Public Health Updates 12/13/10

NOROVIRUS GASTROENTERITIS

Maine CDC has recently investigated five reports of gastroenteritis outbreaks from Cumberland, Oxford, Kennebec, and Hancock counties. Four outbreaks occurred in long-term care facilities and one occurred in a school setting. Norovirus infections typically increase during the winter months, and Maine CDC routinely receives numerous reports of suspected outbreaks each year. Last winter season, December 2009-March 2010, there were 12 suspect and confirmed norovirus outbreaks reported, compared to 56 reported during the same time period the year before. Public health partners are encouraged to consider norovirus when assessing clusters of gastroenteritis and to act promptly to prevent the spread of illness. All of the above facilities have implemented preventive measures to control further spread of illness.

For more information, see this Health Alert: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=163688&v=alert

HEALTH REFORM UPDATE

This 9-minute non-partisan animated video produced by the Kaiser Family Foundation explains health reform – what it does, what it proposes to do in the coming years, its challenges and opportunities: http://healthreform.kff.org/the-animation.aspx

Funding Opportunities

Advanced Education Nursing Traineeship (http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=58907) applications are due by Dec. 22.

Teaching Health Center (THC) Graduate Medical Education (GME) Payment Program (http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=58913) applications are due by Dec. 30.

Nurse Education, Practice, Quality and Retention (NEPQR) Program (http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=59020) applications are due by Jan. 21.

OTHER UPDATES

· The Federal Plain Language Guidelines have been updated and are available at http://www.plainlanguage.gov

· Beware of lead hazards in some toys when holiday shopping: http://www.cdc.gov/Features/LeadInToys/?s_cid=tw_cdc250

Health Reform Update

Health Reform News

CDC Vital Signs highlight recent data on important health topics. November’s health topic is Access to Care: http://www.cdc.gov/vitalsigns/HealthcareAccess/ New estimates show that the number of Americans without health insurance is growing, affecting middle-income Americans as well as those living in poverty. Adults without consistent health insurance are more likely to skip medical care because of cost concerns, which can lead to poorer health, higher long-term health care costs, and early death.

People with Medicare can review their current coverage or choose a new Medicare plan that works for them through the Open Enrollment period that ends Dec. 31: http://www.medicare.gov/navigation/medicare-basics/open-enrollment.aspx?AspxAutoDetectCookieSupport=1

The Affordable Care Act provides important new benefits to most people with Medicare starting in January 2011, including a 50% discount on brand name drugs for people who fall into the coverage gap, free annual wellness visits, and free mammograms, colonoscopies, and other screenings. For more information: http://www.healthcare.gov/foryou/seniors/strengthening/index.html

HHS Secretary Kathleen Sebelius has announced the launch of the new application cycle for the National Health Service Corps (NHSC) Loan Repayment Program. The NHSC offers primary care medical, dental and mental health clinicians up to $60,000 to repay student loans in exchange for two years of service at health care facilities in medically underserved areas. This year’s investment in the program, which includes $290 million from the Affordable Care Act, seeks to address shortages in the primary health care workforce and translates into greater access to healthcare for those who might otherwise go without.

The Affordable Care Act also provides more flexibility in how the Corps administers the loan repayment program. In addition to monetary awards that are higher than previous years, the Corps will give members the option of working half-time to fulfill their service obligation and provide credit for some teaching hours.

For more information: http://www.hhs.gov/newss/press/2010pres/11/20101122b.html

Health Reform in Maine

Maine Primary Care Association has been awarded $86,434 in additional technical assistance and training funds through the Affordable Care Act. For more information: http://www.hhs.gov/news/press/2010pres/11/20101119b.html

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/

Health Reform Update

Health Reform News

An important provision of the Affordable Care Act requires insurance companies to meet new requirements concerning their “medical loss ratios” – the percentage of premium dollars that an insurance company spends on providing health care and improving the quality of care, versus how much is spent on administrative and overhead costs. To be sure that premium dollars are spent primarily on health care itself, the law requires that 80% to 85% of the money collected by insurance companies be spent on health care services and health care quality improvement. For more information on medical loss ratios, see http://www.healthcare.gov/news/blog/MLR.html

HealthCare.gov’s insurance finder (http://finder.healthcare.gov/) now features pricing and detailed benefit information for private insurance plans for individuals and families. The finder also provides enhanced information about public health resources.

Health Reform in Maine

Thirteen employers have enrolled in the Early Retiree Reinsurance Program, which provides financial relief to businesses, schools and other educational institutions, unions, State and local governments, and non-profits, in order to help retirees and their families continue to have quality, affordable health coverage. Find a list of organizations accepted into this program at http://www.healthcare.gov/law/provisions/retirement/states/me.html

Several grants to support biomedical research have been made through the Affordable Care Act. For more information, see this HHS press release: http://www.hhs.gov/news/press/2010pres/11/20101103b.html

HealthCare.gov has state-by-state summaries of Affordable Care Act grants. Summaries of funds awarded in Maine are available at: http://www.healthcare.gov/center/states/me.html##

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/

Health Reform Update 10/14/10

School-based Health Center Funding Opportunity

US HHS Secretary Sebelius has designated $100 million in new investments from the Affordable Care Act for school-based health centers (SBHCs). The Health Resources and Services Administration (HRSA) expects to award an estimated 200 grants in FY2011 to construct, renovate, or purchase equipment in SBHCs. An eligible applicant must be a school-based health center or sponsoring facility, and should certify that the SBHC site(s) serves children eligible for medical assistance under the state Medicaid plan. The application deadline is December 1.

