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Archive February 2025

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In Case You Missed It: DHHS Presents VBP Explanation

Earlier this week, the Maine Department of Health and Human Services (DHHS) held an important session on Making Sense of Value-Based Purchasing (VBP) to help providers and stakeholders better understand the state's transition toward a more outcomes-driven payment system. If you missed the presentation, here are the key takeaways:

What is Value-Based Purchasing?
VBP is a payment model that ties reimbursement to quality and outcomes rather than just the volume of services provided.

Why Is Maine Moving Toward VBP?
MaineCare is implementing VBP to try to:
  • Improve health outcomes for Maine residents.
  • Promote cost efficiency in healthcare spending.
  • Align payment structures with evidence-based practices.
  • Encourage provider accountability and care coordination.
Key Components of Maine’s VBP Model
The presentation outlined several core elements of Maine’s VBP approach, including:
  1. Alternative Payment Models (APMs) – Replacing traditional fee-for-service models with risk-sharing agreements.
  2. Quality Metrics & Performance Incentives – Providers will be rewarded for meeting specific quality benchmarks.
  3. Focus on Equity – Addressing disparities in healthcare access and outcomes.
  4. Provider Readiness & Support – DHHS is working to ensure providers have the tools needed to transition successfully.
  5. Quest Partnership – A collaborative initiative supporting facilities with training, technical assistance, and quality improvement strategies.
What’s Changing for Providers?
  • Providers will see a shift from volume-based payments to performance-based incentives.
  • Data reporting and analysis will play a crucial role in reimbursement.
  • MaineCare will offer technical assistance to help providers adapt.
  • Quality Champions will need to be designated at each nursing facility to lead participation in the Quest Partnership.
  • Facilities must contract with a CoreQ vendor for resident and family satisfaction surveys.
  • Providers will need to meet with Maine’s Health Information Exchange (HIE) to explore data integration opportunities.
Quest: Supporting Providers in the Transition
The Quest Partnership was introduced to assist providers in adapting to VBP. Quest stands for Quality, Excellence, Staffing, and Teamwork and includes:
  • Monthly educational calls covering different aspects of VBP.
  • Dementia Care Partnership – An initiative to reduce the use of antipsychotic medications in long-term care.
  • Culture Change Coalition – A focus on improving staffing stability and reducing turnover through best practices.
  • Technical Assistance & Reports – Providers will receive quarterly performance reports to track progress.
How to Qualify for the Quality Bonus Pool in 2025
To share in the $8.1 million quality bonus pool, nursing facilities must:
  1. Identify and register a Quality Champion who will lead internal efforts.
  2. Participate in the Quest Partnership calls and initiatives.
  3. Contract with a CoreQ vendor to conduct resident and family surveys.
  4. Meet with Maine’s Health Information Exchange (HIE) to explore opportunities for data reporting and integration.
Next Steps & How to Prepare
  • Review the full DHHS presentation slides linked here and video linked here.
  • Assess your organization’s current data collection and reporting capabilities.
  • Stay tuned for upcoming stakeholder engagement opportunities.
  • Ensure your facility is on track to meet the participation requirements by the October 1, 2025, deadline.
MHCA will continue to track these changes and advocate for our members throughout the VBP transition. If you have questions or concerns, feel free to reach out.

Staff contact: bhawkins@mehca.org

Mike McNeil Calendar Winners as of Feb. 20

We have about one week of drawings left, including the largest prize of $500 on February 28th! Below are the winners so far.
 
Sandy River Co Eden Tyler
Affinity Care of ME Jessica Duffy
Country Village Estates Robin Nadeau
North Country Kim Dufour
Maine Vets-So Paris Steve Moore
Caribou Rehab Koralie Emerson
NHCA Jennifer Pelletier
Hibbard Skilled Bridget  Squires
Dexter Health Care Patricia Sisson
Maine Vets-So Paris Travis Labrecque
Dexter Health Care Erin Ranquist
Odd Fellows Home Dave Laroche
Maine Vets-So Paris Jessica Haggerty
Madigan Estates Megan Carroll
Durgin Pines Christine Burke
Montello Manor Mamy Mujawlmana
Hibbard Skilled Peyton Tyler
Inn at Atlantic Heights Danielle Gagnon
Hawthorne House Jaden Tucker
Madigan Estates Amy Witmer
 

2/20/25 Legislative Update

As of February 20, 2025, the Maine Legislature remains in negotiations over the supplemental budget. While bipartisan discussions continue, no final agreement has been reached on addressing the $118 million MaineCare shortfall.

Governor Janet Mills has reiterated the need for a bipartisan solution to avoid disruptions in provider payments. While nursing homes and Private Non-Medical Institutions (PNMIs) have not been specifically identified for rate reductions, uncertainty remains until a final budget is passed. We remain hopeful that lawmakers will reach an agreement and pass the budget when they reconvene on February 25.

MHCA continues to advocate for long term care funding stability and appreciates members who have responded to our action alert. We will keep you updated as the situation develops.

Staff contact: bhawkins@mehca.org

 

Maine Chamber of Commerce Event: Implications of Immigration Changes on Maine Employers:

The Maine Department of Labor is sharing the below upcoming webinar information on behalf of the Maine State Chamber of Commerce:
Implications of Immigration Changes on Maine Employers:
Thursday, February 27, 2025 from 9 - 10 AM
Register on the Maine State Chamber of Commerce's website here! 

As the political landscape in Washington rapidly shifts, staying informed on immigration policy is increasingly challenging. Join us for a webinar designed to assist Maine employers navigate the current immigration policy environment. This discussion will review current immigration authorizations and implications on Maine’s immigrant population. Employers will also receive guidance on compliance requirements and best practices for supporting employees.

