MHDO Rules Development and Proposed Changes Update
Updating MHDO rules and proposed changes for uniform reporting of non-claims based payment data, health care claims data sets, hospital inpatient and outpatient data sets, and interagency reporting of cancer-incidence registry and vital statistics data. The document includes new fields, removal of requirements, and clarifications for data reporting. Legislative actions and schedules for public hearings and board reviews are also outlined.
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Content Content 1. Rulemaking Requests & Timeline for 2021 2. Legislative Session- Update 3. SAMHSA Rule-42 CFR Part 2- Update 4. Data Enhancement Efforts-Update 5. CompareMaine Version 10.0- Proposed Strategy 6. Maine Quality Forum Update-Update Page 1 MHDO BOARD MEETING MAY 6, 2021-DISCUSSION DOCUMENT
MHDO Rules-Development and Proposed Changes (routine/technical) Chapter XXX, UNIFORM REPORTING FOR NON-CLAIMS BASED PAYMENT DATA (Primary Care)-New Rule Chapter 243, UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS-Proposed changes may include: New fields: Payment Arrangement Type Indicator Requirement removed: Subscriber and Member HICN Fields with clarifications: Race Ethnicity Paid Amount Service Facility Identification and Location In-Plan Network Indicator 2 MHDO BOARD MEETING MAY 6, 2021
MHDO Rules-Development and Proposed Changes (routine/technical)-continued Chapter 241, UNIFORM REPORTING SYSTEM FOR HOSPITAL INPATIENT DATA SETS AND HOSPITAL OUTPATIENT DATA SETS--Proposed changes may include: Fields with clarifications: Race Ethnicity Operating Physician First and Last Name Location of Service Place of Service 3 MHDO BOARD MEETING JUNE 4, 2020
MHDO Rules-Development and Proposed Changes Pending Legislative Action Chapter xxx, INTERAGENCY REPORTING OF CANCER-INCIDENCE REGISTRY AND VITAL STATISTICS DATA New Rule LD 541, An Act to Improve Health Care Data Analysis, if enacted, requires the Department to report cancer-incidence registry and vital statistics data to MHDO. The Department and MHDO may adopt a joint rule regarding the data submission (routine/technical). Tentative Schedule: September 3, 2021 Public Hearing November 6, 2021-board reviews comments and responses; and considers adoption of proposed rule. 4 MHDO BOARD MEETING MAY 6, 2021
MHDO Rules-Development and Proposed Changes Pending Legislative Action-continued Chapter 120, Release of Data to the Public- Proposed changes may include: New fields: Medicare Simulated Allowed Amount In-Plan Network Provider Flag Geocoding output fields for provider and person Non-Claims Payment Cancer and Vital Statistics data Developing proposal to include Race and Ethnicity as Level II Field 5 MHDO BOARD MEETING MAY 6, 2021
Proposed Rulemaking Timeline September 3, 2021 Public Hearings 5 Rules-5 public hearings November 6, 2021-board reviews comments and responses; and considers adoption of proposed rule changes for all 5 rules 6 MHDO BOARD MEETING MAY 6, 2021
Legislative Update 1. LD 41, Resolve, Regarding Legislative Review of Portions of Chapter 570, Uniform Reporting System for Prescription Drug Price Data Sets, a major substantive rule of the MHDO 2. LD 686, An Act to Increase Prescription Drug Price Transparency 3. LD 46, An Act to Further Protect Consumers on Surprise Medical Bills 4. LD 1481, An Act To Clarify Surprise Billing Restrictions 5. LD 120, An Act to Lower Health Care Costs through the establishment of the Office of Affordable Health Care 6. LD 749, An Act To Establish a Council on Health Systems Development 7. LD 274, Resolve, Directing the Maine Health Data Organization To Determine the Best Methods and Definitions To Use in Collecting Data To Better Understand Racial and Ethnic Disparities in the Provision of Health Care in Maine 8. LD 541, An Act to Improve Health Care Data Analysis 9. LD 1392, An Act Directing the Maine Center for Disease Control and Prevention To Release Annually Public Health Data Regarding Certain Fatalities and Hospitalizations 10. LD 1196, An Act Regarding Targets for Health Plan Investments in Primary Care and Behavioral Health 11. LD 1258, An Act To Implement the Recommendations of the Stakeholder Group Convened by the Emergency Medical Services Board Related to Reimbursement Rates for Ambulance Services by Health Insurance Carriers and To Improve Participation of Ambulance Service Providers in Carrier Networks 7 MHDO BOARD MEETING MAY 6, 2021
