reglab/statecodes huggingface dataset:
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Section 590-243-4 - Standards for Data; Notification; Response

Current through 2024-29, July 17, 2024
A.
Standards
. The MHDO or its designee shall evaluate each member
				eligibility file, medical claims file, pharmacy claims file, and dental claims
				file submission in accordance with the following standards:
(1) The applicable code for each data element
				identified in Appendices C-1, D-1, E-1, and F-1 shall be included within
				eligible values for the element;
(2) Coding values indicating "data not
				available", "data unknown", or the equivalent shall not be used for individual
				data elements unless specified as an eligible value for the element;
(3) Member sex, diagnosis and procedure
				codes, and date of birth and all other date fields shall be consistent within
				an individual record; and
(4)
				Member identifiers shall be consistent across files.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Section 590-243-5 - Voluntary File Submissions

Current through 2024-29, July 17, 2024
Any self-funded employee benefit plan regulated by ERISA may
				  voluntarily submit completed healthcare data sets for Maine residents. The MHDO
				  shall collect such data sets in accordance with the provisions of this chapter
				  for uniform reporting system for health care claims data sets. Any such data
				  shall be subject to the same laws and regulations as other MHDO
				  data.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Section 590-243-6 - Public Access

Current through 2024-29, July 17, 2024
Information collected, processed and/or analyzed under this
				  rule shall be subject to release to the public or retained as confidential
				  information in accordance with 22 M.R.S. Chapter 1683 and
Code of Maine
				  Rules
90-590, Chapter 120, unless prohibited by state or federal
				  law.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Section 590-243-7 - Extensions or Waivers to Data Submission Requirements

Current through 2024-29, July 17, 2024
If a health care claims processor due to circumstances beyond
				  its control is temporarily unable to meet the terms and conditions of this
				  rule, a written request must be made to the Compliance Officer of the MHDO as
				  soon as it is practicable after the health care claims processor has determined
				  that an extension or waiver is required. The written request shall include: the
				  specific requirement to be extended or waived; an explanation of the cause; the
				  methodology proposed to eliminate the necessity of the extension or waiver; and
				  the time frame required to come into compliance. If the Compliance Officer does
				  not approve the requested extension or waiver, the health claims processor
				  making the request may submit a written request appealing the decision to the
				  MHDO Board. The appeal shall be heard by the MHDO Board at the next regularly
				  scheduled meeting following receipt of the request at the
				  MHDO.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Section 590-243-8 - Compliance

Current through 2024-29, July 17, 2024
The failure to file, report, or correct health care claims
				  data sets when required in accordance with the provisions of this rule may be
				  considered a violation under  22 M.R.S. Sec.8705-A and Code of Maine Rules
				  90-590, Chapter 100:
Enforcement Procedures
.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Appendix 590-243-B-1 - Maine Health Data Organization Header Record Specifications

Current through 2024-29, July 17, 2024
Data Element
								#
Data Element
								Name
Date
								Effective
Type
Maximum
								Length
Description/Codes/Sources
HD001
Record Type
1/1/2003
Text
2
HD
HD002
Submitter
1/1/2003
Text
8
MHDO-assigned identifier of payor submitting claims
								data. Do not leave blank.
HD003
Payor
7/1/2012
Text
8
MHDO-assigned code of the insurer/ underwriter in
								the case of premiums-based coverage, or of the administrator in the case of
								self-funded coverage
HD004
Type of File
1/1/2003
Text
2
CF Capitated Payments File
DC Dental Claims
MC Medical Claims
ME Member Eligibility
PC Pharmacy Claims
HD005
Period Beginning Date
1/1/2003
Text
6
CCYYMM
Beginning of paid period for Claims
Beginning of month covered for Eligibility
Beginning of performance period for Capitated
								Payments
HD006
Period Ending Date
1/1/2003
Text
6
CCYYMM
End of paid period for Claims
End of month covered for Eligibility
End of performance period for Capitated
								Payments
HD007
Record Count
1/1/2003
Number
10
Total number of records submitted in this file
								Exclude header and trailer record in count
HD008
Comments
1/1/2003
Text
80
Submitter may use to document this submission by
								assigning a filename, system source, etc.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Appendix 590-243-B-2 - Maine Health Data Organization Trailer Record Specifications

Current through 2024-29, July 17, 2024
Data Element
								#
Data Element
								Name
Date
								Effective
Type
Maximum
								Length
Description/Codes/Sources
TR001
Record Type
1/1/2003
Text
2
TR
TR002
Submitter
1/1/2003
Text
8
MHDO-assigned identifier of payor submitting claims
								data. Do not leave blank.
TR003
Payor
7/1/2012
Text
8
MHDO-assigned code of the insurer/ underwriter in
								the case of premiums-based coverage, or of the administrator in the case of
								self-funded coverage
TR004
Type of File
1/1/2003
Text
2
CF Capitated Payments File
DC Dental Claims
MC Medical Claims
ME Member Eligibility
PC Pharmacy Claims
TR005
Period Beginning Date
1/1/2003
Text
6
CCYYMM
Beginning of paid period for Claims
Beginning of month covered for Eligibility
Beginning of performance period for Capitated
								Payments
TR006
Period Ending Date
1/1/2003
Text
6
CCYYMM
End of paid period for Claims
End of month covered for Eligibility
End of performance period for Capitated
								Payments
TR007
Date Processed
1/1/2003
Text
8
CCYYMMDD
Date file was created
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Appendix 590-243-C-2 - Maine Health Data Organization Member Eligibility File Mapping to National Standards

