Maine Medicine Weekly Update - 06/10/2019  (Plain Text Version)

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In this issue:
IN THE SPOTLIGHT
•  Governor Signs Bill Enacting "Prudent Layperson" Standard
•  Maine Public Health Association Awards to Dr. Lani Graham and Others
•  Maine Medical Center Wins $14 Million Grant from AMA
•  Women Officers Highlight 2019 AMA Annual Meeting
•  CVS-Aetna Merger Hearing Concludes
•  This Week's Public Health Updates from the AMA
•  New HIPAA Guidelines for Business Associates
•  MedHelp Maine Seeks Data on Unaffordable Medicines
129th MAINE LEGISLATURE
•  MMA Legislative Call Tuesday, June 11th
•  Firearm Safe Storage Bill Fails in House, and Other State House Highlights of the Week
UPCOMING EVENTS
•  Upcoming Specialty Society Meetings
•  Quality Counts: Rapid Induction Starting in the ED (RISE) Training, Webinars, ECHO Program
•  MICIS 2019 Clinical and Legal Opioid Update - June 5 in Augusta
•  Maine Professionals Health Program 1-day wellness conference June 13, 2019 - Augusta Civic Center
•  2019 Jurisdiction K Listening Tour - June 18 - South Portland
•  Assessing and Managing Non-Suicidal Self-Injury and Suicide Risk in Healthcare Settings - 3 Hour CME Training for Healthcare Professionals at MMA on Friday, June 21, 2019
•  The Maine Concussion Management Initiative Will Be Offering Training Programs June 21 and October 29
•  2019 Mary Cushman, MD Award for Exceptional Humanitarian Service as a Medical Volunteer
•  Maine Independent Clinical Information Service 2019 Presentations
HEALTHCARE EMPLOYMENT OPPORTUNITIES
•  Family Medicine Specialist or an Internist
•  Physician (BC/BE in Family Medicine)
•  BC/BE Family Medicine or Internal Medicine Physician
•  Family Medicine Opportunity in Beautiful Western Maine
•  Outpatient Internal Medicine Physician Bangor, Maine
VOLUNTEER OPPORTUNITIES
•  Opportunities at the VA for Volunteer Physicians
•  Volunteer Opportunity with Partners for World Health

 

Governor Signs Bill Enacting "Prudent Layperson" Standard

Last Friday Governor Janet Mills signed LD 1155 into law. It enacts a "prudent layperson" standard for determining when an insurance carrier may not deny or reduce benefits for a patient presenting to an emergency department on the grounds that the patient's condition turned out not to be an emergency.

 

Last Friday Governor Janet Mills signed LD 1155 into law. It enacts a "prudent layperson" standard for determining when an insurance carrier may not deny or reduce benefits for a patient presenting to an emergency department on the grounds that the patient's condition turned out not to be an emergency.

The law, now known as Public Law 2019 chapter 238, requires that the determination of the reasonableness of the patient's decision, and thus the coverage for the treatment, must be based on the standard of whether a prudent layperson, not a medical expert, would believe that the situation presented a medical emergency. Emergency services must be covered without prior authorization.

The law further provides that before a carrier determines the absence of an emergency, it must conduct a utilization review performed by a board certified emergency physician licensed in Maine.

A related bill, LD 249 (now PL 2019 c. 171), requires that an appeal of a carrier's adverse health care treatment decision must be conducted by a clinical peer, defined as a physician or other healthcare practitioner licensed in the U.S.  and board certified in the same or a similar specialty as typically manages the condition under review and whose compensation for the review does not depend on a history of approvals or denials.