MOA Action Alerts & Updates!
Licensing Boards Issue New Joint Rule Chapter 21 re: Opioid Prescribing
The Joint Rule requires the use and documentation of Universal Precautions in prescribing controlled substances. The precautions including conducting a risk assessment to minimize the potential for adverse effects, abuse, misuse, diversion, addiction and overdose, developing a treatment plan, obtaining informed consent, employing a treatment agreement, monitoring, and creating and maintaining adequate medical records to document compliance. There are appropriate exceptions for emergency situations which MMA requested in comments filed on the rule in 2017. The definition of a "medical emergency" is defined in Section 2 of the rule.
The Rule clarifies the obligation of licensees when illegal acts occur and cross references the CDC Guidelines for prescribing opioids issued in 2016 (CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016).
In the purpose section of the Rule the Boards state as follows:
"Clinicians should not fear disciplinary action from the Boards for prescribing controlled substances, including opioid analgesics, for a legitimate medical purpose and in the course of professional practice if they are following standards of care, established guidelines and the requirements of this rule. Judgment regarding the propriety of any specific course of action must be made based on all of the circumstances presented, and thoroughly documented in the patient's medical record.
The new Rule also brings up to date the language in the previous rule in order to conform to the requirements of Chapter 488 and its subsequent amendments enacted and signed into law last year.
Among the new requirements is language requiring the prescribing clinician to periodically review and document in the patient's medical record the course of pain treatment and any new information about the etiology of the pain or the patient's state of health and level of function. The frequency of this review is determined by the patient's risk factors, the medication dose and other clinical indicators but a chart is provided dictating the frequency of the required review. For instance, for a patient at high risk or receiving 90 mg/day MME the review would take every 1 to 3 months.
Clinicians should pay particular attention to the required toxicology drug screens which are required for any patient receiving a controlled substance for chronic non-cancer/non-hospice/non-end-of-life pain for 90 days or more. A drug screen must be done prior to initiating such treatment and at least annually thereafter but with frequency based upon the patient's level of risk.
A full copy of the rule can be accessed HERE.
CDC Report-- Opioid Ovrdose Deaths Increasing in Nearly All Segments of US Population – March 2018
The Centers for Disease Control and Prevention (CDC) released its March 2018 Vital Signs report. Overall, the CDC found:
In 45 states, opioid overdoses increased 30% from July 2016 through September 2017
In the Midwestern region, opioid overdoses increased 70% from July 2016 through September 2017
In large cities in 16 states, opioid overdoses increased by 54% Updated Report (March 30th)
(Maine Overdose Deaths Rose by 11%) See report here.
The 2017 Osteopathic Medical Profession Report Highlights:
- 138,099 Osteopathic Medical Students and Licensed DOs in the US
- (68% Increase since 2007)
- 54% of DOs were age 45 or younger as of 2017
- 56% of DOs practice in primary care specialties (Family Medicine, Internal Medicine, Pediatrics)
- 28,981 Students enrolled in 34 Colleges of Osteopathic Medicine in 32 states
Download the full 2017 Report.
MICIS to Continue Offering Opioid CME in 2018
MICIS has received a contract from the Maine DHHS again this year to provide free continuing medical education (CME) for physicians and others who prescribe. For 2018-19, 3 hours of CME related to opioids must be taken by every health care professional who prescribes opioids and by every physician licensed by the Board of Licensure in Medicine (the MD board) regardless of whether that physician prescribes opioids. This last requirement has been put into place by the BOLIM's Chapter One rule changes which became effective December 23, 2017. Those MDs who have not yet met this CME requirement will have to do so by December 31, 2018.
MICIS will be providing more advanced opioid CME for those who have already taken the basic instruction, along with a continuation of the basic course for those who have not yet taken it. The MMA legal staff will be revamping the legal portion of the CME program to go beyond the basics and address, among other issues, the new Chapter 1 and Chapter 21 changes. Chapter 21, you will recall, applies to all prescribers of opioids, not just MDs and not just physicians.
Those whose licenses are renewed in the early months of 2018 will have to take 3 hours of opioid CME to meet their next cycle's requirement.
