C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-45, subsec. 144-101-III-45.07

Current through 2024-44, October 30, 2024

Subsection 144-101-III-45.07 - VALUE-BASED PURCHASING (VBP) SUPPLEMENTAL SUB-POOL

The Value-Based Purchasing (VBP) Supplemental Sub-Pool awards and distributes $600,000 each year to hospitals that meet the eligibility criteria below. Each awarded hospital will receive its relative share of this supplemental payment, distributed annually in May.

Allocations will not exceed the total VBP Supplemental Sub-Pool amount and will not exceed allowable aggregate upper payment limits.

Hospitals must meet the following criteria to be eligible for the VBP Supplemental Sub-Pool:

A. The hospital must be an Acute Care Non-Critical Access Hospital or, Acute Care Critical Access Hospital, and

B. The hospital must participate in the MaineCare Accountable Communities (AC) Initiative. Participation in the MaineCare AC Initiative is demonstrated by one of the following: The hospital's Emergency Department is in an AC contract as a location that contributes to member attribution to the AC; The hospital is an official contracted partner of the AC; or The hospital is part of the same ownership Employer Identification Number/Taxpayer Identification Number (EIN/TIN) as the AC.

Funds will be distributed based on performance on one or more quality measures. The Department's website at lists the current measure(s). Interested parties may request a paper copy of the measures by calling (207) 624-4050 or Maine Relay number 711. The Department will notify hospitals at least one hundred twenty (120) days prior to any changes to the VBP Supplemental Sub-Pool measure(s).

Hospital Service Area (HSA). The Department will utilize Hospital Service Areas (HSAs) in its calculation of the VBP Supplemental Sub-Pool. The HSA methodology is developed by the Dartmouth Institute for Health Policy and Clinical Practice and made publicly available on their website. Maine Health Data Organization (MHDO) makes available HSA assignments for Maine hospitals based on the most recent available crosswalk posted by the Dartmouth Institute. Annually with the VBP Supplemental Sub-Pool assessment, the Department will post the mapping of HSAs by zip code and hospital on their website. Interested parties may request a paper copy by calling (207) 624-4050 or Maine Relay number 711. Each HSA consists of a group of cities and towns that include one or more hospitals where local residents receive most of their hospitalizations.

Measure Example: Primary care utilization among full benefit MaineCare members in each HSA, assessed for a twelve (12)-month period.

Performance Rank	Share of Sub-Pool
Top ranked HSA	$75,000
2^nd and 3^rd ranked HSA	$50,000 each ($100,000 total)
4^th through 8^th ranked HSA	$25,000 each ($125,000 total)
Total:	$300,000

Numerator: Number of MaineCare Members in the HSA who had one or more primary care visits in a twelve (12)-month period. Denominator: Number of MaineCare Members in the HSA.

The Department first determines which HSAs are eligible to have the hospitals located in the HSA awarded payment from the VBP Supplemental Sub-Pool. The Department will allocate the $600,000 according to performance rank ($300,000 divided) and to performance weighted by HSA size ($300,000 divided). HSA size means the number of MaineCare members in each HSA.

Performance weighted by HSA size:

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If an awarded HSA contains more than one (1) hospital from different ACs, the amount of funds will be distributed proportionate to the number of AC attributed lives within the HSA associated with each hospitals' corresponding AC.

If an awarded HSA contains more than one (1) hospital from the same AC, the funds are distributed according to a secondary AC-specific measure. The secondary AC specific measure can be located on the Department's website. Interested parties may request a paper copy by calling (207) 624-4050 or Maine Relay number 711.

C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-45, subsec. 144-101-III-45.07