Current through 2024-29, July 17, 2024
Data Element
								#
Data Element
								Name
HIPAA Reference ASC
								X12N/005010 Transaction Set/Loop/ Segment ID/Code Value/ Reference
								Designator
ME001
Submitter
N/A
ME002
Payor
N/A
ME003
Insurance Type/Product Code
271/2110C/EB/04, 271/2110D/EB/04
ME004
Year
N/A
ME005
Month
N/A
ME006
Insured Group or Policy Number
271/2100C/REF/1L/02, 271/2100C/REF/IG/02,
								271/2100C/REF/6P/02, 271/2100D/REF/1L/02, 271/2100D/REF/IG/02,
								271/2100D/REF/6P/02,
ME007
Coverage Level Code
271/2110C/EB/02, 271/2110D/EB/02
ME008
Subscriber Social Security Number
271/2100C/REF/SY/02
ME009
Plan Specific Contract Number
271/2100C/NM1/MI/09
ME010
Member Suffix or Sequence Number
271/2100C/REF/49/02,
								271/2100D/REF/49/02
ME011
Member Identification Code
271/2100C/REF/SY/02,
								271/2100D/REF/SY/02
ME012
Individual Relationship Code
271/2100C/INS/Y/02, 271/2100D/INS/N/02
ME013
Member Gender
271/2100C/DMG/03, 271/2100D/DMG/03
ME014
Member Date of Birth
271/2100C/DMG/D8/02,
								271/2100D/DMG/D8/02
ME015
Member City Name
271/2100C/N4/01, 271/2100D/N4/01
ME016
Member State or Province
271/2100C/N4/02, 271/2100D/N4/02
ME017
Member ZIP Code
271/2100C/N4/03, 271/2100D/N4/03
ME018
Medical Coverage
N/A
ME019
Prescription Drug Coverage
N/A
ME020
Dental Coverage
N/A
ME021
Race 1
N/A
ME022
Race 2
N/A
ME023
Race 3
N/A
ME024
Hispanic Indicator
N/A
ME025
Ethnicity 1
N/A
ME026
Ethnicity 2
N/A
ME027
Ethnicity 3
N/A
ME028
Primary Insurance Indicator
N/A
ME029
Coverage Type
N/A
ME030
Market Category Code
N/A
ME031
Special Coverage
N/A
ME032
Group Name
271/2100C/REF/18/03, 271/2100D/REF/28/03,
								271/2100C/REF/6P/03, 271/2100D/REF/6P/03, 271/2100C/REF/N6/03,
								271/2100D/REF/N6/03
ME101
Subscriber Last Name
271/2100C/NM1/ /03
ME102
Subscriber First Name
271/2100C/NM1/ /04
ME103
Subscriber Middle Name
271/2100C/NM1/ /05
ME104
Member Last Name
271/2100C/NM1/ /03, 271/2100D/NM1/ /03
ME105
Member First Name
271/2100C/NM1/ /04, 271/2100D/NM1/ /04
ME106
Member Middle Name
271/2100C/NM1/ /05, 271/2100D/NM1/ /05
ME107
Member Address Line 1
271/2100C/N3/01, 271/2100D/N3/01
ME108
Member Address Line 2
271/2100C/N3/02, 271/2100D/N3/02
ME109
Member Country Code
271/2100C/N4/04, 271/2100D/N4/04
ME110
Placeholder
N/A
ME111
Subscriber MBI
271/2100C/NM1/MI/09
ME112
Placeholder
N/A
ME113
Member MBI
271/2100D/NM1/MI/09,
								271/2100D/REF/F6/02
ME114
Plan Begin Date (Member Effective
								Date)
271/2100C/DTP/346/D8,
								271/2100D/DTP/346/D8
ME115
Plan End Date (Member Cancellation
								Date)
271/2100C/DTP/347/D8,
								271/2100D/DTP/347/D8
ME116
Grandfathered Plan Indicator
N/A
ME117
Metal Tier
N/A
ME118
Enrolled Through a Public Health Insurance
								Exchange
N/A
ME119
Cost-Sharing Reduction Indicator
N/A
ME899
Record Type
N/A
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Appendix 590-243-E-2 - Maine Health Data Organization Pharmacy Claims File Mapping to National Standards