Recent Health Reform Grants in Maine

· Maine DHHS, Husson College, and the University of New England were awarded a total of $822,796 from the American Recovery & Reinvestment Act (ARRA) to purchase equipment for training current and future health professionals across disciplines at the undergraduate, graduate, and post-graduate education levels.

· Maine was one of 20 states funded to strengthen Aging and Disability Resource Centers (ADRCs) Options Counseling and Assistance Programs for community-based health and long-term care services. Options counseling programs help people understand, evaluate, and manage the full range of services and supports available in their community.

· Maine was one of 16 states funded to coordinate and continue to encourage evidence-based care transition models which help older persons or persons with disabilities remain in their own homes after a hospital, rehabilitation or skilled nursing facility stay. These grants will help break the cycle of readmission to the hospital that occurs when an individual is discharged into the community without the social services and supports they need.

· The University of New England in Biddeford was awarded $990,000 to fund its primary care physician assistant training program by providing student stipends.

· Maine DHHS was awarded $747,632 to develop and evaluate a competency-based uniform curriculum to train qualified personal and home care aides. Personal and home care aides (PHCAs) are projected to be the fourth-fastest growing direct care occupation in the United States between 2008 and 2018. Maine is one of six states participating in the 3-year project.

· The Maine Jobs Council was awarded a $150,000 planning grant to assess the state’s current health workforce. These activities are expected to result in a 10 to 25 percent increase in the primary care health workforce over a 10-year period.

· Maine CDC was awarded $250,000 for a personal responsibility education program as part of $155 million in national teen pregnancy prevention grants.

· US HHS awarded nearly $49 million to help plan for the establishment of health insurance exchanges, a key part of the Affordable Care Act set to begin in 2014. In Maine, the Governor’s Office of Health Policy and Finance was awarded $1 million to support the development and implementation plan for the Exchange.

· US HHS awarded $727 million in Affordable Care Act funds to 143 community health centers to address pressing construction and renovation needs and expand access to quality health care. The following table shows the 19 Maine health centers that received a total of almost $20 million:

Health Center Grantee Name	City	Total Award
Bucksport Regional HC	Bucksport	$3,394,076
City of Portland Maine	Portland	$1,747,510
DFD Russell Medical Center	Leeds	$670,557
Eastport Health Care, Inc.	Eastport	$586,626
Fish River Rural Health	Eagle Lake	$491,222
Harrington Family HC	Harrington	$501,579
Health Access Network, Inc.	Lincoln	$903,820
Healthreach Community HC	Waterville	$1,687,496
Islands Community Medical Services, Inc	Vinalhaven	$408,654
Katahdin Valley HC	Patten	$678,154
Maine Migrant Programs, Inc.	Augusta	$407,295
Maine Primary Care Association	Augusta	$446,250
Penobscot Community HC, Inc.	Bangor	$3,741,093
Pines Health Services	Caribou	$829,605
Regional Medical Center at Lubec, Inc.	Lubec	$549,613
Sacopee Valley HC	Porter	$1,341,309
Sebasticook Family Doctors	Pittsfield	$585,950
St. Croix Regional Family HC	Princeton	$488,368
York County Community Action Corporation	Sanford	$455,900

Other Health Reform News

People who retire early often have a difficult time finding affordable coverage, and are too young to be eligible for Medicare. But today, more early retirees can rest easier knowing that their health security won’t be compromised by their early retirement after today’s announcement that more employers and unions will participate in HHS’s Early Retiree Reinsurance Program. For more information: http://www.healthcare.gov/news/blog/ERRPLetters.html

This HealthCare.gov web site lets you search your insurance options: http://finder.healthcare.gov/

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/

Health Reform Update

Health Reform and Public Health

Health reform has many implications for public health. Learn more by viewing or using the Power Point titled “Health Reform and Public Health” on this website: http://www.maine.gov/dhhs/boh/mills_presentations.shtml.

Maine CDC Awarded Public Health Infrastructure Grant

Maine CDC has received an award of $1.76 million per year for five years from the U.S. Department of Health and Human Services for improvements to Maine’s public health system.

The goal of these funds includes improving health departments’ performance management capacity and the ability to meet national public health standards to make programs and people in the public health system more efficient and effective. In Maine, these funds will: complete an electronic death certificate system; make necessary updates to an electronic birth certificate system; build systems to allow health care providers to more easily transfer information on immunizations to Maine CDC; apply public health performance management principles in Maine CDC and its work; improve capacity for health planning at the state and district level; and make public health data more accessible.

The grant is funded by the Affordable Care Act of 2010 and will be administered by US CDC.

For more information: http://www.maine.gov/tools/whatsnew/index.php?topic=DHS+Press+Releases&id=133134&v=article

Other Health Reform Updates

This web chat (http://www.healthcare.gov/news/blog/webchat_behavioralhealth.html) has information on how the Affordable Care Act will help improve behavioral health.

HealthCare.gov has posted updated information (http://www.healthcare.gov/foryou/youngadults/soon/index.html) for young adults about improvements to health care that are coming soon.

