Maine Medicine Weekly Update - April 16, 2021  (Plain Text Version)

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In this issue:
•  Maine Medical Association Statement on Johnson & Johnson COVID-19 Vaccine Pause
•  FDA Update & Statement on Johnson & Johnson COVID-19 Vaccine Pause Recommendation
•  Thrombotic Thrombocytopenia & J&J COVID Vaccine Response from the Manufacturer
•  Over 30 Percent of US Adults Fully Vaccinated, Maine Leads the Nation
•  Maine CDC COVID-19 Update for Clinicians with Stephen Sears, MD
•  Clinical Updates and Guidance Related to COVID-19
•  Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through December
•  MaineCare Updates: Upcoming Accountable Communities Public Webinar & Primary Care 2.0 Presentation Available Online
•  HealthCare Dive: Urgent Care Centers Draw Some ER Visits but Associated with Higher Spending Overall
•  Webinar for Medical Students April 22: So You Are Employed, Now What?
•  Next MMA Legislative Call Will Be Wednesday, April 21st
•  Maine Community Action Partnership is Working for a Successful Vaccine Roll Out for All
•  Maine Medical Association & ActionPPE Partner Again; This Time for FDA Approved Rapid Antigen Tests
•  A Message from Maine Responds: Volunteer Opportunity
•  Maine Legislature Week 14 Update
•  Maine Legislature Public Hearings, Work Sessions & New Bills
•  Upcoming Specialty Society Meetings
•  Maine CDC Physicians To Host Regular Clinician COVID Vaccine Info Sessions
•  "Prescribing to Reduce Opioid Overdose Risk: How to Impact the Epidemic Within the Pandemic"
•  NAMI Maine Workshops in May & June: Suicide Prevention & Management for Clinical Staff
•  AAP EQIPP Course: Immunizations - Strategies for Success (for RURAL Health Providers)
•  New Maine AAP Educational Webinar Series
•  Nurse Practitioner
•  Executive Director
•  Medical Director - ME License Required
•  Practice Administrator
•  Physician
•  Psychiatric Nurse Practitioner


Maine Legislature Week 14 Update

The following is a summary of happenings during week 14 of the Maine Legislature.


Weekly Update

Week of April 12 - April 16

 Health and Human Services

            On Monday, the Committee heard testimony during a public hearing for LD 968, Resolve, to Expand Mental Health Crisis Intervention Mobile Response Services. The bill would expand the existing mobile response services to reach all corners of the State, with the idea being that mental health professionals are more often responding to those in crisis, rather than have law enforcement handling such calls. Mental health advocates and police were in support of the bill, while DHHS opposed the new measures.

            Public Hearing for LD 1262, Resolve, Directing the Department of Health and Human Services To Develop a Comprehensive Statewide Strategic Plan To Serve Maine People with Behavioral Health Needs throughout Their Lifespans, commenced on Monday. The bill directs the DHHS to develop a comprehensive statewide plan to serve behavioral health services. Many testified in favor of the proposed legislation. It was noted that the next step forward is to create a comprehensive strategic plan to solve the behavioral health crisis in Maine. Those in opposition agreed with the intent of the bill but asked for incorporating Anosognosia into the bill’s consideration.

            LD 1147, Resolve, To Enhance Access to Medication Management for Individuals with Serious and Persistent Mental Illness, seeks to raise the reimbursement rate for psychiatric medication management services so providers do not continue to have revenue losses and are able to expand care. Kennebec Behavioral Health’s Tom McAdam stated there were 395 people on their medical management waiting lists, they lost $500,000 last year in providing these essential services.. The cost to provide these services has more than doubled since 2008.

            Tuesdays public hearings of consideration were LD 1388  and LD 1385. LD 1388, An Act To Require Testing of Public Drinking Water Supplies for Toxic Perfluoroalkyl and Polyfluoroalkyl Substances and To Establish Maximum Contaminant Levels, would require water testing and sets a maximum contaminant level of 20ppt. All who testified noted this MCL should be lowered, as this level can still cause serious risk. They also noted there are many other PFAS that are of concern that this bill should address rather than simply address two. Dr. Lani Graham testified on behalf of MMA in support of the bill, noting it is essential a testing requirement be established and enforced as some schools have refused to test for PFAS when free testing was provided. LD 1385, An Act To Provide for Timely Placement with Respect to Violent Patients in Hospital Emergency Rooms, would provide the needed secure facilities to place violent patients that pose physicians, staff, and other patients danger. This bill had many proponents, including Northern Lights’ Lisa Harvey-McPherson  who spoke about the significant delays in discharge because the facility the patient had come from refused to take them back due to their violent behavior. There was concern echoed by DHHS’s Jessica Pollard and Malory Shaughnessy from the Alliance for Addiction & Mental Health Services that oftentimes the facilities cannot accept the patient back because they lack the necessary staff, training, and accommodations for the violent patient.