Arrangements for MICIS presentations at your hospital, FQHC, or practice, or in your region, may be made by contacting Sarah Lepoff at the MMA: email@example.com.
You can also get Category 1 credits for opioid related education from the following places:
DOcme: MOA Programs from June 2017
Maine Quality Counts: Caring For ME (Safe Opioid Prescribing)
Massachusetts Medical Society
American Society of Addiction Medicine (ASAM)
Remember that you need THREE credits, that is, three hours, to meet the statutory requirement.
Register for the Maine Health Alert Network (MaineHAN) & Get important Public Health Updates:
Free CME on Alzheimer's Risk, Detection, and Management
To help you prepare for these visits, the Alzheimer's Association® presents Challenging Conversations About Dementia. In this free course, you'll receive information to confidently approach the detection, diagnostic and care-planning process for your patients with cognitive impairment and dementia.
For more information and to complete this course, go to www.alz.org/FreeCME. Other tools on the website include the Cognitive Impairment Toolkit.
December 13th, 2017
Maine Osteopathic Board of Licensure Requirement:
THREE Credits (3 Hours) of Opioid CME
Required by Dec. 31, 2017
Have You Completed Your 3.0 Hours of Opioid-related CME?
As of April 2017, the Maine Osteopathic Board of Licensure released the following notice regarding Opioid CME in response to Chapter 488 :
"NOTICE: CME FOR PRESCRIBERS OF CONTROLLED SUBSTANCES
Pursuant to legislation recently enacted, licensees prescribing controlled substances are
required to complete three (3) hours of Category 1 CME regarding the prescribing of opioid
medication(s) every two (2) years as a condition of prescribing these medication(s). The
deadline for completion of the initial course is December 31, 2017.
The Legislature also requires that the Board of Osteopathic Licensure (and all other Boards
licensing prescribers of controlled substances) promulgate rules regarding the new
requirement. Rulemaking is a time-consuming process. The Board encourages its licensees
who prescribe controlled substances to complete the requirement as soon as possible.
To that end, the Board will consider any licensee who has completed this continuing
medical education requirement between April 1, 2016 and December 31, 2017 to have
satisfied the initial requirement.
Applicable credits may be obtained through:
The Maine Osteopathic Association (MOA); American Osteopathic Association (AOA);
American Academy of Physician Assistants (AAPA); American Medical Association Council
on Medical Education (AMA); Accreditation Council for Continuing Medical Education
(ACCME); American Academy of Family Practice (AAFP); or the Committee on Continuing
Medical Education of the Maine Medical Association (MMA)"
The MOA has offered a number of these credits at its June 2016 Annual Convention, February 2017 Midwinter Symposium and June 2017 Annual Conventions. If you have attended these meetings, you may have completed the requirements. Please check with the MOA office at (207) 623-1101.
If you have not yet completed these 3 mandatory hours, you can get Category 1 credits for opioid related education from the following places:
Maine Quality Counts: Caring For ME (Safe Opioid Prescribing)
Massachusetts Medical Society:
American Society of Addiction Medicine (ASAM):
By December 31, 2017 all physicians need THREE credits, that is, three hours, to meet the statutory requirement.
Quality Counts also has 6 online modules around SAFE OPIOID PRESCRIBING with funding from the Board of Licensure in Medicine (BOLIM).
Please contact Amanda Richards or Angela Westhoff with any questions about these requirements at (207)623-1101, ext. 12 or by email:
MOA Board of Directors & Staff
New CME Consortium to Create Greater
Continuing Medical Education Opportunities for Members
A twenty-one state “CME Consortium” (see states in red below) has been developed that will allow osteopathic physicians from the member states to attend CME conferences in each other’s states for member rates! Now when you attend a consortium state’s meeting, you get a better rate and your state association benefits as well, with a portion of your fee coming back to your state association.
It’s a great deal for you and provides revenue for your state osteopathic association!
Have you heard?! The CMEprn App has been developed to help you find those CME Consortium member events. Download the app to your smartphone or mobile device and you will see a map with pins denoting CME event locations.
Download the NEW CMEprn mobile app. It's FREE!