The Kaiser Family Foundation has launched an online resource on the health reform law, which provides explanations of the basics of the law, in-depth analysis of policy issues in implementation, and quick and easy access to relevant data, studies and developments. The Health Reform Source is accessible at: http://healthreform.kff.org

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/

Bi-weekly Public Health Update 9/9/10

INFLUENZA UPDATE

Maine CDC has already distributed more than 36,000 doses of flu vaccine. The vaccine distributed so far is earmarked for pre-schoolers as well as residents and employees of nursing homes and long-term care facilities. It is the first time in many years that state-supplied vaccine has been distributed this early.

Most influenza vaccine arrives in Maine through private sector channels, but some federal and state (Tobacco Settlement - Fund for a Healthy Maine) funds allow Maine CDC to purchase flu vaccine for some populations in Maine such as pregnant women, those in nursing homes, K-12 school children and their teachers and other staff, all other children, homeless, and people served by municipal and tribal health departments. Maine CDC will be distributing a total this year of about 290,000 doses of influenza vaccine, most of it over the coming weeks.

Maine CDC has posted materials – including registration forms, consent forms, and sample protocols – for those participating in school-based flu vaccine clinics at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#schoolclinics

Updates from the US CDC can be found on its Influenza Site.


PERTUSSIS

Pertussis is still an important concern in Maine and throughout the U.S., with outbreaks being seen in several states, including significant ones among un and under-vaccinated in California, resulting in 8 infant deaths there. To date in 2010, Maine has seen 32 confirmed cases of pertussis with 11 of those reported in the past month. The majority of people identified are younger than 13 years of age. Half are not up to date on their vaccines or their vaccine status is not known. With school reconvening and with so many children under-vaccinated, we are concerned about increasing outbreaks here in Maine. For more information, see this Health Alert: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=128206&v=alert


NATIONAL HEALTH REFORM

This report (http://www.rwjf.org/coverage/product.jsp?id=68128&cid=xtw_rwjf) examines the demographics and health characteristics of the new population nationally now eligible for Medicaid under health reform.

Although health coverage is currently available to children in families with incomes up to about $45,000 per year in nearly every state, an estimated five million uninsured children are eligible for Medicaid or CHIP but not enrolled. The Centers for Medicare & Medicaid Services (CMS) have built an unprecedented coalition of partners, ranging from state governors to national advocacy organizations, to enroll children in Medicaid and CHIP and educate families. For more information: http://www.hhs.gov/news/press/2010pres/09/20100903a.html

As part of the health reform’s step-by-step efforts to close the Medicare Part D prescription drug coverage gap, more than 1 million eligible Medicare beneficiaries who fall in this “donut hole” this year are mailed a one-time, tax-free $250 rebate check. For more information: http://www.hhs.gov/news/press/2010pres/08/20100830b.html

Through the Affordable Care Act’s Early Retiree Reinsurance Program, employers are going to receive help to maintain health coverage for retirees not yet eligible for Medicare. Nearly 2,000 employers, representing large and small businesses, State and local governments, educational institutions, non-profits, and unions have been accepted into the program and will begin to receive reimbursements for employee claims this fall. For more information: http://www.hhs.gov/news/press/2010pres/08/20100831a.html

The U.S. Department of Health and Human Services has unveiled CuidadodeSalud.gov, the first website in Spanish of its kind to help consumers take control of their health care by connecting them to new information and resources that will help them access quality, affordable health care coverage. This site is the partner of HealthCare.gov, which was launched in July 2010, and is the first website in Spanish to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool. For more information: http://www.hhs.gov/news/press/2010pres/09/20100908a.html

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/


MAINE IS HIGHLIGHTED IN US CDC’S SPOTLIGHT ON TOBACCO USE

CDC Vital Signs is a new report that will appear on the first Tuesday of the month as part of the US CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators. This month’s Vital Signs focus on tobacco use:
• Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years — United States, 2009
• Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2008

Despite the known dangers of tobacco use, 1 in 5 American adults continues to smoke cigarettes, and 4 in 10 nonsmokers were exposed to cigarette smoke during 2007-2008. Among children between the ages of 3 and 11 years old, 54 percent were exposed to secondhand smoke. Nearly all (98%) of children who live with a smoker are exposed and have measureable levels of toxic chemicals from cigarette smoke.

In this report, US CDC commends California for their successful long term comprehensive tobacco control program that has been associated with adult smoking rate reductions. They then commend the successes seen in youth smoking in our state: “Maine, New York, and Washington have seen 45%--60% reductions in youth smoking with sustained comprehensive statewide programs.”

Additionally, the report notes that the 2009 Family Smoking Prevention and Tobacco Control Act gives the Food and Drug Administration authority to regulate the manufacturing, marketing, and distribution of tobacco products and has provided new opportunities to reduce tobacco use.

For more information visit the Partnership for a Tobacco-free Maine, Maine CDC’s tobacco prevention and control program.


SPOTLIGHT ON TATTOOS

Tattoo licensing has been in the local news recently. Licensed tattoo artists in Maine are required to have special training about bloodborne diseases and to utilize safety precautions before, during and after the application of the tattoo. In getting a tattoo, safety should always be vigilantly observed to avoid medical issues. These include preventing diseases such as HIV, AIDS, hepatitis and other diseases that can be acquired through sharing of needles, use of unsterile equipments and sloppy procedures. You can reduce the health risks by only going to tattoo shops and tattoo artists that are fully licensed. The following provides information on the health risks associated with tattoos and the safety precautions that should be used by all licensed tattoo artists in the State of Maine.

