Updates on MHDO Board Meeting Discussions - September 23, 2021

The MHDO Board Meeting held on September 23, 2021, discussed key topics including final adoption of Rule Chapter 570, updates on the Health Information Advisory Committee (HIAC) requirements, reports due to the Legislature, CompareMaine 10.0, and upcoming next steps. Issues related to Rule Chapter 570 amendments and incorporating new laws for prescription drug price transparency were highlighted during the meeting.

• MHDO
• Board Meeting
• Rule Chapter 570
• Health Information Advisory Committee
• Prescription Drug Price Transparency

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1. Content Content 1. Review Next Steps for Final Adoption of Rule Chapter 570, Uniform Reporting System for Prescription Drug Price Data Sets 2. Review the requirements, membership composition, and next steps specific to MHDO s Health Information Advisory Committee (HIAC) as required in Public Law, Chapter 423 (LD 541) 3. Review Summary of Reports Due to Legislature & Timelines 4. Update on CompareMaine 10.0 5. Next Board Meeting 6. Maine Quality Forum Update Page 1 MHDO BOARD MEETING SEPTEMBER 23, 2021-DISCUSSION DOCUMENT

2. Rule Chapter 570, Rule Chapter 570, Uniform Reporting System for Uniform Reporting System for Prescription Drug Price Data Sets Prescription Drug Price Data Sets MHDO Board provisionally adopted proposed changes in October 2020 (major substantive rule); then submitted to Legislature. One of the issues discussed and agreed to in the HCIFS committee work session was to adjust the level of reporting in our proposed changes for the Pharmacy Benefits Manager (PBM) reporting specifications from the US level to the State level Legislature and Governor passed LD 41 (proposed changes in Rule Chapter 570) in June 2021 Unfortunately, the revision noted above did not get into the final version of what was passed The effective date for nonemergency laws passed in the first special session of the 130th Legislature is October 18, 2021 2 MHDO BOARD MEETING SEPTEMBER 23, 2021

3. Rule Chapter 570, Rule Chapter 570, Uniform Reporting System Uniform Reporting System for Prescription Drug Price Data Sets for Prescription Drug Price Data Sets LD 686, An Act to Increase Prescription Drug Price Transparency also passed this session, Public Law 2021, Chapter 305, and will become effective October 18, 2021 There are now several provisions in Rule Chapter 570 that are inconsistent with the new law. When this happens, the statute overrides inconsistencies in rule Staff is preparing language to be included in the board's final adoption of Rule Chapter 570, that will address the inconsistencies with the new law Staff will present a new policy for the board s consideration to address the rule issue regarding the level of reporting for PBM s (US vs State) 3 MHDO BOARD MEETING SEPTEMBER 23, 2021

4. MHDOs Health Information Advisory Committee MHDO s Health Information Advisory Committee LD 541, An Act to Improve Health Care Data Analysis, now Public Law 2021, Chapter 423, created the MHDO Health Information Advisory Committee. The advisory committee is established to make recommendations to the organization regarding public reporting of health care trends developed from data reported to the organization. MHDO BOARD MEETING SEPTEMBER 23, 2021 4

5. Duties of the Advisory Committee as Duties of the Advisory Committee as defined in defined in 8718 8718 The advisory committee shall make: Recommendations to the organization to establish priorities for health care trend data items; Recommendations to the organization on the annual public reporting of health care trend data items; and Additional health care data trend-related recommendations as requested by the executive director of the organization. 5 MHDO BOARD MEETING SEPTEMBER 23, 2021

6. Membership of the advisory committee as Membership of the advisory committee as defined in defined in 8718 8718 The advisory committee consists of the following 11 members: A. The executive director of the organization; B. One member of the Senate, appointed by the President of the Senate; C. One member of the House of Representatives, appointed by the Speaker of the House of Representatives; D. The commissioner or the commissioner's designee; E. The Superintendent of Insurance or the superintendent's designee; and F. Six members appointed by the board as follows: (1) One member representing consumers of health care; (2) One member representing providers; (3) One member representing hospitals; (4) One member representing employers; (5) One member representing carriers; and (6) One member representing the state employee health plan under Title 5, section 285. 6 MHDO BOARD MEETING SEPTEMBER 23, 2021

