Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter III - Allowances for Services › Section 144-101-III-45 - HOSPITAL SERVICES › Subsection 144-101-III-45.07 - VALUE-BASED PURCHASING (VBP) SUPPLEMENTAL SUB-POOL

Current through 2024-29, July 17, 2024
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, Acute Care Critical Access Hospital, or a
					 Hospital Reclassified to a Wage Area Outside of Maine, 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
2nd and
								  3rd ranked HSA
$50,000 each ($100,000
								  total)
4th through
								  8th 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:
Click
						to view image
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.