Health Risks Associated with Tattoos:
• Bloodborne diseases. If the equipment used to create your tattoo is contaminated with infected blood, you can contract various bloodborne diseases, including hepatitis B, hepatitis C, tetanus and HIV — the virus that causes AIDS.
• Skin infections. Tattoos can lead to local bacterial infections, characterized by redness, swelling, pain and a pus-like drainage.
• Allergic reactions. Tattoo dyes — especially red dye — can cause allergic skin reactions, resulting in an itchy rash at the tattoo site. This may occur even years after you get the tattoo.
• Other permanent skin problems. Sometimes bumps called granulomas form around tattoo ink, especially red ink. Tattooing can also lead to raised areas caused by an overgrowth of scar tissue (keloids).

Safety Precautions for Reducing Health Risk Associated with Tattoos:
• Go to a reputable tattooing studio that employs only licensed, properly trained employees.
• Make sure the tattoo artist washes his or her hands and wears a fresh pair of protective gloves for each procedure.
• Make sure the tattoo artist removes a needle and tubes from sealed packages before your procedure begins. Any pigments, trays and containers should be unused as well.
• Make sure the tattoo artist uses a heat sterilization machine (autoclave) to sterilize all nondisposable equipment after each customer. Instruments and supplies that can't be sterilized with an autoclave — including drawer handles, tables and sinks — should be cleaned with a commercial disinfectant or bleach solution after each use.

If you think your tattoo may be infected or you're concerned that your tattoo isn't healing properly, contact your doctor.


UPDATED RECOMMENDATIONS FOR PNEUMOCOCCAL VACCINE

The U.S. CDC’s Advisory Committee on Immunization Practices (ACIP) has updated its recommendations for prevention of invasive pneumococcal disease through use of the 23-valent pneumococcal polysaccharide vaccine among all adults aged ≥65 years and those adults aged 19–64 years with underlying medical conditions that put them at higher risk for serious pneumococcal infection. The new recommendations include the following changes from previous ACIP recommendations: 1) indications for which PPSV23 vaccination is recommended now include cigarette smoking and asthma, and 2) routine use of PPSV23 is no longer recommended for Alaska Natives or American Indians aged ≤65 years unless they have medical or other indications for PPSV23. For more information, read this MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm?s_cid=mm5934a3_w

Health Reform Update

How to Find a Health Reform (PPACA) Related Grant in www.grants.gov
1. Go to www.grants.gov. Click on "Find Grant Opportunities" and then "Advanced Search."
2. For the key word search, type in "Affordable Care Act."
3. Or, in the "Search by Funding Activity Category" field, choose "Health" (unless another subject is more appropriate). 4. Or, in the "Search by Agency" field, choose the appropriate agency (U.S. DHHS) or leave the field blank to select all.

Sign up for the RSS feed or daily emails with grant notices from U.S. DHHS or that are related to the Affordable Care Act.

New rules have been issued to make it easier to appeal decisions made by a person’s health plan, including claims denials and rescissions, directly to insurers and then, if necessary, to external review boards. For more information, see this press release from the US Department of Health and Human Services (HHS) and this Kaiser Health News article.

The Robert Wood Johnson Foundation has funded several brief reports that explore the effects health reform will have on consumers, state government, the economy, and health care costs.

Two recently issued reports examine how physicians and hospitals will be affected.

HHS and the US Departments of Labor and Treasury have issued new regulations requiring new private health plans to cover evidence-based preventive services and eliminate cost-sharing requirements for those services. These rules are designed to enable easier access to blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; pre-natal care; and regular wellness visits for infants and children. For more information:

http://www.hhs.gov/news/press/2010pres/07/20100714a.html

Health Reform Update

This Kaiser Health News article describes seven health care changes that will take effect in the coming months: http://www.kaiserhealthnews.org/Stories/2010/July/09/health-overhaul-changes.aspx


This article explains Comparative Clinical Effectiveness Research and its roles in health reform: http://www.healthreformgps.org/resources/comparative-clinical-effectiveness-research/


Healthcare.gov is a new web site with various information, including your new consumer rights and benefits under the Affordable Care Act, a timeline of when new programs under the new law will come online between now and 2014 and a new insurance finder that will make it easy to find both private and public health insurance option that works for you. The site also features important new information about the quality of care available in outpatient and emergency departments, including how well hospitals care for patients with heart attacks and protect outpatients from surgical infections: http://www.healthcare.gov/compare/index.html.

Health Updates

State Health Plan

The new state health plan has been released, outlining strategies for making Maine the healthiest state with the most efficient and effective health care delivery system by 2012. Currently, Maine is ranked the ninth healthiest state, up from sixteenth in 2003.

Other Health-related Reports

A new government report reveals that 90% of Americans are eating more salt than they should. Most salt comes from processed foods that don’t taste salty. For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_100363.html


This new report shows Maine as the 29th most obese state in the nation: http://healthyamericans.org/reports/obesity2010/release.php?stateid=ME


Health Reform Update

The US Department of Health and Human Services (HHS) has established a new website - http://www.healthcare.gov/ This web site features consumer information and implementation updates where people will be able to research plans available in their area. Pricing information will be available starting in October, and the site will also provide additional resources on quality.

The National Prevention, Health Promotion, and Public Health Council, which was created by the health reform law, has submitted its first report to Congress. For more information: http://www.healthreform.gov/forums/blog/preventioncouncil.html

Secretary Sebelius has announced an Affordable Care Act program to provide temporary coverage for Americans without insurance due to preexisting conditions. The program will cover people from now through 2014, when the new insurance exchanges are established. For more details, see this press release.