SAMHSA Rule-42 CFR Part 2 MHDO (along with other State APCD s) continue to seek clarification from the Substance Abuse and Mental Health Services Administration (SAMHSA). In November 2020, NAHDO and the APCD-Council formally asked SAMHSA to respond to the following key question: Can a state-created all payer claims database (APCD) lawfully receive data regarding substance use claims that are protected under Part 2? SAMHSA initially stated that they would respond in March 2021. Still waiting for written response. In the interim, the lack of access to all SUD data continues to be a significant barrier for MHDO s data users. 8 MHDO BOARD MEETING MAY 6, 2021
SAMHSA Rule-42 CFR Part 2-Continued History of Events/Decisions 1. In 2016, MHDO asked the payers if they would use the code list (filter) created by CMS to redact the applicable SUD, Part 2 program data from their claims submissions in an effort to standardize the submissions; 2. Payers responded that they would use their own code lists; and that claims submissions did not identify a Part 2 program. 3. In response to the payers feedback, at the June 2017 MHDO board retreat, staff proposed a uniform approach to redacting SUD claims data (based on feedback from the data user group). Board agreed to this approach. MHDO applies the CMS filter to all claims submissions after the payers apply their own SUD filter; and removes these SUD claims from MHDO s data release files. 9 MHDO BOARD MEETING MAY 6, 2021
SAMHSA Rule-42 CFR Part 2-Continued The result of MHDO applying the CMS filter to the data once submitted , in an effort to create uniformity in the submissions, is described below. Counts are of distinct claims from the top five payers. Payer A Payer B Payer C Payer D Payer E % of SUD claims removed by applying CMS filter # of SUD claims removed by applying CMS filter # of SUD claims removed by applying CMS filter % SUD claims removed (as a result of filter) % SUD claims removed (as result of CMS filter) # of SUD claims removed by applying CMS Filter % SUD claims removed (as result of filter) % SUD claims removed (as result of filter) % SUD claims removed (as result of filter) # of SUD claims removed by applying CMS filter # of Non- SUD Claims # of Non- SUD Claims # of Non- SUD Claims # of Non-SUD Claims # of Non-SUD Claims 2015 21,310 1,900,900 1.11% 28,799 3,238,257 0.88% 870 38,444 2.21% 28,949 731,751 3.81% 7,386 664,164 1.10% 2016 13,056 1,282,824 1.01% 21,373 2,765,746 0.77% 1,958 304,243 0.64% 34,343 792,101 4.16% 3,157 700,274 0.45% 2017 908 1,121,925 0.08% 1,630 2,620,267 0.06% 778 433,944 0.18% 5,745 483,073 1.18% 1,930 736,621 0.26% 2018 799 832,655 0.10% 701 2,321,445 0.03% 738 436,467 0.17% 4,275 547,232 0.78% 2,359 863,479 0.27% 2019 1,391 914,066 0.15% 831 2,581,782 0.03% 3,401 461,481 0.73% 14,534 413,701 3.39% 2,297 716,567 0.32% 2020 798 913,522 0.09% 650 2,361,014 0.03% 5,631 398,492 1.39% 9,144 262,004 3.37% 2,316 598,746 0.39% 10 MHDO BOARD MEETING MAY 6, 2021
SAMHSA Rule-42 CFR Part 2-Continued Although the majority of SUD data is being removed before the payers submit their files to MHDO; the analysis shows that additional SUD data is being removed as a result of MHDO s application of the CMS filter. At this time, data uniformity is not as important as access to SUD data (albeit it minimal) that is not subject to 42 CFR part 2. New Staff Recommendation Discontinue the application of the CMS filter effective immediately. Incorporate those SUD claims that were removed as a result of applying the CMS filter, after the payers applied their own filter, into the data release files. 11 MHDO BOARD MEETING MAY 6, 2021
Data Enhancement Updates 1. Linking Claims and Hospital Data & Assessing the Differences Conducting an assessment to link APCD and Hospital Encounters Data to support current and future analyses, data quality assessments, and answer questions such as: What share of people are present in both data sources, or present in one but not the other data source? For those present in both data sources, which data source is more complete, in terms of demographics, diagnoses, service/procedure, service location and payment information? 2. Assigning Payer Typology in the Hospital Encounter Database Reviewing past assignments of payer names into the payer categories, through linking hospital and APCD data, and seeing if there are any refinements of the respective categories or gaps in information. 3. Assigning Race and Ethnicity for Person ID 2.0 Using information from the Hospital Encounter Data and create business rule to assign the race and ethnicity information at the person level and add into the Person ID 2.0 index. This includes proposing assignments into APCD release structures. 12 MHDO BOARD MEETING MAY 6, 2021