Current through 2024-29, July 17, 2024
Data Element
								#
Data Element Name
National Council for
								Prescription Drug Programs Field #
PC001
Submitter
879-N2
PC002
Payor
569-J8
PC003
Insurance Type/Product Code
A90
PC004
Payor Claim Control Number
993-A7
PC005
Line Counter
A91
PC006
Insured Group or Policy Number
246
PC007
Subscriber Social Security Number
A89
PC008
Plan Specific Contract Number
302-C2
PC009
Member Suffix or Sequence Number
303-C3
PC010
Member Identification Code
332-CY
PC011
Individual Relationship Code
247
PC012
Member Gender
305-C5
PC013
Member Date of Birth
304-C4
PC014
Member City Name
728-SU
PC015
Member State or Province
729-TA
PC016
Member ZIP Code
730-TC
PC017
Date Service Approved (AP Date)
578
PC018
Pharmacy Number
201-B1
PC019
Pharmacy Tax ID Number
N/A
PC020
Pharmacy Name
833-5P
PC021
National Provider ID - Pharmacy
								Provider
201-B1
PC022
Pharmacy Location City
728-SU
PC023
Pharmacy Location State
729-TA
PC024
Pharmacy ZIP Code
730-TC
PC024A
Pharmacy Country Code
A93-1T
PC025
Claim Status
A88
PC026
Drug Code
407-D7
PC027
Drug Name
397
PC028
New Prescription
254
PC029
Generic Drug Indicator
425-DP
PC030
Dispense as Written Code
408-D8
PC031
Compound Drug Indicator
406-D6
PC032
Date Prescription Filled
401-D1
PC033
Quantity Dispensed
442-E7
PC034
Days' Supply
405-D5
PC035
Charge Amount
430-DU
PC036
Paid Amount
281
PC037
Ingredient Cost/List Price
506-F6
PC038
Postage Amount Claimed
N/A
PC039
Dispensing Fee
507-F7
PC040
Co-pay Amount
518-FI
PC041
Coinsurance Amount
572-4U
PC042
Deductible Amount
517-FH
PC043
Patient Pay Amount
505-F5
PC044
Prescribing Physician First Name
717
PC045
Prescribing Physician Middle Name
A92
PC046
Prescribing Physician Last Name
716
PC047
Prescribing Physician DEA
411-DB
PC048
Prescribing Physician NPI
411-DB
PC101
Subscriber Last Name
716
PC102
Subscriber First Name
717
PC103
Subscriber Middle Name
718
PC104
Member Last Name
716
PC105
Member First Name
717
PC106
Member Middle Name
718
PC107
Member Address Line 1
B08-7A
PC108
Member Address Line 2
B09-7B
PC109
Member Country Code
A43-1K
PC110
In-Plan Network Indicator
N/A
PC111
Placeholder
N/A
PC112
Member Age
N/A
PC113
Substance Use Disorder (SUD)
								Indicator
N/A
PC114
Total POS Rebate Amount
N/A
PC115
Member POS Rebate Amount
N/A
PC116
Pharmacy Benefits Manager Compensation
								Amount
N/A
PC899
Record Type
A94
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Section 590-247-2 - Non-Claims-Based Payments and Other Supplemental Health Care Data Set Filing Description

Current through 2024-29, July 17, 2024
A.
General
				Requirements
(1) Payors that:
a) provide medical benefits to Maine
				residents; and
b) are not excluded
				from submitting health care claims data sets under 90-590 Chapter 243 Sec
				2(A)(9)(a-b); and
c) reimburse
				providers by means other than a Fee-for-Service model shall submit to the MHDO
				or its designee complete non-claims-based (NC) payment data and/or aggregated,
				redacted claims-based (AC) payment data, if applicable, and each data set type
				must be accompanied by the appropriate supporting information file in
				accordance with the requirements of this section. NC and AC payments are
				payments from payors to providers based on the definitions above. The
				supporting information file for an NC payment data set must describe the
				methods used to reimburse behavioral health care providers. The supporting
				information file for an AC payment data set must detail the methods used to
				redact the substance use disorder claims, the specific code lists that are used
				for procedure codes, revenue codes and diagnosis codes, provider types and any
				other detail on the claim that is required to select the substance use disorder
				redacted claim. See
https://mhdo.maine.gov/portal
for
				sample NC and AC supporting information files.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Section 590-247-3 - Submission Requirements

Current through 2024-29, July 17, 2024
A.
File
				Organization.
Each file shall be submitted to the MHDO or its designee
				separately.
B.
Filing
				Method
. Data files and supporting information must be submitted to the
				MHDO's Payor Data Portal via secure FTP or secure web upload interface at
https://mhdo.maine.gov/portal
.
				E-mail attachments shall not be accepted.
C.
Testing of Files
. File
				testing shall be completed within one hundred and eighty days of the adoption
				of any changes to the data element content or format of the files described in
				Section 2(B) or at least
				sixty days prior to the initial submission of production files.
D.
Rejection of Files
. Failure
				to conform to the requirements subsections A, B, or C of this Section shall
				result in the rejection of the applicable data file(s). All rejected files must
				be resubmitted in the appropriate, corrected form to the MHDO or its designee
				within 15 days.
E.
Filing
				Period
. The annual filing for each submission shall cover the previous
				completed calendar year and shall be due by August 31.
F.
Update/Replacement of Data
. A
				payor may update or replace a data file submission up to one year after its
				original due date. Any updates or replacements after this period must be
				approved by the MHDO.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Section 590-247-4 - Data Validation; Notification; Response

Current through 2024-29, July 17, 2024
A.
Attestation
. The MHDO or its
				designee shall require an authorized user for each payor to electronically sign
				an attestation that the payor is compliant with the requirements outlined in
				this rule. The annual attestation shall be due by August 31.
B.
Notification
. Within 15 days,
				the MHDO or its designee will complete the evaluation of any data file
				submissions and notify any payors whose data submissions for any filing period
				do not satisfy the requirements of Section
				2(B). This
				notification will identify the specific file(s) and the data elements within
				the file(s) that do not satisfy the requirements.
C.
Response
. Each payor notified
				under subsection
				4(B) shall respond
				in writing within 15 days of notification and make the necessary changes within
				30 days to satisfy the requirements.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Section 590-247-5 - Public Access