Questions and Answers related to Health Reform

· This blog post from HHS Secretary Kathleen Sebelius discusses protections that apply to people with private health insurance starting on or after September 23.

· Q&A for families and small business.

· Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights


Updates related to Medicare and Medicaid

· This link describes strategies for reaching out to low-income individuals eligible for coverage through Medicaid and CHIP and enrolling them in the appropriate programs

· CMS has issued a proposed rule on preventive and primary care


Funding opportunity

As part of the Patient Protection and Affordable Care Act, the Health Resources and Services Administration (HRSA) has announced a funding opportunity that will support school-based health center efforts to expand capacity to provide primary healthcare services to school-aged children. There will be awards of $50,000 to 1,000 school-based health centers nationwide for the purchase of moveable equipment to address significant and pressing needs and to support the expansion of services at SBHCs. Applications are due to HRSA July 30.

Update on Health Reform

The U.S. Departments of Health and Human Services, Labor, and Treasury have issued regulations on grandfathered health plans under the Affordable Care Act.

This webchat describes how the Affordable Care Act will give individuals and families more choices and provide stronger consumer protections.

This Kaiser Health News article describes additional benefits for new moms and pregnant women as a result of health reform.

Seniors across the country recently joined President Obama’s discussion on health reform and Medicare. This blog post also describes ways that the new legislation will strengthen Medicare.

The IRS has issued regulations on the 10 percent tax on indoor tanning services included in the health reform law.

Update on health reform

This Kaiser Health Tracking Poll indicates that many Americans are still confused about health reform and what it means to them.

This Health Reform Implementation Brief describes the Prevention and Public Health Fund: http://healthreformgps.org/resources/prevention-and-public-health-fund/

The Internal Revenue Service has released guidance on the health reform law’s health care tax credit for small businesses. More information is available here: http://healthreformgps.org/resources/irs-releases-guidance-on-small-business-tax-credit/

The National Association of Public Hospitals and Health Systems has developed this simple tool to help determine what health reform means to an individual, based on insurance status and age.

Update on Health Reform

The Congressional Research Service issued this 100-page report reviewing the public health, health workforce, and quality provisions in the Patient Protection and Affordable Care Act (health reform).


Healthreform.gov is a comprehensive federal website on health reform, including this webpage with information on Maine. This link on the same site has information about dependent adults under age 26 being eligible for health insurance in advance of September’s start up date.


This open letter from the president and CEO of the Maine Health Access Foundation includes a summary of the health reform legislation and how it relates to Maine. It also includes links to other summaries.


Gov. Baldacci has formed a committee to work on implementing the health reforms in Maine.

Health Reform

President Obama signed the Patient Protection and Affordable Care Act into law on March 23. Last week, he spoke about health reform when he visited Portland. The entire speech is available here.

This National Association of State Medicaid Directors document gives a side-by-side comparison of the different health care reform bills, while the Kaiser Family Foundation developed this summary of the final law and implementation timeline.

This Trust for America’s Health web page describes the prevention components of the final legislation.

The Association of Maternal and Child Health Programs’ Health Reform web page has a number of helpful links focused on the impact on maternal and child health programs as well as more general information.

Selected Prevention, Public Health & Workforce Provisions in the Patient Protection and Affordable Care Act (HR 3590)

from Trust for America's Health (www.healthyamericans.org)

Selected Prevention and Public Health Provisions

Essential Health Benefits Requirements (Sec. 1302) – Includes an essential health benefits package that covers essential health benefits defined by the Secretary and limits cost-sharing. Included in the general benefit categories are preventive and wellness services and chronic disease management, maternity and newborn care, mental health and substance use disorder services, and pediatric services, among other things.

Coverage of Preventive Health Services (Sec. 2713) – Stipulates that a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for:
(1) evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force (USPSTF);
(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the CDC with respect to the individual involved;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by HRSA;
(4) with respect to women, additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by HRSA;States that for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

States that nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by the Task Force.

Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan (Sec. 4103) – Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, BMI measurement, and other screenings and risk factors. The personal prevention plan would take into account the findings of the health risk assessment and would be completed prior to or as part of a visit with a health professional. The personalized health advice and referral may include community-based lifestyle interventions to reduce health risks and promote self-management and wellness, as well as lists of risk factors and a screening schedule.

Directs the Secretary to establish publicly available guidelines for health risk assessments, standards for interactive telephonic or web-based programs to furnish health-risk assessments and a health risk assessment model.

Removal of Barriers to Preventive Services in Medicare (Sec. 4104) – Waives coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. Services for which no coinsurance or deductible would be required are the personalized prevention plan services, an initial preventive physical examination and any covered preventive service if it is recommended with a grade of A or B by the USPSTF. Clarifies that cost sharing for colorectal cancer screening services would be waived.

Evidence-Based Coverage of Preventive Services in Medicare (Sec. 4105) – Provides the Secretary with the authority to modify coverage of existing preventive services, consistent with USPSTF recommendations. It would allow the Secretary to withdraw Medicare coverage for services not rated as A, B, C, or I by the USPSTF.