Android Users: Google Play Store Apple Users: Apple Store
On the CMEprn App: Green pins denote CME Consortium member events. The gold pin found centered in Missouri indicates on-demand CME available through the Association of Osteopathic State Executive Directors. Using this pin, you can access www.docme.org and choose from hundreds of recorded CME programs from around the country. The AOA allows 15 credits of online CME per 3-year cycle.
Need CME Credits Now? Complete Online Courses From Your Home or Office!
Sept. 9th, 2017
Patients are in jeopardy if Congress does not act by September 30. The Teaching Health Center Graduate Medical Education (THCGME) program has preserved primary care training opportunities for future physicians since 2011. The program trains primary care residents in community-based health care settings which is vital to filling our nation’s primary care gaps in rural and underserved communities. Nearly 800 osteopathic resident physicians have been trained through the THCGME program, with the majority of these programs providing AOA accredited residency training. Congress must reauthorize this program by September 30.
Congress introduced the “Training the Next Generation of Primary Care Doctors Act of 2017,” which reauthorizes the successful THCGME program for an additional three years, and would allow for the expansion of existing programs and creation of entirely new teaching health centers. This bipartisan legislation has 62 cosponsors in the House and 6 cosponsors in the Senate; however, we need your help. Unless Congress acts quickly, vital resident slots will be lost.
Click here to write to your Members of Congress and ask them to cosponsor “Training the Next Generation of Primary Care Doctors Act of 2017” to protect our fellow DOs and provide care to our nation’s most vulnerable populations.
Mark A. Baker, DO
HHS Adopts Final Version of Major Substantive and Routine Technical Rules on Opioid Prescribing
August 24, 2017, Maine Medicine Weekly Update
The rule will be effective 30 days following filing with the Secretary of State's office or a later date to be announced by the Department. But because these changes are already part of the law, prescribers and dispensers should comply with these provisions now.
(September 13, 2017) Various
Attention Cycle 2 Providers: MaineCare Provider Revalidation
Providers assigned to Cycle 2 are required to update and confirm their enrollment information beginning November 13, 2017. Providers will receive a letter 60 and 30 days prior to their assigned cycle. Providers assigned to this cycle should have received a letter during the week of September 11, 2017.
If you are required to revalidate with MaineCare during this cycle, you must initiate your revalidation application on or after November 13, 2017and complete and submit it by January 12, 2018. Failure to meet this deadline will impact your claims being processed for payment. In order to allow ample time to complete your revalidation during your assigned cycle, we recommend you complete all maintenance two weeks prior to the beginning of your revalidation cycle. An open maintenance case could delay your ability to begin your revalidation. If you are unsure which cycle you have been assigned to, please see the MaineCare provider revalidation schedule currently posted under the “Revalidate as a Current Provider” section of the MaineCare Provider Enrollment webpage.
MaineCare recommends that you review the updated Enrollment Checklists prior to revalidating or enrolling with MaineCare to verify that you have all the required documentation. The checklists include all new information related to the ACA that is required for MaineCare provider enrollment and revalidation for each provider type. Submitting an incomplete application may result in the delay or denial of your application.
MaineCare Services is committed to keeping you informed throughout the enrollment and revalidation process. We will offer free trainings through the Learning Management System (LMS) on topics related to enrollment and revalidation. Online webinar trainings will be scheduled throughout each of the revalidation cycles to offer a number of opportunities to attend each of the trainings. For additional information regarding provider revalidation training, please see the “Training Opportunities” section of the MaineCare Provider Enrollment webpage.
The following resources are available to assist you with the revalidation process:
Save Time and Effort: Submit Prior Authorizations (PA) through the MyHealth PAS Online Portal
Submitting a PA by logging into your Trading Partner Account on the portal will save you time and effort compared to submitting a PA by facsimile (fax).
Some benefits of submitting a PA through the portal include:
There is a potential for errors when keying information into the fax machine. By utilizing the portal, you minimize the possibility of this risk.
When faxing a PA, it can become lost or corrupt. By utilizing the portal, you minimize the chance of requests becoming lost or data becoming corrupt during transmission.