Current through 2024-29, July 17, 2024
Information collected, processed and/or analyzed under this
				  rule shall be subject to release to the public or retained as confidential
				  information in accordance with 22 M.R.S. Chapter 1683 and
Code of Maine
				  Rules
90-590, Chapter 120, unless prohibited by state or federal
				  law.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Section 590-247-6 - Extensions or Waivers to Data Submission Requirements

Current through 2024-29, July 17, 2024
If a payor, due to circumstances beyond its control, is
				  temporarily unable to meet the terms and conditions of this rule, a written
				  request must be made within 30 days of the filing deadline of August 31 to the
				  Compliance Officer of the MHDO. The written request shall include: the specific
				  requirement to be extended or waived; an explanation of the cause; the
				  methodology proposed to eliminate the necessity of the extension or waiver; and
				  the time frame required to come into compliance. If the Compliance Officer does
				  not approve the requested extension or waiver, the payor may submit a written
				  request appealing the decision to the MHDO Board. The appeal shall be heard by
				  the MHDO Board at the next regularly scheduled meeting following receipt of the
				  request at the MHDO.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Section 590-247-7 - Compliance

Current through 2024-29, July 17, 2024
The failure to file, report, or correct non-claims-based
				  payment data sets when required under the provisions of this rule may be
				  considered a violation under 22 M.R.S. Sec.
				  8705-A and Code of Maine Rules
				  90-590, Chapter 100:
Enforcement Procedures
.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Appendix 590-247-A - Primary Care Provider Type Taxonomy Codes and Description

Current through 2024-29, July 17, 2024
Primary Care
261QF0400X
Federally Qualified Health Center
261QP2300X
Primary Care Clinic
261QR1300X
Rural Health Clinic
207Q00000X
Physician, Family Medicine
207R00000X
Physician, General Internal Medicine
175F00000X
Naturopathic Medicine
208000000X
Physician, Pediatrics
208D00000X
Physician, General Practice
363L00000X
Nurse Practitioner
363LA2200X
Nurse Practitioner, Adult Health
363LF0000X
Nurse Practitioner, Family
363LP0200X
Nurse Practitioner, Pediatrics
363LP2300X
Nurse Practitioner, Primary Care
363A00000X
Physician Assistants
363AM0700X
Physician Assistants, Medical
207RG0300X
Physician, Geriatric Medicine
207QG0300X
Family Practice Geriatrics
207QA0505X
Family Practice Adult
207QA0000X
Family Practice Adolescent
175L00000X
Homeopathic Medicine
2083P0500X
Physician, Preventive Medicine
364S00000X
Certified Clinical Nurse Specialist
163W00000X
Registered Nurse, Non-Practitioner
OB/GYN Codes
207V00000X
Physician, Obstetrics and Gynecology
207VG0400X
Physician, Gynecology
363LW0102X
Nurse Practitioner, Women's Health
363LX0001X
Nurse Practitioner, Obstetrics and Gynecology
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 247 - UNIFORM REPORTING SYSTEM FOR NON-CLAIMS-BASED PAYMENTS AND OTHER SUPPLEMENTAL HEALTH CARE DATA SETS › Appendix 590-247-B - Maine Health Data Organization Source Codes

Current through 2024-29, July 17, 2024
Accredited Standards Committee (ASC)
ASC X12 Directories
(MHDO Data Element: NC003)
SOURCE: Complete ASC X12 005010 Standard AVAILABLE
				  FROM:
https://www.nex12.org/
Data Interchange Standards Association, Inc. (DISA)
7600 Leesburg Pike Ste 430
Falls Church, VA 22043
ABSTRACT: The complete standard includes design rules and
				  guidelines, control standards, transaction set tables, data element dictionary,
				  segment directory and code sources. The data element dictionary contains the
				  format and descriptions of data elements used to construct X12 segments. It
				  also contains code lists associated with these data elements. The segment
				  directory contains the format and definitions of the data segments used to
				  construct X12 transaction sets.
Several Definitions are adapted from the Milbank Memorial
				  Fund Report, available from:
https://www.milbank.org/wp-content/uploads/2021/04/Measuring_Non-Claims_7-1.pdf
National Uniform Claim Committee
Healthcare Provider Taxonomy Code Set
(MHDO Data Element: NC010; Tables in Appendices A and
				  C)
SOURCE:
https://taxonomy.nucc.org/
ABSTRACT: The Healthcare Provider Taxonomy Code Set is a
				  hierarchical code set that consists of codes, descriptions, and definitions.
				  Healthcare Provider Taxonomy Codes are designed to categorize the type,
				  classification, and/or specialization of health care providers. The Code Set
				  consists of two sections: Individuals and Groups of Individuals, and
				  Non-Individual.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 270 - UNIFORM REPORTING SYSTEM FOR QUALITY DATA SETS › Section 590-270-3 - Nursing-Sensitive Patient-Centered Health Care Quality Data Set Filing Description