7. Next Steps & Timing Next Steps & Timing Create a sub-committee of the board to make recommendations regarding the 6 members of the advisory committee appointed by the board Goal is to convene first meeting of the advisory committee in the spring of 2022 7 MHDO BOARD MEETING SEPTEMBER 23, 2021

8. MHDO Report Statute Due Date Submit to Annual Prescription Drug Pricing Transparency PL 2020, Chapter 470 November 1, 2021 Joint Standing Committee on Health Coverage, Insurance and Financial Services (HCIFS) Reports Due to Legislature & Timelines Reports Due to Legislature & Timelines Top 25 most frequently prescribed drugs in the State, costliest and highest year-over-year increases PL 2017, Chapter 406 December 1, 2021 HCIFS Best Methods and Definitions to Use in Collecting Data to Better Understand Racial and Ethnic Disparities in the Provisions of Health Care in Maine (including suggested legislation) Resolve 2021, Chapter 34 January 1, 2022 HCIFS Annual Primary Care Spending PL 2019, Chapter 244 January 1, 2022 HCIFS & the Commissioner of DHHS Annual Healthcare- Associated Infections PL 2007, Chapter 594 January 30, 2022 HCIFS & HHS MHDO BOARD MEETING SEPTEMBER 23, 2021 8

9. CompareMaine Stats: Overview CompareMaine Stats: Overview October 1, 2015 August 31, 2021: 153,000 Sessions and 762,000 pageviews Top 10 Procedures Searched on CM since launch: 1. Vaginal Delivery 2. Colonoscopy with Biopsy for Noncancerous Growth 3. Knee Replacement 4. Colonoscopy Without Biopsy for Encounter for Preventative Health Services 5. Hip Replacement 6. Gallbladder Removal 7. MRI Scan of Brain 8. C-section (Cesarean Delivery) 9. MRI Scan of Leg Joint 10. MRI Scan of Lower Spinal Canal 9 MHDO BOARD MEETING SEPTEMBER 23, 2021

10. CompareMaine 10.0 CompareMaine 10.0 Release Scheduled for December 2021 Update the Data: Cost Data for the period, April 1, 2020 March 31, 2021 Quality Data (based on availability) CompareMaine Trends Over Time Dashboard Top 25 Rx Reports Add a hover for the cost breakdown to include the number of procedures used to calculate the cost estimate Language updates and clarifications 10 MHDO BOARD MEETING SEPTEMBER 23, 2021

11. CompareMaine 10.0 CompareMaine 10.0 Boards Goal: 80% of the total eligible payments in the commercial claims data is reported on CompareMaine. Anticipate total payments on CM will represent 60% of total eligible payments with the release of 10.0 Focused on procedures that: Are in categories with largest opportunities for growth: Ob/Gyn, Outpatient Procedures, Cardiology, Surgical Procedures Are on the CMS 500 List Have at least 20 CompareMaine facilities reporting Have at least 5,000 eligible claims Outcome of review: Add 27 Outpatient procedures that are on the CPT Pathway Add 3 procedures that utilize the ETG Grouper for surgical and cardiology Outpatient procedures 11 MHDO BOARD MEETING SEPTEMBER 23, 2021

12. CMS 500 vs. CMS 300 CMS 500 vs. CMS 300 CMS 500 CMS 300 Who Health Insurance Issuers and Group Plans Hospitals What 500 CMS-specified shoppable services (CMS- 9915F) 300 CMS-specified shoppable services (released in 2019 by HHS and CMS) When January 1, 2023 January 1, 2021 (feds begin to enforce) How Disclose on a public website and make machine readable files available for in- network negotiated rates, billed charges, and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs. Requires hospitals to post on their website standard charges , including negotiated payment rates with insurers, for all services provided by the hospital. CompareMaine Currently displays 182/500 procedures- (36 %) After adding procedures identified for CompareMaine 10.0, CM will report on 209/500 procedures (42%) CMS requires 70/300 procedures to be reported. CompareMaine currently reports on 57/70 procedures (81%). After adding procedures identified for CompareMaine 10.0, CM will report on 209/500 procedures (84%). (Note: the 70 required procedures are all included on the CMS 500 list. MHDO BOARD MEETING SEPTEMBER 23, 2021 12

