Health Care Facility Fees

Public Law 2023, Chapter 410 (LD1795), An Act to Create Greater Transparency for Facility Fees Charged by Health Care Providers and to Establish the Task Force to Evaluate the Impact of Facility Fees on Patients, requires the Maine Health Data Organization (MHDO) to submit an annual report on payments for facility fees made by payers, to the extent that payment information is already reported to the MHDO, to the Office of Affordable Health Care and the Joint Standing Committee on Health Coverage, Insurance and Financial Services. This is MHDO’s first annual report.

As part of this annual report MHDO created a detailed data set of over 100,000 data points leveraging the information reported in CompareMaine. The data set consist of 111 health care procedures displayed by health care providers with a breakdown of the percentage of claims paid on a CMS-1500 (non-institutional) and claims paid on a UB-04 (institutional) for each of the Top 5 commercial payers in Maine, which include: Aetna, Anthem, Cigna Healthcare, Community Health Options, Harvard Pilgrim Health Care. The procedures were organized in the following procedure categories:

Procedure Category Number of CPT Codes
Office Visits  24
Behavioral Health Services  15
Outpatient Services    8
Radiology & Imaging  64
Total 111

Each provider associated with the 111 procedures was organized into two different categories – ownership and health care setting type. Ownership indicates whether the provider is affiliated or unaffiliated with a hospital or a health system based on data reported to MHDO per the requirements of 90-590 Chapter 300. The health care setting type identifies if the provider is a hospital, critical access hospital, or a non-hospital.

Category Number of Providers
   Affiliated with a Hospital or Hospital System   82
   Unaffiliated   74
Setting Type
   Hospital - Critical Access   16
   Hospital - Not Critical Access   18
   Non-Hospital 122
Total 218

Complete Data Set is available in the Excel File here.