Welcome to MAPA Online, the Official Website of the Maryland Academy of Physician Assistants

MAPA Open Board Meeting April 26, 2008 at Anne Arundel Community College, Arundel Mills Campus, Room #214 at 10am. Grayce Kang, Pharm D Medical Liason, Sanofi-Aventis will be speaking on Osteoporosis (NOT A SALES DISCUSSION). Breakfast will be provided. Please RSVP to kellyjpa@yahoo.com by Monday, April 21, 2008. Member Benefits Curves continues to offer our members a special discount. Check out the Member Benefits page for more infomation. RENEW/JOIN Online NOW!!! Conference 2007 Items Another very successful conference in Ocean City, Maryland has come to a close. For those who attended and did not get a chance to pick up a copy of the CXR Workshop handout. Here is a link to the PowerPoint presentation. Here is a link to Dr. Frissora's Advice (Sensitive Stomach information) More items as they become available...	Students - Scholarship Application Information Available Check out the information now for the 2009 Evie Wollman Memorial Scholarhip. The deadline for submissions is July 5, 2008. Don't miss your chance at a $2,500 scholarship. Check out the Student Info section on the CME tab, or go here. MAPA Annual Trends in Patient Management Fall CME Conference Dates Announced!!! MAPA will be holding the annual CME conference this year in Ocean City, MD from Thursday, September 4 - Sunday, September 7 at the Clarion Resort. The CME committee is working the schedule to give you time to enjoy the beach, as well as fulfill your CME requirements! Look for conference information in the coming weeks. AstraZeneca, PAs and Patient Advocacy One of the premises for the founding of the PA profession has been providing care to the underserved populations. In today’s society, different situations come to mind. This could mean rural and remote locations, or it could mean the poor and destitute in a large populous with a multitude of providers, or it could even mean non-English-speaking immigrants who are culturally ignorant. Whatever the case, it is our duty and mission to provide these people with excellent healthcare. Physician assistants often provide the immediate care, but what happens after the visit? Many of these patients cannot afford prescription medications, and many cannot understand the discharge instructions we provide. Many pharmaceutical companies offer some kind of prescription assistance program. AstraZeneca has contacted the Maryland Academy of Physician Assistants to offer assistance in our mission to treat the underserved. AstraZeneca has recently increased its “poverty level” definition; starting November 15, 2006, prescription assistance is now available to individuals grossing up to $30,000 annually, or a family of four grossing up to $60,000 annually. This is 300% of the federal government-determined level! Additionally, AstraZeneca will educate and help individuals identify and obtain health insurance coverage that they might be able to afford and obtain. AZ’s program provides up to a 90-day supply of their medications for free, delivering the pharmaceutical directly to the patient’s home. Refills can be requested by the healthcare provider. Once enrolled in a prescription assistance program sponsored by AZ, patients remain enrolled for one year and can reapply at the end of that year. The application is very basic and a single page in length, so it is streamlined for simplicity. For patient education, AstraZeneca offers patient education on many common health issues through their website. Not only do they offer this in English (www.azandme.com), but it is also available completely in Spanish (www.azconmigo.com). This information is download- and printer-friendly, and it is reader/patient-friendly. Check it out for yourself; you may be able to utilize this service in your practice and better serve your patient. If you work in a hospital or larger practice, you may want to share this information with case managers and social workers as a more comprehensive team approach. For more information, you can visit the website or call 1-800-424-3727. You can also access a link through the MAPA website (www.mdapa.org).
The NPI is here. The NPI is now. Are you using it? ATTENTION: FFS Medicare Physicians, Non-Physician Practitioners & Other Suppliers MARCH 1st IS A CRITICAL DATE! Last week, CMS issued the January NPI message to all providers. (You can view the January NPI message online at http://www.cms.hhs.gov/ NationalProvIdentStand/02_WhatsNew.asp on the CMS website.) This week begins a weekly messaging campaign for Medicare Fee-For-Service providers in order to raise the level of urgency as the March 1st implementation date approaches. Prior to March 1, 2008: Claims with both an NPI and a Medicare legacy number are rejected if the pair is not found on the Medicare NPI Crosswalk. Claims submitted with just a Medicare legacy number are being paid (unless of course, they have other errors that cause them to be rejected). As of March 1, 2008: Claims with both an NPI and a Medicare legacy number will continue to be rejected if the pair is not found on the Medicare NPI Crosswalk. Claims without an NPI in the primary provider field will be rejected! Claims with only a Medicare legacy number in the primary provider field will be rejected! This means that you will not be able to get paid for any Medicare services you provide until you begin using your NPI. Also, if needed, you must correct any data which may be preventing the NPI/legacy match on the NPI Crosswalk. The correction might require that you file a CMS-855 Medicare Provider Enrollment form with your Medicare carrier, A/B MAC, or DME MAC a process which can take a number of months to accomplish. TEST NPI-only NOW: If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, call your Medicare carrier or A/B MAC enrollment staff for advice right away. The enrollment number is likely to be quite busy after the March 1 deadline, so don't wait. Need More Information? Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CME website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.	The National Uniform Billing Committee has approved a new data element of Present on Admission (POA) Indicator. Present on Admission is defined as present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered as present on admission. What does this mean? This means that unless you thoroughly document in your history and physical that a patient has a history of a condition, or list potential diagnosis in your differential, the hospital may not be reimbursed for conditions you treat that come up during the patients hospital stay. Want to know more? Click here for the entire article, as written by Suzanne Hewes. ARHP Offers Mobile CME Earn continuing education credit anywhere, any time, on your PDA. ARHP now offers mobile CME on your Personal Digital Assistant (including Palm Pilot and Pocket PC operating systems). Simply download our new activity, Choosing When to Menstruate: The Role of Extended Contraception, complete the activity and post-test at your convenience, and receive your certificate when sync your PDA. Continuing education credits are all available.