Current through 2024-29, July 17, 2024
American Nurses Association (ANA) measures (NSPC-2 &
				  NSPC-3):Each hospital or their agent shall report data to the MHDO for NSPC-2
				  and NSPC-3 as defined by NDNQI, National Database for Nursing Quality
				  Indicators,
Guidelines for Data Collection on the American Nurses
				  Association's National Quality Forum Endorsed Measures, May 2010
or as
				  updated by the ANA.
The Joint Commission measures (NSPC-1): Each hospital or
				  their agent shall report data to the MHDO for NSPC-1as currently defined by the
				  Joint Commission,
Implementation Guide for the NQF Endorsed Nursing
				  Sensitive Care Measure Set.
For each nursing-sensitive patient-centered (NSPC) health
				  care outcome measure, the NSPC metrics are:
NSPC - 1 Percentage of inpatients who have a
				  hospital-acquired Stage 1 or greater pressure ulcer (Measure steward - The
				  Joint Commission);
NSPC - 2 Number of patient falls per patient days (Measure
				  steward: ANA); and
NSPC - 3 Number of patient falls with injuries perpatient
				  days (Measure steward- ANA)
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 270 - UNIFORM REPORTING SYSTEM FOR QUALITY DATA SETS › Section 590-270-4 - Submission Requirements

Current through 2024-29, July 17, 2024
A.
File
				submission
. With the exception of data submitted via NHSN, each
				hospitaland nursing facility or their agent shall file all applicable data sets
				by using the current version of the electronic forms provided by the MHDO at
				its website at <mhdo.maine.gov/quality_data.htm>.Data files must be
				submitted to the MHDO Hospital Data Portal via the secure web upload
				interface.E-mail attachments shall not be accepted.File naming conventions are
				specified in the Portal User Manual.
B.
Filing Periods
.Data
				generated in accordance with the provisions of Sections
				2 and
				3 shall be submitted no later than the
				date of the 15th of the 5th month following the end of each calendar quarter in
				which the service occurred.The filing periods are as follows:
1st Quarter January, February,
				  March August 15th
2nd Quarter April, May, June
				  November 15th
3rd Quarter July, August,
				  September February 15th
4th Quarter October, November,
				  December May 15th
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 270 - UNIFORM REPORTING SYSTEM FOR QUALITY DATA SETS › Section 590-270-5 - Standards for Data; Notification; Response

Current through 2024-29, July 17, 2024
A.
Standards
. The MHDO or its designee shall evaluate each file
				submission in accordance with the following standards:
1. When more than one licensed health care
				facility is operated by the reporting organization, the information required by
				this Chapter must be reported for each health care facility separately. When a
				provider of health care operates in more than one location, the MHDO may
				require that information be reported separately for each location.
2. Coding values indicating "data not
				available", "data unknown", or the equivalent will not be accepted.However,
				thosehealth care facilities that do not have relevant patient populations for
				any section of metrics may submit a letter to the MHDO stating there are no
				appropriate data available and therefore they will not be submitting data for
				that section of metrics. This will be an annual requirement for those health
				care facilities not submitting data.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 270 - UNIFORM REPORTING SYSTEM FOR QUALITY DATA SETS › Section 590-270-6 - Public Access

Current through 2024-29, July 17, 2024
Information collected, processed and/or analyzed under this
				  rule shall be subject to release to the public or retained as confidential
				  information in accordance with
				  22 M.R.S.A.
				  §8707 (or §8714 when effective) and
				  Code of Maine Rules 90-590, Chapter 120:
Release of Information to the
				  Public,
unless prohibited by state or federal law.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 270 - UNIFORM REPORTING SYSTEM FOR QUALITY DATA SETS › Section 590-270-7 - Waivers to Data Submission Requirements

Current through 2024-29, July 17, 2024
If a health carefacility due to circumstances beyond its
				  control is temporarily unable to meet the terms and conditions of this Chapter,
				  a written request must be made to the Executive Director of the MHDO as soon as
				  it is practicable after the health care facilityhas determined that an
				  extension is required.The written request shall include: the specific
				  requirement to be waived; an explanation of the cause; the methodology proposed
				  to eliminate the necessity of the waiver; and the time frame required to come
				  into compliance.The Executive Director shall present the request to the MHDO
				  Board at its next regularly scheduled meeting where the request shall be
				  approved or denied.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 270 - UNIFORM REPORTING SYSTEM FOR QUALITY DATA SETS › Section 590-270-8 - Compliance

Current through 2024-29, July 17, 2024
The failure to file, report, or correct quality data in
				  accordance with the provisions of this Chapter may be considered a violation
				  under
				  22 M.R.S.A.
				  §8705-A and
Code of Maine
				  Rules
90-590, Chapter 100:
Enforcement
				  Procedures
.
In the event that a measure steward announces a modification
				  to a measure required under Chapter 270,health care facilities must continue to
				  collect data based on specifications of the existing version of the measure up
				  until the date that the measure steward requires reporting based on the
				  modified version.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 270 - UNIFORM REPORTING SYSTEM FOR QUALITY DATA SETS › Section 590-270-9 - Summary Tables of Reporting Requirements by Facility Unit Type