Improving Access to Preventive Services for Eligible Adults in Medicaid (Sec. 4106) – The current Medicaid State option to provide other diagnostic, screening, preventive, and rehabilitation services would be expanded to include: (1) any clinical preventive service recommended with a grade of A or B by the USPSTF and (2) with respect to adults, immunizations recommended by the Advisory Committee on Immunization Practices and their administration. States that cover these additional services and vaccines, and also prohibit costsharing for such services and vaccines, would receive an increased Federal medical assistance percentage (FMAP) of one percentage point for these services.

Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women in Medicaid (4107) - States would be required to provide Medicaid coverage for counseling andpharmacotherapy for tobacco cessation by pregnant women. Prohibits cost-sharing for these services.

Incentives for Prevention of Chronic Diseases in Medicaid (Sec. 4108) – Directs the Secretary to award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in a healthy lifestyles program and demonstrate changes in health risk and outcomes. The program shall be comprehensive, evidence-based, widely available, and easily accessible and shall be proposed by the state and approved by the Secretary. It shall be designed to address the needs of Medicaid beneficiaries to achieve: ceasing the use of tobacco;controlling or reducing weight; lowering cholesterol; lowering blood pressure; avoiding the onset of diabetes or improving management of diabetes.
The programs shall last for 5 years. The section includes impact assessments, evaluation and reporting requirements. The section appropriates $100 million for the program, out of any funds not otherwise appropriated in the Treasury.

National Prevention, Health Promotion & Public Health Council (Sec. 4001) – Creates a Council within HHS to provide coordination and leadership at the Federal level, and among Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system and integrative health care in the U.S. & to develop the National Prevention Strategy. The Council shall be composed of departmental Secretaries from across the federal government, with the Surgeon General serving as Chair.

National Prevention and Health Promotion Strategy (Sec. 4001) – Tasks the Council with creating a national strategy to: set goals and objectives for improving health through federally-supported prevention, health promotion and public health programs, establish measurable actions and timelines to carry out the strategy, and make recommendations to improve Federal prevention, health promotion, public health and integrative health care practices.

Prevention and Public Health Fund (Sec. 4002) Establishes a fund, to be administered through the Office of the Secretary at HHS, to provide for an expanded and sustained national investment in prevention and public health programs (over the FY 2008 level). The Fund will support programs authorized by the Public Health Service Act, for prevention, wellness and public health activities, including prevention research and health screenings and initiatives, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs. Funding levels: FY 2010 - $500 million; FY2011 - $750 million; FY 2012 - $1 billion; FY 2013 - $1.25 billion; FY 2014 - $1.5 billion; FY 2015 and each fiscal year thereafter- $2 billion.

Community Health Centers and the National Health Service Corps Fund (Sec. 10503) -Creates a Community Health Center Fund that provides enhanced funding for the Community Health Center program, the National Health Service Corps, and construction and renovation of community health centers. Fund totals $10 billion over 5 years. **Of note, the President’s proposal would invest $11 billion in Community Health Centers over five years.

Clinical and Community Preventive Services Task Forces (Sec. 4003) – Defines, clarifies duties of, and provides better coordination between the U.S. Preventive Services Task Force and the Community Preventive Services Task Force.

Education & Outreach Campaign Regarding Preventive Benefits (Sec. 4004) - Directs the Secretary to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the lifespan.

Requires the Secretary, acting through the CDC Director, to establish and implement a national science-based media campaign on health promotion and disease prevention. Directs the Secretary, acting through the CDC Director, to enter into a contract for the development and operation of a Federal Internet website personalized prevention plan tool. Funding for activities authorized under this section shall take priority over funding provided by CDC for grants with similar purposes. Funding for this section shall not exceed $500 million.

Directs the Secretary to provide guidance and relevant information to States and health care providers regarding preventive and obesity-related services that are available to Medicaid enrollees, including obesity screening and counseling for children and adults. States shall design a public awareness campaign to educate Medicaid enrollees regarding availability and coverage of such services. The Secretary shall report on the status and effectiveness of these efforts.

School-Based Health Centers (Sec. 4101) – Directs the Secretary to award grants to support the operation of school-based health centers, with an emphasis on communities with barriers in access to health services. Out of any funds in the Treasury not otherwise appropriated, there is appropriated for each of the fiscal years FY 2010-2013 $50 million for expenditures for facilities and equipment or similar expenditures. Authorizes the Secretary to award grants to pay the costsassociated with expanding and modernizing existing buildings for use as a School-Based Health Center.

Oral Health (Sec. 4102) Directs the Secretary (subject to the availability of appropriations) to establish a 5-year national public health education campaign focused on oral healthcare prevention and education. Establishes demonstration grants to show the effectiveness of research-based dental caries disease management. Includes various oral health improvement provisions relating to school-based sealant programs, oral health infrastructure, and surveillance.

Community Transformation Grants (Sec. 4201) – Authorizes CDC to award competitivegrants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming. Eligible entities shall submit to the Director a detailed plan including the policy, environmental programmatic and as appropriate infrastructure changes needed to promote healthy living and reduce disparities. Activities may focus on creating healthier schoolenvironments, creating infrastructure or programs to support active living and access to nutritious foods, smoking cessation and other chronic disease priorities; implementing worksite wellness; working to highlight healthy options in food venues; reducing disparities; and addressing special population needs. The section includes evaluation and reporting requirements.