The portal requires you to complete specific fields before you can submit your PA request. If a field is left blank when submitting a PA by fax, the PA unit will request you to complete the fields and submit a new request before it can be processed. By submitting your PA request through the portal, you will ensure the request is complete and save time by avoiding multiple PA request submissions.
Although the PA still needs medical approval when submitted through the portal, you will receive a PA number immediately following submission. Many facilities require a PA number in order to schedule the service. This will allow you to schedule the service immediately after submitting the PA request.
The portal allows you to check the status of a PA online. You will no longer have to call to have someone check the status of your PA request for you.
Medically Urgent Prior Authorization (PA) Requests through the Health PAS Online Portal: Medically Urgent Field Added, CR 61353
An urgent field has been added to the Direct Data Entry (DDE) PA Request Screen on the Health PAS Online Portal. You now have the option to mark your PA as medically urgent before submitting the PA. Prior to this change, you were required to submit medically urgent PA request through fax or mail. We now encourage you to submit them through the portal.
Please note that this field should be utilized for medically urgent PA requests, not time sensitive ones.
If you have questions, please contact Provider Services at: 1-866-690-5585.
Sept 14th Correction Regarding Medically Urgent Prior Authorization (PA) Requests through the Health PAS Online Portal: Medically Urgent Field NOT Added, CR 61353
At this time, the Medically Urgent Field has NOT been added to the Direct Data Entry (DDE) PA Request Screen. It will added after testing is complete. Please see the e-message sent earlier today in error:
An urgent field has been added to the Direct Data Entry (DDE) PA Request Screen on the Health PAS Online Portal. You now have the option to mark your PA as medically urgent before submitting the PA. Prior to this change, you were required to submit medically urgent PA request through fax or mail. We now encourage you to submit them through the portal. Please note that this field should be utilized for medically urgent PA requests, not time sensitive ones.
If you have questions, please contact Provider Services at: 1-866-690-5585.
Maine Worker's Compensation Board:
INPATIENT FACILITY FEE SCHEDULE UPDATED - Effective 10/1/2017
The Board has updated its inpatient facility fee schedule (Appendix III) for dates of discharge on or after October 1, 2017. The fees are based on version 35 of the US Federal Government’s DRG Grouper for FY 18. Questions or concerns regarding the annual update may be addressed toKimberlee.Barriere@maine.gov.
Training Bulletin on Protected Health Information from the Office of Medical/Rehabilitation Services & Maine Worker's Compensation Board:
Brush up on Title 39-A M.R.S.A 208, which "allows for the release of medical information by health care providers to the employer without authorization if the information pertains to treatment of an injury or disease that is claimed to be compensable under the Act.
CLICK HERE to read download the Training Bulletin, which contains important details and definitions.
Register for the Maine Health Alert Network (MaineHAN) & Get important Public Health Updates:
Quality Payment Program Hardship Exception Application for the 2017 Transition Year Is Now Open
Clinicians can now submit Quality Payment Program Hardship Exception Applications through the Quality Payment Program Hardship Exception Application for the 2017 transition year via the Quality Payment Program website.
MIPS-eligible clinicians and groups may qualify for a re-weighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application for any of the following reasons.
Insufficient internet connectivity
Extreme and uncontrollable circumstances
Lack of control over the availability of Certified EHR Technology (CEHRT)
For More Information, contact the Quality Payment Service Center at 1-866-288-8292 or TTY: 1-877-715-6222 or QPP@cms.hhs.gov.
Maine CDC Publishes Modified Opioid/PMP Rule
Friday, March 31st, saw the Maine CDC publish its "final" version of the opioid prescribing and PMP use rule. You can read the entire rule here.
Here are some of the new changes:
- the definition of "opioid medication" includes all controlled substances containing opioids, not just Schedule II drugs.
- the term "administer" is now defined.
- a prescriber's duty to review the PMP check done by a delegate is defined.
