MaineCare Issued Annual Hospital Value-Based Purchasing (VBP) Supplemental Payments and Correction to Previous Results

Jun 18, 2024

Earlier this month, MaineCare issued supplemental payments to nine hospitals rewarding the high levels of primary care utilization for MaineCare members in their Hospital Service Areas (HSAs). The table below shows how the top eight HSAs, which include nine hospitals, surpassed the statewide average of 57.5% MaineCare members within the HSA with a primary care visit in 2023. This sub-pool, totaling $600,000 annually, supports hospitals that partner with a MaineCare Accountable Community. MaineCare Accountable Community leads currently include Community Care Partnership of Maine (CCPM), Kennebec Region Health Alliance (KRHA), MaineHealth ACO (MHACO), and Northern Light Health (NLH).

For a full description of this VBP supplemental payment methodology please review MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services (Section 45.07).  

For the full crosswalk used to map HSA to zip code please review the Dartmouth Atlas Supplemental Data.

Accountable Community	Hospital/HSA	Percentage of MaineCare Members in the HSA with a Primary Care Visit (CY 2023)
CCPM	Millinocket Reg. Hosp. (20022)	72.3%
MHACO	MaineHealth – Franklin Memorial Hospital (20016)	67.3%
CCPM/ NLH	St. Joseph Hospital / Northern Light Eastern Maine Medical Center (20002)	62.9%
NLH	Northern Light Inland (20031)	62.9%
MHACO	MaineHealth – Southern Maine Health Care (20006)	60.7%
MHACO	St. Mary's Regional Medical Center (20019)	60.6%
MHACO	MaineHealth – Mid Coast Hospital (20010)	60.2%
KRHA	MaineGeneral Medical Center (20001)	59.9%

 

For hospitals that have been awarded these funds, the invoice type should display on any paper Remittance Advice (RA) and be listed as “OTHER.” The invoice number should display on any electronic 835 with a prefix of “VBPS.” 

Correction to 2022 Results/Payments

The Department issued payments to hospitals in the top performing HSAs in June 2023 for both Calendar Years (CY) 2021 and 2022. The initial two years’ worth of payments were issued concurrently due to the timing of the Section 45 rule adoption (fall 2022) and in order to spend the full appropriation of these funds. In reviewing the methodology used to determine eligible hospitals and payment amounts per hospital, the Department found that there was an error in how it had assigned hospitals with multiple service locations to HSAs for the CY 2021 payment, which resulted in incorrect performance data. As a result, some hospitals were paid incorrect amounts. The Department has issued correspondence directly to those hospitals that were overpaid with repayment instructions and will notify hospitals that will receive a new payment or increased payment shortly. The updated table below identifies the hospitals in the top performing HSAs for CY 2021.

Accountable Community	Hospital/HSA (corrected)	ORIGINALLY REPORTED Percentage of MaineCare Members in the HSA with a Primary Care Visit (CY 2021)	UPDATED Percentage of MaineCare Members in the HSA with a Primary Care Visit (CY 2021)
CCPM	Millinocket Regional Hospital (20022)	74%	74%
MHACO	MaineHealth – Franklin Memorial Hospital (20016)	70%	70%
MHACO	St. Mary's Regional Medical Center (20019)	70%	70%
MHACO	MaineHealth – Southern Maine Health Care (20029)	71%	69%
NLH	Northern Light Inland (20031)	69%	69%
Kennebec Region Health Alliance	MaineGeneral Medical Center (20001)	68%	68%
CCPM/ LH	St. Joseph Hospital / Northern Light Eastern Maine Medical Center (20002)	68%	68%
NLH	Northern Light Maine Coast Hospital (20015)	--	66%
MHACO	MaineHealth – LincolnHealth (20008)	66%	--

 

 Please contact Tiffany Norton, Provider Relations Specialist, with any questions.