Healthcare Reporting System Rule Adoption Updates

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The board votes on the final adoption and provisional adoption of rule chapters related to uniform reporting systems for health care claims, non-claims based payments, and health care quality data sets. Updates include rulemaking timelines, status reports on mandated and agency reporting, board nominations, and meeting calendar reviews. Recommendations for adoption and initiation of rulemaking are made for ensuring compliance and data submission efficiency.

  • Healthcare
  • Reporting System
  • Rule Adoption
  • Board Meeting
  • Data Sets

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  1. Content Content 1. Board votes on Final Adoption of Rule Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, as proposed and amended. 2. Board votes on Final Adoption of Rule Chapter 247, Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Sets, as proposed and amended. 3. Board votes on Provisional Adoption of Rule Chapter 270, Uniform Reporting System for Health Care Quality Data Sets, as proposed. 4. Board votes on Final Adoption of Rule Chapter 247, Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Sets, as proposed and amended 5. Update on Rulemaking Timeline to Implement New Requirements of 1728, Prescription Drug Transparency Report Regarding the 340B Program. 6. Update on Status of Mandated Reporting and other Agency Reporting. 7. Update on Status of Board Nominations and Appointments. 8. Review Board Meeting Calendar for 2024. 9. Maine Quality Forum Update Page 1 MHDO BOARD MEETING DECEMBER 7, 2023

  2. Rule Chapter 243, Uniform Reporting System for Health Care Claims Data Sets (routine technical rule) Written comments were received on the proposed rule. Board received copies of the written comments submitted and an updated copy of the Basis Statement, documenting the comments received, staff s proposed responses and recommendations. Summarize content of updated Basis Statement. MHDO BOARD MEETING DECEMBER 7, 2023 2

  3. Rule Chapter 243, Uniform Reporting System for Health Care Claims Data Sets (routine technical rule) Recommendation: Board votes to adopt Rule Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, as proposed and amended; and authorize Karynlee to sign the MAPA 1 form. Recommendation: Board votes to authorize Karynlee to initiate Rulemaking (routine technical) early 2024 for Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, so that staff can create a separate file for the submission of capitation data. MHDO BOARD MEETING DECEMBER 7, 2023 3

  4. Rule Chapter 247, Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Sets Written comments were received on the proposed rule. Board received copies of the written comments submitted and an updated copy of the Basis Statement, documenting the comments received, staff s proposed responses and recommendations. Summarize updated Basis Statement. MHDO BOARD MEETING DECEMBER 7, 2023 4

  5. Rule Chapter 247, Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Sets Recommendation: Board votes to adopt Rule Chapter 247, Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Sets, as proposed and amended; and authorize Karynlee to sign the MAPA 1 form. MHDO BOARD MEETING DECEMBER 7, 2023 5

  6. Rule Chapter 270, Uniform Reporting System for Health Care Quality Data Sets (major substantive rule) Written comments were received on the proposed rule. Board received a copy of the written comment submitted and an updated copy of the Basis Statement, documenting the comments received, staff s proposed responses and recommendations. Summarize updated Basis Statement. MHDO BOARD MEETING DECEMBER 7, 2023 6

  7. Rule Chapter 270, Uniform Reporting System for Health Care Quality Data Sets (major substantive rule) Recommendation: Board votes to adopt Rule Chapter 270, Uniform Reporting System for Health Care Quality Data Sets, as proposed; and authorize Karynlee to sign the MAPA 1 form. MHDO BOARD MEETING DECEMBER 7, 2023 7

  8. Revised Timeline for Implementing Public Law 2023, Chapter 276 (LD 1395) An Act to Increase Transparency Regarding Certain Drug Pricing Programs Title 22, Ch. 1683 1728 2. Beginning January 1, 2024, each hospital participating in the federal drug pricing program under Section 340B of the federal Public Health Service Act, 42 United States Code, Section 256b, referred to in this section as "the 340B program," shall provide an annual report to the Maine Health Data Organization. The Maine Health Data Organization shall post the report on its publicly accessible website. Each hospital shall report in a standardized format as agreed upon by the Maine Health Data Organization and the hospital, and include, at a minimum, the following information in the report consistent with the annual reporting of hospitals voluntarily participating in the good stewardship program of the American Hospital Association. MHDO BOARD MEETING DECEMBER 7, 2023 8