Current through 2024-29, July 17, 2024
A.
Healthcare Associated Infection
				Measures
Measures
Hospitals
Nursing Facilities
Adult and Pediatric Units
Neonatal NICU
ICU
Medical
Surgical
Medical/ Surgical
Mixed Acuity
Rehab
HAI-1 CLABSI
[TICK]
[TICK]
[TICK]
[TICK]
[TICK]
HAI-2 CLABSI
[TICK]
HAI-6 CAUTI
[TICK]
[TICK]
[TICK]
[TICK]
[TICK]
[TICK]
HAI-7 KPRO SSI
Applies to all KPRO surgical
							 patients
HAI-8 HPRO SSI
Applies to all HPRO surgical
							 patients
MRSA
Facility-wide inpatients (FacWideIN)
C. difficile.
Facility-wide inpatients (FacWideIN), excluding any
							 nursery or NICU
[TICK]
B.
Nursing Sensitive Indicator Measures
All three Nursing Sensitive Indicators apply to the following
				  list of units:
*Critical Access Hospitals
All units
*Adult and pediatric hospital units
Critical care
										Step-down
										Medical
										Surgical
										Medical/Surgical
										Mixed Acuity
*Rehabilitation units
Adult
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 280 - FILING REQUIREMENTS FOR PRESCRIBERS SEEKING CONFIDENTIALITY PROTECTION › Section 590-280-1 - Definitions

Current through 2024-29, July 17, 2024
A.
MHDO
. "MHDO" means the Maine
				Health Data Organization or its predecessor agencies.
B.
M.R.S.A.
"M.R.S.A." means
				Maine Revised Statutes Annotated.
C.
Prescriber
. "Prescriber" means a person who is licensed,
				registered or otherwise authorized in the appropriate jurisdiction to prescribe
				and administer drugs in the course of professional practice, including but not
				limited to nurse practitioners and nurse midwives; dentists; allopathic and
				osteopathic physicians; naturopathic doctors; optometrists; physician's
				assistants; podiatrists and veterinarians.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 280 - FILING REQUIREMENTS FOR PRESCRIBERS SEEKING CONFIDENTIALITY PROTECTION › Section 590-280-2 - Filing Requirements

Current through 2024-29, July 17, 2024
A prescriber who seeks confidentiality protection pertaining
				  to prescription drug information pursuant to
				   22
				  M.R.S.A., Sections1711-E, Subsection
				  4,
				  and
				  8713 must
				  conform to the following requirements.
A.
Filing Method
. Prescribers
				shall file, and when necessary, update with the MHDO the information described
				in Section 3 directly via a secure, internet, web-based registration form. The
				URL address of the web-based registration form will be indicated on all
				applicable prescriber license or certificate renewal forms, whether in an
				electronic or paper format. A prescriber may register with the MHDO at any time
				prior to his or her renewal date using the URL address, which shall be provided
				by the appropriate licensing entity or the MHDO.
B.
Filing Frequency
. After the
				confidentiality protection registration form is initially completed by the
				prescriber, it shall remain in effect in perpetuity. If a prescriber wishes to
				waive his or her confidentiality protection, the prescriber must notify the
				MHDO in writing. Electronic notifications shall not be accepted.
C.
Modifications
. If any of the
				information submitted on the initial registration form is inaccurate or no
				longer valid, the form may be modified at any time. It is the responsibility of
				the prescriber to make the modifications, as needed, and not the responsibility
				of the MHDO to ensure that all of the information is the most
				current.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 280 - FILING REQUIREMENTS FOR PRESCRIBERS SEEKING CONFIDENTIALITY PROTECTION › Section 590-280-3 - Prescriber Data Set Filing Description

Current through 2024-29, July 17, 2024
Each prescriber seeking confidentiality protection must
				  submit to the MHDO, at the URL address as indicated in Section
				  2(A), information
				  which corresponds to each of the following data elements:
A. Drug Enforcement Administration (DEA)
				Number;
B. Maine Professional
				License or Certificate Number;
C.
				National Provider Identification (NPI) Number;
D. First Name;
E. Middle Name;
F. Last Name;
G. Generational Indicator/Suffix;
H. Degree or Credential;
I. Professional Specialty;
J. Practice Name;
K. Practice Physical Address; and
1. City/Town;
2. State; and
3. Zip Code
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 280 - FILING REQUIREMENTS FOR PRESCRIBERS SEEKING CONFIDENTIALITY PROTECTION › Section 590-280-4 - Public Access

Current through 2024-29, July 17, 2024
A. Information
				collected, processed and/or analyzed under this rule shall be subject to
				release to the public or retained as confidential information in accordance
				with 22 M.R.S.A. §8707 and Code of Maine Rules 90-590, Chapter
				120:
Release of Information to the Public,
unless prohibited
				by state or federal law.
B. Upon
				complying with the provisions set forth in Section 4(A) of Chapter 120, a party
				requesting prescriber data shall be provided by the MHDO a user name and
				password with a URL address to access and download XML CSV files containing the
				most current data. After an initial twelve months have elapsed, and for each
				twelve month period that follows, the requesting party shall complete a
				web-based registration form to continue to access the prescriber data. Provided
				the information is accurate and complete, and the requesting party has not
				violated any MHDO statutes or rules, the MHDO shall provide the requesting
				party with a new password.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 280 - FILING REQUIREMENTS FOR PRESCRIBERS SEEKING CONFIDENTIALITY PROTECTION › Appendix 590-280-A - Prescriber Data Set File Specifications

