burwell case, will decide that the subsidies offered through the federal exchange are consistent with the underlying law.
  4. The Maine legislature will enact a modest MaineCare expansion, proposed by Governor LePage.  The expansion will assist largely those individuals under 100% of the federal poverty level and will require a CMS waiver.
  5. The consolidation of hospitals in Maine will continue with at least one of the major systems merging into another.
  6. The U.S. Congress will not deal with the proposed SGR Medicare reductions scheduled for April 1, 2015 until mid March.  Shortly before the deadline, they will enact a temporary reprieve, resulting in the 18th patch to the flawed payment system established in the mid 1990s.
  7. Physician reimbursement will continue to be impacted by pressures on health care costs and by new payment models.  More revenue will come from alternative payment systems and less from fee for service.  But the transition away from fee for service will continue to be slow.  Price transparency will continue to be an issue.  More physicians will participate in one or more ACOs.
  8. Ebola will not become an epidemic in the U.S. but will continue to be a serious threat in West Africa.  It will also continue to be a political issue in this country.
  9. Immunization rates will continue to decline in Maine despite significant efforts to educate parents as to the benefits of vaccination.
  10. Opioid use in Maine will decline, led by the 50% reduction seen in MaineCare patients in the past 24 months.  While no research has been done, it is presumed that the decrease in opioid use among MaineCare patients is because of the prior authorization requirements established with the support of the medical community in 2012.



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Upcoming Events


February 6, 2015 - DOT Physical Exam Certification Training for Health Professsionals: MD, DO, PA, NP & Chiropractors available at the Maine Association of Physician Assistants 25th Annual Winter CME Conference at Sunday River Resort

WHY WAIT WHEN YOU CAN SKI & LEARN??   Your Department of Transportation (DOT) Physical Exam Certification program is just around the corner!  Join us for comfortable, affordable, live, DOT physical exam training event in February of 2015, at the Grand Summit Hotel & Conference Center.   National guidelines now require all providers of DOT Exams to be certified, and we are here to assist.  Our program combines years of occupational DOT experience with the current National Guidelines for Certification in an enjoyable, interactive educational setting.  Our providers, Howard Jones, MD and Lisa Gordon, PA-C facilitate an excellently received day of learning for all providers able to perform DOT Physicals under  the National Regulations, including Medical Doctors (MD), Doctors of Osteopathy (DO), Physician Assistants (PA) , Nurse Practitioners (NP) and Chiropractors.  They are also available as a continued resource for those who need information on sleep study facilities and much more.    

This enjoyable day of learning is slated for Friday, February 6, 2015 at the Sunday River Resort, Newry, Maine. Wonderful skiing, local eateries and entertainment abound.  BRING YOUR FAMILY and BRING YOUR FRIENDS!   We are happy to be able to include additional CME offerings at the time of this event.   

A certificate of completion is provided at the end of the day, which will allow attendees to sit for the exam.  Details of this process will be discussed and reviewed at the time of the education. Visit www.mainepa.com/conference for more information or contact Diane McMahon at dmcmahon@mainemed.com or 207-622-3374 ext. 216.


Dementia Care in Primary Care

Friday, March 13, 2014

Join us to learn about, and work with colleagues, on the implementation of best practices for Dementia Care in Primary Care.  This symposium will be offered on Friday, March 13.  The focus of this symposium is on implementation of a standardized approach to memory related problems in Primary Care.  The symposium will be useful to all providers working in Primary Care.  It will be an all-day event, offering CME as well as an opportunity to engage in an office based Quality Improvement process.

The symposium is sponsored by the Office of Aging and Disability Services and is free to participants.  We encourage bringing a member of your support staff who might be integral to implementation of process improvement.

 The primary site will be at MaineGeneral in Augusta, but work is in progress to transmit to both EMMC in Bangor and MMC in Portland.

Cliff Singer, MD                                                                           Roger Renfrew, MD, FACP

Geriatric Mental Health and Neuropsychiatry                     Facilitator Clinical Geriatrics

Acadia Hospital and EMMC                                                   MaineGeneral Medical Center

207-973-7026                                                                         207-621-3699



SAVE THE DATE:  Maine Academy of Family Physicians Spring Events

23rd Annual MAFP Family Medicine Update – April 8-10, 2015, at the Atlantic Oceanside in Bar Harbor

April 11th (tentative) Certified Medical Examiner Training (for DOT Exams) – dependent on registration minimum met

For more information check our website:  http://www.maineafp.org/cme/mafp-cme-meeting

Complete schedule and registration available after January 15th. [return to top]

Job Openings

Chief Dermatologist Job in Central Maine

Challenging, Lucrative, Chief Dermatologist job in central Maine - honoring and serving Veterans.  An experienced Dermatologist is needed in Augusta, Maine.  Must have an unrestricted medical license (from any U.S. state), and current BLS 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 Dermatology by the appropriate accrediting agencies.

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.

Contact John Poulin at 207-621-6913 or john.poulin@va.gov.


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 psychiatrists 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 PS0314D.

Dartmouth College/Dartmouth Hitchcock Clinic/Geisel School of Medicine is an equal opportunity/ affirmative action employer with a strong commitment to diversity. In that spirit, we are particularly interested in receiving applications from a broad spectrum of people, including women, persons of color, persons with disabilities, veterans or any other legally protected group.









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