Healthy Aging, Living Well; Evaluation of Community-Based Prevention; and WellnessPrograms for Medicare Beneficiaries (Sec. 4202) - Authorizes the Secretary, acting through the CDC Director, to award competitive grants to health departments and Indian tribes to carry out five-year pilot programs to provide public health community interventions, screenings, and when necessary, clinical referrals for individuals who are between 55-64 years old. Grantees must design a strategy to improve the health status of this population through community based public health interventions. Intervention activities may include efforts to improve nutrition,increase physical activity, reduce tobacco use and substance abuse, improve mental health and promote healthy lifestyles among the target population. Screenings may include mental health/behavioral health and substance abuse disorders; physical activity, smoking and nutrition; and any other measures deemed appropriate by the Secretary. The section includes an evaluation component.

The Secretary shall conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries. The evaluation shall include programs sponsored by the Administration on Aging that are evidence-based and have demonstrated potential to help Medicare beneficiaries reduce their risk of disease, disability and injury by making healthy lifestyle choices. CMS and AOA shall also conduct an evaluation of exiting community prevention and wellness programs. The Secretary shall submit a report to Congress on recommendations to promote healthy lifestyles and chronic disease self-management for Medicare beneficiaries; relevant findings; and the results of the evaluation.

Removing Barriers and Improving Access to Wellness for Individuals with Disabilities (Sec. 4203) – Requires the establishment of standards for accessible medical diagnostic equipment for individuals with disabilities.

Immunizations (Sec. 4204) – Authorizes states to obtain additional quantities of adult vaccines through the purchase of vaccines from manufacturers at the applicable price negotiated by the Secretary and authorizes a demonstration program to improve immunization coverage.

Reauthorizes the Immunization Program under Section 317 of the PHSA. Requires a GAO study and report on Medicare beneficiary access to vaccines and coverage of vaccines under Medicare Part D.

Nutrition Labeling of Standard Menu Items at Chain Restaurants (Sec. 4205) – Establishes nutrition labeling of standard menu items at chain restaurants (20 or more locations doing business under the same name). This includes disclosing calories on menu boards and in a written form, available on request, additional information pertaining to total calories and calories from fat, amounts of fat and saturated fat, cholesterol, sodium, total and complex carbohydrates, sugars, dietary fiber, and protein.

Demonstration Project Concerning Individualized Wellness Plan (Sec. 4206) – Directs the Secretary to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellness plan designed to reduce risk factors for preventable conditions identified by a comprehensive risk factor assessment.

Reasonable Break Time for Nursing Mothers (Sec. 4207) – Requires employers to provide reasonable break times for nursing mothers and a place, other than a bathroom, which may be used to express breast milk. Employers with less than 50 employees shall not be subject to this requirement if it would impose an undue hardship by causing significant difficulty or expense.

Research on Optimizing the Delivery of Public Health Services (Sec. 4301) – Directs the Secretary, acting through the CDC Director, to fund research in the area of public health services and systems. Research shall include examining best practices relating to prevention, with a particular focus on high priority areas identified by the Secretary in the National Prevention Strategy or Healthy People 2020; analyzing the translation of interventions to real-world settings;and identifying effective strategies for organizing, financing or delivering public health services in real world community settings, including comparing State and local health department structures and systems in terms of effectiveness and cost.

Understanding Health Disparities: Data Collection and Analysis (Sec. 4302) – Requires the Secretary to ensure that any ongoing or federally conducted or supported health care or public health program, activity, or survey collects and reports, to the extent practicable, data on race,ethnicity, gender, geographic location, socioeconomic status, language and disability status, inaddition to data at the smallest geographic level. The Secretary shall analyze the data to detect and monitor trends in health disparities and disseminate this information to relevant Federal agencies.

Employer-Based Wellness Programs (Sec. 4303) – Directs CDC to provide employers with TA, consultation and tools in evaluating wellness programs and build evaluation capacity among workplace staff. Directs CDC to study and evaluate employer-based wellness practices. Clarifies that any recommendations, data or assessments carried out under this part shall not be used to mandate requirements for workplace wellness programs.

Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs(Sec. 10408) - Directs the Secretary to award grants to small businesses to provide employees with access to comprehensive workplace wellness programs.

Pain Management (Sec. 4305) – Calls for an IOM Conference on Pain and includes various provisions relating to pain research and pain care education and training.

Funding for Childhood Obesity Demonstration Project (Sec. 4306) – CHIPRA established a Childhood Obesity Demonstration Project and authorized $25 million for FY 2009-2013. This section appropriates $25 million for the Secretary to carry out the demonstration project in FY 2010 – FY 2014.

Effectiveness of Federal Health and Wellness Initiatives (Sec. 4402) - Requires the Secretary of HHS to evaluate all existing Federal health and wellness initiatives and report to Congress concerning the evaluation, including conclusions concerning the reasons that such existing programs have proven successful or not successful and what factors contributed to such conclusions.

Better Diabetes Care (Sec. 10407) - Directs the Secretary, acting through the CDC Director, to prepare on a biennial basis, a national diabetes report card. Directs the Secretary and the IOM to study the impact of diabetes on the practice of medicine and the level of diabetes medical education that should be required prior to licensure, board certification and board recertification.

Cures Acceleration Network (Sec. 10409) - Requires the NIH Director to establish a Cures Acceleration Network to accelerate the development of high need cures, including the development of medical products and behavioral therapies.

Centers of Excellence for Depression (Sec. 10410) - Establishes a Network of HealthAdvancing National Centers of Excellence for Depression.