            LD 1113, Resolve, To Direct the Permanent Commission on the Status of Racial, Indigenous and Maine Tribal Populations To Study and Propose Solutions to Disparities in Access to Prenatal Care in the State, directs the Permanent Commission on the Status of Racial, Indegenous and Maine Tribal Populations to study disparities in access to prenatal care. The bill would be a combination of research on previous data and original research from the patients via interviews. Senator Baldacci added an amendment to report back to the HHS committee and to allow the committee to make legislation in response to the recommendations from the Commision. It was voted OTP-AM with 7 in favor, 2 against, and 4 absent. The minority report, presented by Representative Lemelin, was to strike the study of racial disparities from the bill so it would only include Indegenous and Tribal populations.

            On Wednesday, LD 432, Resolve, To Improve Behavioral Health Care for Children, was voted “ought to pass” with the amendment to change the previous 10 hours/year MaineCare reimbursement to 20 hours/year and cap hours at 24 per year. This bill will reimburse for collateral contacts for children’s home and community based-treatment. Public Hearing for LD 1386, Resolve, To Improve Access to Bariatric Care, was on Wednesday as well. This bill will provide sixteen bariatric beds for patients who are morbidly obese. The proponents of the bill spoke on the difficulty of finding bariatric beds for patients and the lack of these beds in Maine often forces the patients to move out of state.

            If there is one bill of the week it is LD 718, An Act To Improve the Health of Maine Residents by Closing Coverage Gaps in the MaineCare Program and the Children's Health Insurance Program. This bill would use state funds to cover the care for immigrants who are not eligible for federal Medicaid or CHIP. There were 71 pieces of testimony in support of this bill. All of which urged the passing of this bill because of the health inequalities amongst the immigrant population. LD 1282, An Act To Prevent Underage Tobacco and Nicotine Access and Use, received the opposite to that of LD 718 in that there were only opponents. This bill would limit the amount of liquid nicotine that can be solved in a single transaction and require sellers to have license scanning technology to verify IDs. Those who testified stated the bill would have adverse effects as it may increase the sales of nicotine products rather than limit sales to those who are underage. MMA submitted testimony in opposition to this bill’s failure to include any other nicotine products and its possible unintended consequences on sales.

            LD 196, Resolve, To Ensure Access to Community Mental Health Services, had its public hearing in the afternoon on Thursday. This bill directs the DHHS to increase reimbursement rates for sections 17 and 65 for direct care workers. All were in support of this proposed legislation. LD 360, Resolve, To Reduce Barriers to Recovery from Addiction by Expanding Eligibility for Targeted Case Management Services, removes special conditions around receiving services for substance use disorders. Current law only permits SUD services for adults who are pregnant, living with their own minor children, and/or using drugs intravenously –– excluding many adults from receiving this treatment. All supported this bill to address the rising number of SUD and fatal overdoses. LD 582, An Act To Support the Fidelity and Sustainability of Assertive Community Treatment, adjusts the definition of assertive community treatment to better align with evidence-based models of treatment and adds in a medical assistant as part of the ACT model. All were in support of this bill as well; specifically in that this bill would expand the hiring pool and access to ACT because it adds a medical assistant to those qualified.

            LD 979, An Act To Expand Maine's School-based Health Centers, provides ongoing funding of $600,000 to fund the expansion of school-based health clinics. The committee unanimously voted “ought to pass: with the fiscal note as the amendment!


            LD 861, Resolve, Directing the Department of Health and Human Services to Contract for Assessments for Involuntary Hospitalizations, was tabled on Friday to allow time for concerned parties to gather further materials for the work session.

Health Coverage, Insurance and Financial Services

            On Tuesday, the Committee held public hearings on a package of bills entitled, “The Making Healthcare Work Package.”  Its lead sponsor was Senate President Jackson. The package was made of five bills, including LD 120, LD 673, LD 675, LD 6868, and LD 1117.  LD 120 focused on creating the Maine Office for Affordable Healthcare, which would give Maine residents a place to turn to when dealing with insurance disputes. The bill was met with wide support and no direct opposition. LD 1117 aims to prohibit drug manufacturers from excessive price increases, as well as lets the Attorney General investigate price gouging. LD 673 had robust support, as it would allow pharmacists to supply a 30-day emergency supply of insulin and help avoid patients having to ration or go without necessary insulin. Finally, LD 675 had support from patients, but was opposed by pharmaceutical companies. The bill would make drug manufacturers subject to fines if the drug has been identified as having an unsupported price increase. All bill packages move on to a work session shortly.

            On Wednesday, the Committee held a lengthy public hearing on LD 1266, An Act to Improve the Value of Dental Insurance. Where medical insurance has to have a 80% minimum loss ratio, dental insurance is not required to have such a percentage. This bill looks to apply the same MLR to dental insurance, thus providing consumers with more value for their dental insurance. The bill had support from dentists and the Maine Dental Association, but hit lots of resistance from a host of dental insurance carriers.