Current through 2024-29, July 17, 2024
Data Element Name
Type
Maximum Length
DEA Number
Text
9
License Number
Text
30
NPI Number
Number
10
First Name
Text
50
Middle Name
Text
50
Last Name
Text
50
Suffix
Text
6
Degree or Credential
Text
50
Professional Specialty
Text
100
Practice Name
Text
100
Practice Physical Street 1
Text
100
Practice Physical Street 2
Text
100
Practice Physical Street 3
Text
100
Practice Physical City
Text
100
Practice Physical State
Text
2
Practice Physical ZIP
Text
9
Practice Mailing Street 1
Text
100
Practice Mailing Street 2
Text
100
Practice Mailing Street 3
Text
100
Practice Mailing City
Text
100
Practice Mailing State
Text
2
Practice Mailing ZIP
Text
9
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 300 - UNIFORM REPORTING SYSTEM FOR HOSPITAL FINANCIAL DATA › Section 590-300-2 - Format and content of financial data to be filed with the MHDO

Current through 2024-29, July 17, 2024
A. Every parent entity shall file with the
				MHDO individually and for its Maine hospital(s), subsidiaries and/or affiliated
				health care facilities the following:
(1) An
				electronic copy of its annual audited consolidated financial statements that
				include a balance sheet, income statement, statement of changes in net assets,
				and cash flow statements with accompanying supplemental information in PDF
				format and submitted via the MHDO Hospital Data Portal
(2) An electronic copy of its consolidating
				schedules for all entities to include a consolidating balance sheet, income
				statement, changes of net assets, and cash flow statements in PDF format and
				submitted via the MHDO Hospital Data Portal.
(3) An electronic copy of its individual
				hospital(s) audited financial statements with additional accompanying
				supplemental information including details/schedule of revenue by inpatient and
				outpatient charges; and the deductions from revenue in PDF format and submitted
				via the MHDO Hospital Data Portal.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 300 - UNIFORM REPORTING SYSTEM FOR HOSPITAL FINANCIAL DATA › Section 590-300-3 - Schedule for filing

Current through 2024-29, July 17, 2024
Every parent entity, or any other person as defined under
				  section
				  1, required to file data with the MHDO
				  in accordance with
				  22 M.R.S.A.
				  §8709, shall file with the MHDO all
				  required financial and supplemental data annually, not later than six months
				  after its most recent fiscal year end in accordance with the following
				  schedule:
Fiscal Year End Date
Filing Deadline
January 31
July 31
February 28
August 31
March 31
September 30
April 30
October 31
May 31
November 30
June 30
December 31
July 31
January 31
August 31
February 28
September 30
March 31
October 31
April 30
November 30
May 31
December 31
June 30
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 300 - UNIFORM REPORTING SYSTEM FOR HOSPITAL FINANCIAL DATA › Section 590-300-4 - Standards for data; notification; response

Current through 2024-29, July 17, 2024
A. Upon submission, each parent entity or
				hospital's electronic file(s) of the MHDO Standardized Accounting Template(s)
				shall be reviewed by the MHDO for comparison to the submitted audited financial
				statements and other supplemental documents provided.
B. Upon completion of the review, the MHDO
				will promptly notify each parent entity or hospital if discrepancies are found
				in the submitted data. The notification will specify the data fields and lines
				in the template which appear to be in conflict with financial data
				submitted.
C. Upon receipt of the
				notification, each parent entity or hospital shall respond to the MHDO within
				30 days with corrected data or with information clarifying the
				discrepancies.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 300 - UNIFORM REPORTING SYSTEM FOR HOSPITAL FINANCIAL DATA › Section 590-300-5 - Certification

Current through 2024-29, July 17, 2024
The Chief Financial Officer or appropriate responsible
				  official of the parent entity or hospital shall attest to the correctness and
				  accuracy of all data and documents submitted to the MHDO as required by this
				  chapter.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 300 - UNIFORM REPORTING SYSTEM FOR HOSPITAL FINANCIAL DATA › Section 590-300-6 - Public access

Current through 2024-29, July 17, 2024
Information collected, processed and/or analyzed under this
				  rule shall be released to the public in accordance with
				  22 M.R.S.A.
				  §8707, sub-§§
									1 and
				  4 and
Code of Maine
				  Rules
90-590, Chapter 120: Release of Data to the Public. The MHDO may
				  initiate studies and/or analyses of financial data submitted and merge it with
				  clinical data as defined in
				  22 M.R.S.A.
				  §8708.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 300 - UNIFORM REPORTING SYSTEM FOR HOSPITAL FINANCIAL DATA › Section 590-300-7 - Compliance

Current through 2024-29, July 17, 2024
The failure to file financial data in accordance with the
				  provisions of this Chapter may be considered a violation under
				  22 M.R.S.A.
				  §8705-A.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 570 - UNIFORM REPORTING SYSTEM FOR PRESCRIPTION DRUG PRICE DATA SETS › Section 590-570-2 - Registration and Submission Requirements