- prescriptions must include notations of the prescriber's DEA number; whether the pain being treated is acute or chronic; a notation of "acute" when prescription is for "acute on chronic" pain; and as any exemption being claimed
- notation of ICD-10 codes is only necessary when claiming the palliative care exemption
- a new exemption has been created for situations where a patient proves intolerant of a prescribed opioid and must get another (Code H)
- the rule sets out the types of information the CDC is looking for when reviewing PMP information
All physicians who prescribe opioids should review the new rule as soon as possible.
Electronic Opioid Prescribing Waiver Applications Now Available from Maine CDC
Maine's new opioid law, PL 2015 c. 488, includes a requirement that all opioid prescriptions be done electronically. Of course, there will be circumstances where that is either impossible, extremely difficult or burdensome. The Maine CDC has now (as of April 3, 2017) issued a waiver application that is available online at http://www.maine.gov/dhhs/samhs/osa/data/pmp/E-Prescribing-Waiver-and-Policy_Individual.pdf .
This is what the CDC says about the waiver requirements:
- "Waivers may be granted based on documentation by a practitioner that his or her ability to issue an electronic prescription is unduly burdened by: technological limitations that are not reasonably within the control of the practitioner; or other exceptional circumstances demonstrated by the practitioner. Detailed evidence of, technological limitations and other exceptional circumstances must be provided, including all steps that are being taken, in the interim, to meet this mandate. A waiver may be granted for a period determined appropriate by the department not to exceed twelve (12) months, although the Department may renew the waiver upon a new demonstration that the practitioner’s ability to issue an electronic prescription is unduly burdened."
CMS Releases New Resources to Help Clinicians Successfully Participate in QPP
CMS has recently revamped the look of the QPP website and also posted new resources to help clinicians successfully participate in the first year of the QPP. The following new resources have been posted to the website:
MIPS quick start guide: Outlines the steps clinicians participating in the Merit-based Incentive Payment System (MIPS) need to take between now and March 2018 to prepare for and participate in MIPS, including checking participation status, choosing to participate as an individual or as part of a group, deciding how to submit data, and selecting measures and activities.
Medicare Shared Savings Program and QPP fact sheet: Explains how the Shared Savings Program and the QPP align reporting requirements for participating ACOs and MIPS clinicians, and how certain tracks in Shared Savings Program ACOs meet Advanced Alternative Payment Model (APM) criteria under the QPP.
MIPS APM fact sheet: Provides an overview of a specific type of APM, called a "MIPS APM," and the special APM scoring standard used for those in MIPS APMs.
CMS releases "CAHPS for MIPS" conditionally approved survey vendor list
Physicians who plan on reporting the CAHPS for MIPS measure as one of their quality measures to satisfy MIPS requirements in 2017 must use a CMS-approved CAHPS for MIPS survey vendor. As conditionally approved survey vendors, these organizations have demonstrated they have the facilities, project experience and staff expertise required to conduct the 2017 survey administration with appropriate rigor, given the demands of the survey procedures and timeline.
Final approval of these organizations is dependent on satisfactory completion of CMS training and submission of a Quality Assurance Plan. A final list of the CAHPS for MIPS survey vendors approved by CMS to administer the 2017 survey will be made publicly available this summer.
Keep in mind, physicians who are reporting the CAHPS for MIPS measure must register and inform CMS by June 30, 2017.
An Update on Opioid Health Homes
MaineCare's new Opioid Health Home (OHH) program has begun accepting applications from organizations wishing to be considered for the designation. Amy MacMillan (previously Dix) at MaineCare can be reached at Amy.MacMillan@maine.gov. Currently, Section 93 Emergency Rule is in effect at https://www1.maine.gov/sos/cec/rules/10/ch101.htm/ Comments are being taken until May 18th. We encourage groups to submit comments at http://www.maine.gov/dhhs/oms/rules/proposed.shtml#anchor741339.
In addition, the Maine Office of Substance Abuse and Mental Health Services has a program to cover uninsured for MAT treatment. The coverage will be provided through contracts to agencies that are approved as providers for Opioid Health Homes. As applications are received and approved, the Office of Substance Abuse and Mental Health Services will reach out to OHHs to encumber funds. Mike Parks, Associate Director, DHHS, Office of Substance Abuse and Mental Health Services, can be reached at firstname.lastname@example.org for questions about this part of the program.