Scheduled speakers are:
Tarlan Ahmadov - Director, Office of New Americans
Michael Deheeger - Campaign Director, American Business Immigration Coalition (ABIC)
Barbara Leen - Senior Corporate Counsel, Microsoft
Katie Minervino - Partner, Pierce Atwood
Sue Roche - Executive Director, Immigrant Legal Advocacy Project (ILAP)

Register on the Maine State Chamber of Commerce's website here! 

Research Study: Care-Wallet for Family Caregivers of Alzheimer’s/Dementia Patients

The University of Maine Center on Aging is conducting a research study to evaluate Care-Wallet, a secure web application designed to assist family caregivers managing complex care, such as dementia and Alzheimer’s. The study aims to explore how Care-Wallet can reduce caregiver burden and improve caregiving confidence.

Eligible participants who provide or coordinate care for someone with dementia in Maine or Massachusetts may receive $100 compensation for completing study activities, including three short surveys and a final interview.

Care-Wallet offers tools to help caregivers:
  • Manage healthcare appointments and medications
  • Navigate healthcare benefits and resources
  • Coordinate care with family members
  • Receive specialized support from care managers
MHCA members who work with families providing care for loved ones with dementia are encouraged to share this opportunity. If you know of family caregivers who may be interested, please direct them to complete the screening survey at https://bit.ly/carewallet.

For more information, click here for a flyer or contact study coordinator Rachel Coleman at rachel.coleman@maine.edu.

Office of MaineCare Services: Reminder for all Providers: A 30-Day Notice is Required Prior to Closure

All MaineCare enrolled providers are required to provide at least a 30-day notice to the Office of MaineCare Services (OMS) if they are closing one of their programs or their agency. This requirement is listed in the MaineCare Benefits Manual (MBM) Chapter I Section 1.03-6.
  1. Providers must notify the Provider Enrollment Unit of any Change in Ownership (CHOW), closure, or intention to disenroll from the MaineCare program no less than thirty (30) days prior to the intended change, except in the case of reasonably unforeseen circumstances. Providers must take all reasonable and appropriate steps requested by the Department to transition members before the intended change and, upon request, submit a transition plan to the Department for review and approval.
In addition to notifying OMS, we ask providers who are closing a program or agency to also contact other relevant state offices to ensure full awareness of the closure. This includes, but is not limited to, the following offices:
  • Office of Aging and Disability Services (OADS)
  • Office of Behavioral Health (OBH)
  • Division of Licensing and Certification (DLC)
For questions, please contact Kenneth Jamison (KJ), Enrollment Manager.? 
Staff contact: awesthoff@mehca.or

Office of MaineCare Services: Reminder on Disclosure of Organizational Changes

If your organization is going through an organizational change, please contact Gainwell to receive guidance before beginning an enrollment/revalidation/re-enrollment application or maintenance case and prior to submitting the Disclosure of Organizational Change for MaineCare form. This allows Gainwell/MaineCare to review the change and decide what is the best way the provider needs to enroll or update their enrollment. More information can be found here.

Please contact the MaineCare Enrollment email box with questions.  

Staff contact: awesthoff@mehca.org

MaineCare Notice of Rulemaking for Nursing Facility, Section 67, Principles of Reimbursement

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.

Below, please find a MaineCare Notice of Agency Rulemaking Proposal. You can access the complete rule, including a redline version of changes, and a concise summary here.

A Public Hearing will be held on Monday, March 10, 2025, 1:00 PM EST at 109 Capitol Street, Augusta, Maine 04333.
The Department has determined that its public hearing will be hybrid, conducted both in-person and remotely, via Zoom.
Zoom meeting link: https://mainestate.zoom.us/j/81377592832

Meeting ID: 813 7759 2832
One Tap Mobile: 1-309-205-3325

The deadline for written comments is 11:59 PM on Thursday, March 27, 2025.

For more information contact Derrick Grant, Policy Manager at derrick.grant@maine.gov

Staff contact: awesthoff@mehca.org

Five Star Preview Reports Availability & Access Instructions

The Five Star Preview Reports will be accessible on or around February 19, 2025. As of August 2023, Provider Preview Reports have transitioned to iQIES. https://qtso.cms.gov/news-and-updates/notice-5-star-preview-reports-february-2025
Follow these steps to locate your Provider Preview Report:
  1. Log into iQIES at https://iqies.cms.gov/ using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) user ID and password.
  2. Select "My Reports" from the Reports menu.
  3. On the My Reports page, navigate to the Provider Preview Reports folder.
For assistance with logging into iQIES or locating Provider Preview Reports, contact the iQIES Service Center:  Email: iQIES@CMS.HHS.GOV    or Phone: 800-339-9313
Nursing Home Care Compare will update with the January Five Star data on or around February 26, 2025.
The Five Star Help Line (800-839-9290) will be available from February 24 to February 28, 2025.
 
Staff contact: mcarland@mehca.org
 

2025 KX Modifier Threshold Amounts

CMS has released the updated KX modifier threshold amounts for Calendar Year (CY) 2025. The new threshold amount has been set at $2,410, which applies to relevant services requiring the use of the KX modifier. To ensure compliance and accurate reporting, this updated threshold should be clearly reflected in the “Implementation of the Bipartisan Budget Act of 2018” section on the landing page. This update aligns with CMS's ongoing efforts to provide transparency and guidance on billing requirements, helping providers adhere to the latest regulatory standards.  Click here for more information from CMS.
 
Staff contact: mcarland@mehca.org
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