Current through 2024-29, July 17, 2024
Reporting entities shall submit to the MHDO or its designee
				  complete prescription drug price data sets in accordance with the requirements
				  of this section. Data may be submitted by corporate entities or their
				  subsidiaries. Reporting entities that engage subcontractors or other third
				  parties to submit information on their behalf warrant the completeness and
				  accuracy of all data submitted.
A.
Registration.
Each entity required to report shall complete an
				online registration form, or update an existing one, via the MHDO Prescription
				Drug Price Data Portal web interface (
https://mhdo.maine.gov/pharma_portal/
)
				by January 30th of each year. It is the
				responsibility of the reporting entity to complete, as needed, all company and
				contact information.
B.
Public Notice of Substantial Drug Price Change or Introduction.
No
				later than January 30th of each year, the MHDO shall produce and post on its
				publicly accessible website a list of prescription drugs for which the
				manufacturer has during the prior calendar year:
1) Increased the wholesale acquisition cost
				of a brand-name drug by more than 20% per pricing unit;
2) Increased the wholesale acquisition cost
				of a generic drug that costs at least $10 per pricing unit by more than 20% per
				pricing unit; or
3) Introduced a
				new prescription drug for distribution in this State when the wholesale
				acquisition cost is greater than the amount that would cause the drug to be
				considered a specialty drug under the Medicare Part D program (hereinafter "new
				drug"). For the purposes of this paragraph, "Medicare Part D" has the same
				meaning as in
				22 M.R.S.
				§254-D(1)(F).
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 570 - UNIFORM REPORTING SYSTEM FOR PRESCRIPTION DRUG PRICE DATA SETS › Section 590-570-3 - Evaluation; Notification; Response

Current through 2024-29, July 17, 2024
A.
Evaluation.
The MHDO or its vendor shall evaluate each file in
				accordance with the following standards:
1)
				When applicable, only an eligible code value for a specified data element shall
				be accepted;
2) Coding values
				indicating "data not available", "data unknown", or the equivalent shall not be
				used for individual data elements unless specified as an eligible value for the
				element.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 570 - UNIFORM REPORTING SYSTEM FOR PRESCRIPTION DRUG PRICE DATA SETS › Section 590-570-4 - Compliance

Current through 2024-29, July 17, 2024
A.
Certification of accuracy.
A notification or report to the MHDO by
				a reporting entity shall include a signed, written certification of the
				notification or report's accuracy. Reporting entities will be allowed to attest
				to the accuracy of their notification or report through the MHDO Prescription
				Drug Price Data Portal web interface. Confirmation will be documented
				electronically and will count as the written certification.
B.
Audit.
With a 30-day notice,
				the MHDO may audit the finalized data submitted by a reporting entity, and that
				entity shall pay for the costs of the audit. The MHDO will consider
				recommendations from the reporting entity as to the scope of the audit and the
				selection of the independent auditor.
C.
Corrective action plan.
The
				MHDO may require a reporting entity to develop a corrective action plan to
				correct any deficiencies in compliance discovered during an audit. The
				corrective action plan shall include, in writing: the specific requirement to
				be extended; an explanation of the cause; the methodology proposed to eliminate
				the necessity of the extension; and the time frame required to come into
				compliance.
D.
Enforcement.
The failure to file, report, or correct prescription
				drug price data sets when required in accordance with the provisions of this
				chapter may be considered a civil violation under
				22 M.R.S.
				§8705-A and
Code of Maine
				Rules
90-590, Chapter 100:
Enforcement
				Procedures
.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 570 - UNIFORM REPORTING SYSTEM FOR PRESCRIPTION DRUG PRICE DATA SETS › Section 590-570-5 - Extensions to Data Submission Requirements

Current through 2024-29, July 17, 2024
If a reporting entity, due to circumstances beyond its
				  control, is temporarily unable to meet the terms and conditions of this
				  chapter, a written request must be made to the Compliance Officer of the MHDO
				  as soon as it is practicable after the reporting entity has determined that an
				  extension is required. The written extension request shall include the same
				  elements as the corrective action plan in Section
				  4(C).
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 570 - UNIFORM REPORTING SYSTEM FOR PRESCRIPTION DRUG PRICE DATA SETS › Section 590-570-6 - Confidentiality

Current through 2024-29, July 17, 2024
Information provided to the MHDO as required by this chapter
				  by a manufacturer, wholesale drug distributor or pharmacy benefits manager is
				  confidential and not a public record under Title 1, Chapter 13, except that the
				  MHDO may share information:
A.
Bureau of Insurance.
With the Department of Professional and
				Financial Regulation, Bureau of Insurance, to the extent necessary for the
				bureau to enforce the provisions of Title 24-A, as long as prior notice is
				provided to reporting entities that information will be shared, and any
				information shared is kept confidential;
B.
Aggregate.
In the aggregate,
				as long as it is not released in a manner that allows the determination of
				individual prescription drug pricing contract terms covering a manufacturer,
				wholesale drug distributor or pharmacy benefits manager; and
C.
Publicly Available.
That is
				available, for purchase or otherwise, to the public.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 630 - UNIFORM SYSTEM FOR REPORTING BASELINE INFORMATION AND RESTRUCTURING OCCURRENCES FOR MAINE HOSPITALS AND PARENT ENTITIES › Section 590-630-2 - Schedule and format for filing baseline information

Current through 2024-29, July 17, 2024
Every hospital and parent entity must file baseline
				  information no later than ninety days from the effective date of these rules,
				  as follows:
A. A current
				organizational chart or charts depicting the organizational structure and
				relationships, in terms of ownership, control, and membership, and the
				individual corporate tax status, tax identification number, and functional
				description, among the persons and health care facilities owned by or
				affiliated with the hospital and parent entity.
B. Hospitals must file, in addition to the
				chart described in section 2(A):
1. A chart
				depicting the organizational structure, location and relationship of separate
				health service delivery sites or treatment centers that are not located in the
				same municipality as the hospital; and
2. For all physicians employed or owned by
				the hospital, the physician's name and, where applicable, the department of the
				hospital or the name of the group practice with which the physician is
				associated.