Success in the School System Pursuant to a letter sent by MAPA’s lawyer, Howard Sollins of Ober and Kaler, on MAPAs behalf to Baltimore County Public Schools (BCPS) regarding the administration of medications to students prescribed by physician assistants, BCPS have amended their policy regarding this issue. This policy has been distributed to all schools within the jurisdiction such that all school nurses are aware of the updated policy. The language pertaining to physician assistant prescribing is as follows: All prescription and non-prescription medications that are needed on a regular basis, including homeopathic medicines, must be accompanied by a written order signed by a physician/nurse practitioner/dentist/physician assistant/osteopath. A signature stamp may be accepted in lieu of a written signature. BEBCO 153 should be completed by the health care provider and should identify the student, medication, dosage, time frequency, anticipated duration of treatment, side/toxic effects, and mode of administration. Medication orders that include all of the above information may be accepted on health care provider letterhead or prescription blank in lieu of BEBCO 153. If there are questions or concerns, please contact MAPA through this website or by emailing info@mdapa.org. Please be sure to include appropriate contact information so that we can respond promptly.	Living Well The Maryland Department on Aging (MDoA), in partnership with the Department of Health and Mental Hygiene, has recently received a grant from the Federal Administration on Aging (AOA) to implement Evidence Based programming in selected areas in Maryland. Each selected jurisdiction will implement the Chronic Disease Self Management Program (CDSMP), which is called "Living Well". CDSMP is an evidence-based program developed by Kate Lorig, RN, Dr.PH of Stanford University. The CDSMP is a self-management program designed to enhance regular treatment and disease-specific education so that sufferers of one or more chronic diseases can better learn the skills to manage their health, and stay active. The program utilizes systematic strategies such as skills mastery, modeling, re-interpretation of symptoms, sharing, action planning, and social persuasion in order to enhance self-efficacy. For more information on CDSMP, please visit the program web site at patienteducation.stanford.edu/ programs/cdsmp.html. The MDoA has awarded grants to six jurisdictions in Maryland (Baltimore, Kent, Caroline, Talbot, Howard, Montgomery, Wicomico and Prince George's Counties). These grants enable each county to train leaders and begin conducting this evidence-based program in the community through local partnerships of service providers, area agencies on aging, local health departments, and other interested organizations. Trainings will be held for leaders beginning in the Spring. In addition to Living Well, Montgomery County will offer an evidence-based program called Active for Life, which assists people to make more active lifestyle choices. The Department would like your help to promote Living Well to your clients to better manage their chronic conditions in order to obtain better quality of life. Please contact Joe Gennusa if you need additional information on promoting the Chronic Disease Self-Management Program. Contact Information: 410-767-1090 800-243-3425 extension 71090 410-333-7943 (Fax) jvg@ooa.state.md.us Or visit their website www.mdoa.state.md.us
Physician Rehabilitation Program Joanna Fitzick, LCSW-C, is the case manager for the Maryland Board of Physicians Rehabilitation Program. Burton D'Lugoff, M.D. is Medical Director for the PRP. The program can be contacted at 443-803-4567. Staff can provide or arrange presentations on the program as well as on topics related to substance abuse and mental health.	Emergency Preparedness Volunteer Corps Training Available Online MedChi, the Maryland State Medical Society, has approved the on-line program for 4 AMA PRA Category I Credits. ALL FEES WAIVED. www.mbp.state.md.us
Health Care Volunteers Needed Beans & Bread Outreach Center, a program of St. Vincent de Paul of Baltimore, seeks volunteer PAs, NPs and doctors to provide medical treatment, triage, and medical referrals to clients. The Mid Level Provider Position (NP or PA) at Beans & Bread Outreach Center and the Frederick Ozanam Transitional Housing Program (BBOC/FOH) is a part-time/volunteer position available for an experienced nurse practitioner/physician assistant. This is an excellent opportunity to join a team of highly dedicated volunteer nurses, and full time staff (mental health, outreach, and para-professionals) whose primary mission is to provide high quality, compassionate care to the homeless population of Baltimore, MD. You will have the opportunity to provide primary care, episodic sick visits, and periodic urgent care to the homeless population that frequents BBOC on a daily basis. Current state licensure, national certification for the mid-level position and certification in basic life support is required. Volunteers are needed Monday through Friday for three hour shifts between the hours of 10am and 4pm. Beans & Bread Outreach Center is located at 402 South Bond Street, Baltimore, MD. For more information, contact Sue Elias at 410-732-1892 or selias@bbfoh.org. .	