Programs Relating to Congenital Heart Disease (Sec. 10411) - Authorizes the Secretary, acting through the Director, to establish programs relating to congenital heart disease, including the formation of a National Congenital Heart Disease Surveillance System.

Young Women’s Breast Health Awareness and Support of Young Women Diagnosed withBreast Cancer (Sec. 10413) - Establishes a public education and a healthcare professional education campaign regarding women’s breast health.

National Diabetes Prevention Program (Sec. 5316) - Creates a CDC National DiabetesPrevention Program targeted at adults at high risk for diabetes, which entails a grant program for community-based diabetes prevention program model sites.

Selected Workforce Provisions

National Health Care Workforce Commission (Sec. 5101) – Establishes a commission toserve as a national resource for Congress, the President, States and Localities, determine whether the demand for health care workers is being met, identify barriers to coordination and encourage innovation. It shall disseminate information on retention practices for health care professionals and shall review current and projected health care workforce supply and demand and make recommendations regarding healthcare workforce priorities, goals and policies. The Commissionshall communicate and coordinate with a variety of federal agencies and departments. Specific topics to be reviewed include health care workforce supply and distribution, health care workforce education and training capacity; existing education loan and grant programs, the implications of federal policies; the healthcare workforce needs of specific populations, and recommendations creating or revising loan repayment and scholarship programs. Public health professionals are included in the definition of health care workforce and the definition of healthprofessionals. Public health workforce capacity is also included in the high priority areas list.

State Health Care Workforce Development Grants (Sec. 5102) – Establishes a competitive healthcare workforce development grant program to enable Statepartnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels.

Authorizes $8 million for planning grants and $150 million for implementation grants for FY 2010 and such sums for each subsequent year.

Health Care Workforce Program Assessment (Sec. 5103) – Codifies the existing National Center for Health Care Workforce Analysis to provide for the development of information describing the health care workforce and the analysis of related issues and collect, analyze and report data related to programs under this title. The National Center and relevant regional and State centers and agencies shall collect labor and workforce information and provide analyses and reports to the Commission.

Public Health Workforce Recruitment and Retention Programs (Sec. 5204) – Establishes a public health workforce loan repayment program to eliminate critical public health workforce shortages in Federal, State, local and tribal public health agencies. Individuals receiving assistance must work at least three years in these agencies. In FY 2010, $195 million is authorized to be appropriated for this program, and such sums as necessary for FY 2011-2015. Sec. 5205 creates allied health workforce recruitment and retention programs.

Training for Mid-Career Public and Allied Health Professionals (Sec. 5206) - Authorizes the Secretary to make grants or enter into contracts to award scholarships to mid-career public health and allied health professionals to enroll in degree or professional training programs. Authorizes $60 million for these programs in FY 2010 and such sums as necessary for FY 2011-2015.

Elimination of cap on Commissioned Corps (Sec. 5209) This section strikes the required cap of 2,800 for members of the Regular Corps.

Establishing a Ready Reserve Corps (Sec. 5210) - Assimilates active duty Ready Reserve Officers into the Regular Corps & establishes a Ready Reserve to participate in training exercises, be available and ready for involuntary calls to active duty during national emergencies and public health crises, be available for deployment and for backfilling positions left vacant during deployment of active duty Corps members, and be available for service in isolated, hardship & medically underserved communities. This section authorizes $5 million for FY 2010– FY 2014 for carrying out the duties and responsibilities of the Commissioned Corps under this section and for recruitment and training; and $12.5 million for the Ready Reserve Corps for FY 2010 – FY 2014.

Grants to Promote the Community Health Workforce (Sec. 5313) – Directs the Director of CDC to award grants to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.

Epidemiology-Laboratory Capacity Grants (Sec. 4304) Directs the Secretary (subject to the availability of appropriations) to establish an Epidemiology and Laboratory Capacity Grant Program to award grants to eligible entities to assist public health agencies in improving surveillance for and response to infectious diseases and other conditions of public health importance. Authorizes $190 million for each year of fiscal years 2010-2013 to carry out this section.

Fellowship Training in Public Health (Sec. 5314) – Authorizes funding for fellowship training in applied public health epidemiology, public health laboratory science, public health informatics, and expansion of the epidemic intelligence service in order to address documented workforce shortages in State and local health departments. Authorizes, for each of fiscal years 2010 through 2013, $5 million for epidemiology fellowship training programs, $5 million forlaboratory fellowship training programs; $5 million for the Public Health Informatics Fellowship Program; and $24,500,000 for expanding the Epidemic Intelligence Service.

Training in General, Pediatric and Public Health Dentistry (Sec. 5303) – Authorizes the Secretary to make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital or a public or private nonprofit entity to plan, develop and operate or participate in an approved professional dentistry program; to provide financial assistance to dental students, residents, practicing dentists and dental hygiene students, and for other purposes.

United States Public Health Sciences Track (Sec. 5315) Authorizes the establishment of a United States Public Health Sciences Track with authority to grant appropriate advanced degrees in a manner that uniquely emphasizes team based service, public health, epidemiology, and emergency preparedness and response. Students receive tuition remission and a stipend and are accepted as Commissioned Corps officers with a 2-year service commitment for each year of school covered. Included among the graduates shall be 100 public health students annually. Includes a provision that would develop elite federal disaster teams.

Preventive Medicine & Public Health Training Grant Program - Directs the Secretary to award grants to or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties.