Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 10 - DETERMINATION OF ASSESSMENTS › Section 590-10-2 - Assessments

Current through 2024-29, July 17, 2024
A.
Determination
. Total annual
				assessments shall be based upon the total annual allocation authorized by the
				Maine State Legislature for the operational costs of the MHDO as indicated in
				the biennial budget. The amount to be assessed shall be reduced by the
				difference between the total annual authorized allocation for the next fiscal
				year and the beginning fund balance in the account established pursuant to
				Title 22 M.R.S.A. §8706, sub-§6 for the prior fiscal year. Any
				assessment reduction shall be applied proportionately to the categorical groups
				assessed and shall be based upon the maximum percentages of the total
				assessment as described in this section.
Non-hospital health care facilities shall be assessed an
				  aggregate amount that is 11.5% of the total annual authorized allocation and
				  shall be individually assessed in the manner described in subsection B.
				  Third-party administrators and carriers that provide only administrative
				  services for a plan sponsor shall also be assessed an aggregate amount that is
				  11.5% of the total annual authorized allocation and shall be individually
				  assessed in the manner described in subsection D. The remaining assessment
				  balance shall be divided equally between hospitals and health insurance
				  entities. The assessment share for hospitals and the assessment share for
				  health insurance entities shall each not exceed 38.5% of the total annual
				  authorized allocation. Individual hospitals and health insurance entities shall
				  be assessed in the manner described in subsections C and E, respectively.
				  Annual assessments shall be at least $100 for each individual entity required
				  to pay an assessment under this Chapter.
B.
Non-Hospital Health Care
				Facilities
. The maximum assessment for each non-hospital health care
				facility by category is listed below. The specific dollar amount to be assessed
				for each non-hospital health care facility shall be established from the
				determination of the relative percentage reduction as described in subsection
				A. If an individual non-hospital health care facility is licensed or certified
				under multiple categories, only one assessment shall be imposed and it shall be
				the per facility assessment with the highest dollar amount.
Non-Hospital Health Care Facility Category
							 Assessment
Maximum Per Facility
End-Stage Renal Disease
$2,500
Federally Qualified Health Center
$150
Freestanding Ambulatory Surgical Center
$2,500
Independent Radiological Service Center
$2,500
Home Health Agency
$150
Mental Health Agency
$150
Portable X-Ray Units
$150
Rehabilitation Agencies
$150
Retail Store Drug Outlets
$225
Rural Health Clinic
$150
C.
Hospitals
. Hospitals shall be assessed by establishing the total
				net patient service revenue for each as a percentage of the total net patient
				service revenue for all. The individual total net patient service revenue
				numbers are to be established from the most recently completed fiscal year
				standardized accounting template for each hospital. The specific dollar amount
				to be assessed shall be determined by multiplying each percentage by the
				hospital assessment share as determined in subsection A.
D.
Third-Party Administrators and
				Carriers that Provide Administrative Services Only for a Plan Sponsor
.
				Third-party administrators, carriers that provide administrative services only
				for a plan sponsor, and pharmacy benefits managers that process and pay claims
				shall be assessed by establishing the total dollar amount of health care claims
				processed or paid for each as a percentage of the total dollar amount of health
				care claims processed or paid for all. The total dollar amounts of health care
				claims processed or paid shall be derived from the most recent annual numbers
				for all covered individuals in the State compiled by the Maine Bureau of
				Insurance with direct verification from the third-party administrators and
				carriers that provide administrative services only for a plan sponsor and from
				the MHDO claims database. The specific dollar amount to be assessed shall be
				determined by multiplying each percentage by the third-party administrators,
				carriers that provide administrative services only for a plan sponsor, and
				pharmacy benefits managers that process and pay claims assessment share as
				determined in subsection A.
E.
Health Insurance Entities
. Health insurance entities shall be
				assessed by establishing the total dollar amount of health care premiums
				written for each as a percentage of the total dollar amount of health care
				premiums written for all. The total dollar amounts of health care premiums
				written shall be derived from the most recent annual numbers compiled by the
				Maine Bureau of Insurance with direct verification from the health insurance
				entities. The specific dollar amount to be assessed shall be determined by
				multiplying each percentage by the health insurance entity assessment share as
				determined in subsection A.