Latest Legislative Update 5/4/2007 UPDATE 2007 LEGISLATIVE REVIEW Tom Killmond, PA-C Below you will find a quick overview of a number of health care related Bills taken from the "90 Day Report - Review of the 2007 Legislative Session". The entire "90 Day Report" can be found at http://mlis.state.md.us *Infectious Disease* **House Bill 119 (passed) adds anaplasmosis and babesiosis, which are both caused by ticks, to the list of diseases or conditions that medical laboratories must report to a county health officer if the laboratory is in Maryland, or to the Secretary of Health and Mental Hygiene if the laboratory is outside Maryland. By January 1, 2010, DHMH is required to report on the continued need to monitor anaplasmosis and babesiosis. The bill terminates September 30, 2010 Information Sharing Senate Bill 348 / H ouse Bill 1071 (both bills passed) allow a local child fatality review team to investigate the information and records of a child convicted of a crime or adjudicated as having committed a delinquent act that caused a death or near fatality. Upon request, appropriate information maintained by a health care provider has to be provided to the review team as must information and records maintained by specified State and local government entities that provided services to such a child or to the family of such a child. However, information identifying such a child or regarding the involvement of any agency with such a child may not be disclosed during a public meeting. Prostate Cancer Senate Bill 280 (passed) African American men face a far greater risk from prostate cancer than Caucasian men. Senate Bill 280 establishes the Charles County Prostate Cancer Pilot Program to fund prostate cancer screening and treatment and provide prostate cancer education to uninsured or economically challenged men in Charles County. By September 2010, DHMH is required to report on the number of individuals screened and treated by the program, including racial and ethnic data on the individuals who were screened and treated. Health Care Facilities and Regulations House Bill 510 (failed) would have established the Prince George's County Hospital Authority as a State entity to develop a long-term strategy for delivering hospital services and related health care in Prince George's County. The fiscal 2008 budget includes $20.0 million contingent upon passage of House Bill 510 for crucial operating needs. With the failure of the bill, $20.0 million is available only to ensure orderly closure of Prince George's Hospital Center. Sick Cell Disease House Bill 793 (passed) There are approximately 1,700 adult patients in Maryland with SCD, and African Americans are the largest high-risk group in the State. This bill establishes the Statewide Steering Committee on Services forAdults with Sickle Cell Disease. The committee is required to establish institution and community partnerships; establish a statewide network of stakeholders who care for individuals with SCD; and educate individuals with SCD, the public and health care providers about the State options for care of SCD. The steering committee also must seek grant funding to develop and establish a case management system for adults with SCD; establish an adult SCD day infusion center; develop, implement, and lead a State comprehensive education and treatment program for adults with SCD; and develop and implement a health care provider awareness and education campaign. Prescriptive Drug Coverage House Bill 1033 (passed) Prohibits health insurance carriers from imposing a co-payment or co-insurance requirement for a covered prescription drug or device that exceeds the retail price of the prescription drug or device. Individuals with Disabilities Senate Bill 920 / House Bill 1359 (both bills passed) extend the termination date relating to the requirement that State residential centers provide respite care to September 30, 2009. Accordingly, State residential centers will continue reserving the current specified percentage of respite beds in State residential centers to care for individuals with developmental disabilities whose families are caring for those persons in their home. Families caring for individuals with developmental disabilities in their homes will continue to have a choice of obtaining respite care in a State residential center or a community setting. Baby Boomers Senate Bill 700 / House Bill 599 (both bills passed) establish a Baby Boomer Initiative Council staffed by the University of Maryland's College of Health and Human Performance, in cooperation with Johns Hopkins Institutions. The University of Maryland and Johns Hopkins Institutions representatives on the council must initiate a study documenting the economic and social impact of older workers' roles in the economy and in the community. The bills terminate December 31, 2011. Health Care Decisions House Bill 682 (passed) authorizes a health care provider, other than certified or licensed emergency medical services (EMS) personnel, who sees, in a valid form, an EMS "do not resuscitate order" that is not superseded by a subsequent physician's order, to provide, withhold, or withdraw treatment in accordance with the order before a patient's cardiac or respiratory arrest. The bill also requires that health care providers withhold or withdraw treatment in accordance with the order