13. Procedure Categories on CompareMaine (CM) Category % of Total Paid on CM compared to same categories in APCD (commercial only) # CPT Codes on CM vs. AMA Deliveries 72% 12/84 Office Visits 94% 29/152 PT & OT 98% 34/66 Mental & Behavioral Health 98% 15/45 OB/GYN 39% 9/255 Laboratory 65% 111/1,561 Radiology & Imaging 71% 55/620 Integrative Medicine 88% 12/16 Surgical Procedures 20% 54/5,498 Outpatient Procedures 39% 15/704 Cardiology 61% 8/182 Emergency Department 24% 5/8 Total 60% 357/9,625 Since the previous analysis, several CPT Codes have been recategorized. This increased the denominator of the categories and resulted in changes to the % Total Paid across categories.

14. List of New Procedures for CM 10.0 List of New Procedures for CM 10.0 Number of Procedures Category Procedure Names Behavioral Health 1 Psychotherapy, 45 minutes Cardiology 2 Catheter insertion of stents in major coronary artery or branch, accessed through the skin Utilize the ETG Insertion of catheter for imaging of heart blood vessels or grafts (Diagnostic cardiac catheterization, coronary arteriography) Utilize the ETG Laboratory 13 General health panel Testing for presence of drug Urinalysis, manual test Urine microalbumin (protein) level Creatinine level to test for kidney function or muscle injury Lead level Troponin (protein) analysis Hemoglobin measurement Hepatitis B core antibody measurement Detection test for HIV-1 and HIV-2 Detection test for influenza virus Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) Ob/Gyn 1 Biopsy of uterine lining Office Visits 2 Developmental Screening Treatment of speech, language, voice, communication, and/or hearing processing disorder Radiology and Imaging 7 X-ray of chest, 1 view X-ray of spine of neck, 2 or 3 views X-ray of middle spine, 3 views X-ray of pelvis, 1 or 2 views X-ray of hand, minimum of 3 views Ultrasound of head and neck Nuclear medicine study of vessels of heart using drugs or exercise multiple studies Surgical Procedures 4 Tangential biopsy of single skin lesion Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs Aspiration and/or injection of large joint or joint capsule Biopsy of prostate gland Utilize the ETG 14 MHDO BOARD MEETING JUNE 4, 2020 Total 30

15. MHDO Board Meeting Schedule for MHDO Board Meeting Schedule for Remainder of Calendar Year Remainder of Calendar Year November 4, 2021 Public Hearings for two rules MHDO Board Meeting December 2, 2021 MHDO Board Meeting 15 MHDO BOARD MEETING SEPTEMBER 23, 2021

16. Key Activities Preparing annual report on Primary Care Spending in the State of Maine Participating in LD 1196, Investments in Primary Care & Behavioral Health, Stakeholder Group, (as requested by HCIFS Committee) Preparing annual report on Rate of Healthcare Associated Infections in State of Maine Updating Quality Data on CompareMaine as data becomes available: Preventing Serious complications Preventing Healthcare- Associated Infections Preventing Falls with Injury Preventing Pressure ulcers Unplanned Hospital-Wide Readmissions MHDO BOARD MEETING SEPTEMBER 23, 2021 16

17. Project Firstline Federal CDC s infection control training collaborative, designed to help every frontline healthcare worker gain the knowledge and confidence to stop infections. MQF is providing technical support to the Maine CDC New Content added to the Infection Prevention Forum (infection prevention online learning modules for healthcare and direct care professionals) https://maineinfectionpreventionforum.org/ MHDO BOARD MEETING SEPTEMBER 23, 2021 17