  9. Public Law 2023, Chapter 276 (LD 1395) continued A. A description of how the hospital uses savings from participation in the 340B program to benefit its community through programs and services funded in whole or in part by savings from the 340B program, including services that support community access to care that the hospital could not continue without savings from the 340B program; B. The annual estimated savings from the 340B program to the hospital, comparing the acquisition price of drugs under the 340B program to group purchasing organization pricing. If group purchasing organization pricing is not available for a drug under the 340B program, the acquisition price for that drug must be compared to a price from another acceptable pricing source; MHDO BOARD MEETING DECEMBER 7, 2023 9

  10. Public Law 2023, Chapter 276 (LD 1395) continued C. A comparison of the hospital's estimated savings under the 340B program to the hospital's total drug expenditures, including examples of the hospital's top drugs purchased through the 340B program; and D. A description of the hospital's internal review and oversight of the 340B program, which must meet the federal Department of Health and Human Services, Health Resources and Services Administration's program rules and guidance for compliance. MHDO BOARD MEETING DECEMBER 7, 2023 10

  11. Public Law 2023, Chapter 276 (LD 1395) continued 1728. 3. Reporting. The Maine Health Data Organization shall produce and post on its publicly accessible website a report that includes a summary of the aggregate information received from hospitals required to report under subsection 2. The Maine Health Data Organization shall submit the report required by this subsection to the Office of Affordable Health Care, as established in Title 5, section 3122, the Maine Prescription Drug Affordability Board, as established in Title 5, section 12004-G, subsection 14-I, and the joint standing committee of the Legislature having jurisdiction over health data reporting and prescription drug matters. MHDO BOARD MEETING DECEMBER 7, 2023 11

  12. Next Steps and Revised Timeline Staff shared draft reporting structure with reps from Maine Hospital Association, MaineHealth and Northern Light Health Feedback has been provided and staff is working on revisions to proposed reporting structure; Tentative schedule: Public Hearing March 7th MHDO BOARD MEETING DECEMBER 7, 2023 12

  13. MHDO Report Statute Due Date Submit to Annual Prescription Drug Pricing Transparency PL 2020, Chapter 470 January 2024 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 Interactive Report included in CM 12.0 Release PL 2017, Chapter 406 January 2024 HCIFS Cost and Quality Data by procedure, provider and payer PL 2009, Chapter 613 January 2024 Interactive Website-CompareMaine V. 12.0 Annual International Referenced Rate Pricing for Prescription Drugs Online Report PL 2021, Chapter 606 January 2024 HCIFS, Office of Affordable Health Care and the Maine Prescription Drug Affordability Board Annual Primary Care Spending (plan to send MQF s advisory committee draft report for review week of) PL 2019, Chapter 244 January 2024 HCIFS & the Commissioner of DHHS Behavioral Health Care Spending (plan to send MQF s advisory committee draft report for review week of) PL 2021, Chapter 603 January 2024 HCIFS & the Commissioner of DHHS 13 MHDO BOARD MEETING DECEMBER 7, 2023

  14. MHDO Report Statute Due Date Submit to New-Annual report on Payments for Facility Fees made by Payors PL 2023, Chapter 410 January 1, 2024 HCIFS and the Office of Affordable Health Care Reports Due to Legislature & Timelines Reports Due to Legislature & Timelines New-Annual Report on 340B Prescription Drug Program PL 2023, Chapter 276 Not defined in the law HCIFS, Office of Affordable Health Care and the Maine Prescription Drug Affordability Board Other Reporting: 2022 Standardized Annual Hospital Financial Report (three-part report)- posted to MHDO website before end of December 2023 Health Care Expenditures in Maine-Baseline Report (update with additional year of data)- posted to MHDO website (by end of January 2024) 14 MHDO BOARD MEETING DECEMBER 7, 2023

  15. 2024 MHDO Board Meeting Schedule February 1st March 7th Public Hearing on New Proposed Rule Re 340B Drug Program (date is tentative) April 4th June 6th September 5th November 7th Note: Meetings will start at 9am and depending on agenda will run 60-90 minutes. Additional board meetings and public hearings may be added depending on need. 15 MHDO BOARD MEETING DECEMBER 7, 2023

  16. 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/ 16 MHDO BOARD MEETING DECEMBER 7, 2023

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