after a patient's cardiac or respiratory arrest. House Bill 797 (Ch. 81) requires the State Advisory Council on Quality Care at the End of Life and the Maryland Health Care Commission to jointly study the current services and potential care delivery alternatives for caring for children with life-threatening medical conditions. The bill establishes a report deadline of December 1, 2007. HIV / AIDS Senate Bill 987 / House Bill 270 (both bills passed) These bills repeal Maryland's code-based HIV reporting system and establishes a name-based HIV reporting system. The bills preserve $37.5 million in federal funding for DHMH beginning in fiscal 2009. Further, the bills establish criminal penalties for any person who knowingly or willfully discloses personal identifying health information acquired for the purposes of HIV and AIDS reporting to any person who is not authorized to receive such information or otherwise is in violation of the bill or for any person who obtains information on HIV and AIDS under false pretenses or through deception. Senate Bill 746 / House Bill 784 (both bills passed) trequire the AIDS Administration to convene a workgroup to review and make recommendations regarding the Centers for Disease Control and Prevention (CDC) guidelines regarding HIV/AIDS, including pre- and post-test counseling and written informed consent. The workgroup is also required to consider best practices and research and data regarding treatment for HIV/AIDS and report on any recommendations by January 1, 2008. Sexually Transmitted Diseases Senate Bill 349 / House Bill 769 (both bills passed) create an Expedited Partner Therapy Pilot Program in the Baltimore City Health Department to provide antibiotic therapy to the partner of a patient diagnosed with chlamydia or gonorrhea in order to contain the infection. The health department must report each year to the Governor and the General Assembly on the pilot program's operation and performance. The bills terminate June 30, 2010. "This Bill specifically identifies PAs as a health care provider authorized to dispense antibiotic therapy!" Senate Bill 774 / House Bill 1049 (both bills passed) establishes a subcommittee on the Human Papillomavirus Vaccine within DHMH's Cervical Cancer Committee of the Maryland Comprehensive Cancer Control Plan. In 2006, CDC's Advisory Committee on Immunization Practice recommended that Gardasil, a vaccine to protect against the Human Papillomavirus (HPV), be routinely given to girls at ages 11 and 12. HPV is the most common sexually transmitted infection in the United States and two types of HPV cause most cervical cancers. The subcommittee is required to examine federal and State programs relating to the HPV vaccine, develop a public awareness and education campaign about the vaccine with an emphasis on parental education, evaluate the availability and affordability of the vaccine, identify barriers to the vaccine's administration to all recommended individuals, identify and evaluate various resources to cover the vaccine's costs, and identify and evaluate appropriate mechanisms that Maryland may use to increase access to the vaccine. Smoking Prohibitions Senate Bill 91 / House Bill 359 (both bills passed) prohibit smoking in an indoor area open to the public; an indoor area where public meetings are held; a government-owned or -operated means of mass transportation including buses, vans, trains, taxicabs, and limousines; or an indoor place of employment. This prohibition does not apply to most private homes, residences, and private vehicles, up to 25 percent of hotel or motel rooms, tobacco stores, industrial facilities that involve processing, manufacturing, or distribution of tobacco products, or a research or educational laboratory for scientific research into the health effects of smoking. Smoking ban waivers may be granted by the health officer of a county if a waiver applicant meets all conditions required under regulations adopted by the Secretary of Health and Mental Hygiene. A waiver applicant must establish in writing that compliance with a specific provision of the bill would cause undue financial hardship or other factors would render compliance unreasonable. Any waiver granted under the bill will terminate January 31, 2011, and no waiver will be granted on or after January 31, 2011. The bills also establish progressively stringent punishments based on the number of violations for a person who violates a provision of the bills or a regulation adopted under the bills. Stem Cell Research Funding Fiscal 2008 is the second year of State funding for stem cell research. At $23 million, the fiscal 2008 appropriation represents an $8 million increase over fiscal 2007. The stem cell program was established by Chapter 19 of 2006 to support activity at research institutions or private companies in Maryland. >> Continue reading Stem Cell Research Funding ADDITIONAL LEGISLATIVE ARTICLES Health Occupations (Includes Physicians, Military Health Care, Pesonnel, Nurses and Social Workers) Health Insurance (Includes Major Reform Proposals, Continuation of Coverage for Child Dependants, Access to Coverage for Domestic Partners Relationships Between Health Insurance Carriers and Health Care Providers, Non-Physician Specialist Referrals, Reimbursement for Psychiatric Treatment) Mental Health**