Data Enhancement Updates - Continued 5. Assessing Location of Service in MHDO Data Sources Building from the preliminary assessment and communication with data users that work within hospitals and hospital systems, we are assessing the accuracy and usability of location of service information submitted to MHDO through the Hospital Outpatient data and exploring a path to integrate it into the APCD data, if determined to be accurate and of sufficient precision for the most frequently inquired use cases. 6. Geocoding Addresses Creating business rules to assign the geocoded output to DW address information. This involves the assignment of identifiers for geographic coordinates and standardized addresses, assignment of geocoded details to specific new and existing production structures. 7. Adding DRG s (inpatient) and APC s (outpatient) in Claims Data Through agreements with other data users, incorporate assignments they ve made as part of their analysis of MHDO claims back into the MHDO APCD. 8. MHDO Provider Database Collected provider information from existing MHDO data sources, developed the MHDO Provider Database, enhanced the MHDO Hospital Data Portal with functionality for health systems and hospitals to login to review and validate the organization s information. The MHDO Provider Database is also being used to populate the Department s Behavioral Health Service Locator Tool, and plans are in process to develop a provider API to comply with Medicaid requirements. 13 MHDO BOARD MEETING MAY 6, 2021
CompareMaine Stats October 1, 2015-April 30, 2021: Approx. 141,000 Sessions and 728,000 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 14 MHDO BOARD MEETING MAY 6, 2021
CompareMaine 10.0 MHDO plans to release version 10.0 in December 2021 Update the cost data (defined as payments to providers) from the period: April 1, 2020 March 31, 2021 Update the Top 25 Rx Reports with cost data from the period: July 1, 2020 June 20, 2021 Update the quality measures with the most current data available: patient survey ratings, preventing serious complications, preventing healthcare associated infections, falls with injury, pressure ulcers and unplanned hospital-wide readmissions Page 15 MHDO BOARD MEETING MAY 6, 2021
Continued Currently reviewing what procedures to add to CM 10.0 (based on high cost, high utilization and high variation) Add a hover for the cost breakdown and add the number of procedures being used to calculate the cost estimate Link the names of the cost procedures on the profile pages to the data displays Revisit the methodology for calculating the average cost when there are a small number of procedures used to calculate the estimate More visibly feature the resources on CM, like GoodRx 16 MHDO BOARD MEETING MAY 6, 2021
Procedure Categories on CompareMaine (CM) 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 73% 12/84 Office Visits 95% 27/152 PT & OT 99% 34/66 Mental & Behavioral Health 98% 14/45 OB/GYN 40% 8/255 Laboratory 57% 98/1,561 Radiology & Imaging 67% 48/620 Integrative Medicine 85% 12/16 Surgical Procedures 17% 50/5,498 Outpatient Procedures 40% 13/704 Cardiology 49% 5/182 Emergency Department 28% 5/8 Total 59% 326/9,625 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.
2/26 MQF released its 2021 Annual Report on Primary Care Spending in the State of Maine (PL Chapter 244) to HCIFS and Commissioner Lambrew (DHHS), as required by statute. Copy can be found here: https://mhdo.maine.gov/_mqfdocs/MQF%20Primary%20Care%20Spending%20Report_Feb%202 021.pdf Continue to focus on the deliverables defined in the Memorandum of Agreement between MQF and DHHS, Maine-CDC, for the technical support for Project Firstline. Project Firstline is the CDC s (Federal) new infection control training collaborative, designed to help every frontline healthcare worker gain the knowledge and confidence to stop infections. MHDO BOARD MEETING MAY 6,2021 18
