1. 90-590 MAINE HEALTH DATA ORGANIZATION
   1. Chapter 841: UNIFORM REPORTING SYSTEM FOR HOSPITAL PRICE TRANSPARENCY

SUMMARY: Public Law 2023, Chapter 584, requires Maine hospitals comply with the price transparency requirements established in 45 Code of Federal Regulations, Part 180, Subparts A and B; and it requires hospitals to provide price transparency data in a standardized format as established by rule by the Maine Health Data Organization and provides that a hospital that fails to comply with the price transparency requirements established by the Maine Health Data Organization may be subject to a fine for noncompliance.

This Chapter establishes provisions for:

1. Identification of the hospitals required to report;

   Establishment of requirements for the content, format, submission method, and time frame for filing hospital price transparency data; and

   Compliance provisions.

1. Definitions

Unless the context indicates otherwise, the following words and phrases shall have the following meanings:

1. 1. CMS Validator Tool. “CMS Validator Tool” means the tool available at https://cmsgov.github.io/hpt-tool/online-validator/ that checks Hospital Price Transparency files against CMS form and manner requirements (45 CFR 180.50(c)(2)). This tool does not necessarily certify that files fully comply with all Hospital Price Transparency requirements at 45 CFR 180.50.
   2. Code Type. “Code Type” means the name of the standard coding system of billing codes or accounting codes provided for each individual or bundled service.
   3. Hospital. "Hospital" means any type of hospital institution required to be licensed pursuant to 22 M.R.S., Chapter 405.
   4. Hospital Price Transparency rule. “Hospital Price Transparency rule” refers to 45 CFR Part 180 that requires each hospital operating within the United States, for each year, to establish, update, and make public a list of the hospital's standard charges for items and services provided by the hospital, including for diagnosis-related groups (DRGs). Part 180.50 outlines the federal requirements for making public hospital standard charges for all items and services in a machine-readable file.
   5. Machine-Readable File. “Machine-Readable File means a single digital in a format that can be read by computers and includes the data requirements as specified by the federal requirements.
   6. MHDO. "MHDO" means the Maine Health Data Organization.
   7. M.R.S. “M.R.S.” means Maine Revised Statutes.
   8. Payer Name. “Payer Name” means the name of the third-party payer that is, by statute, contract, or agreement, legally responsible for payment of a claim for a healthcare item or service.
   9. Plan Name. “Plan Name” means the name of the payer’s specific plan associated with the standard charge.
   10. Standard Hospital Charge Fields. “Standard Hospital Charge Fields” means the rates charged and contextual information for services that do not vary by payer and plan.
   11. Standard Negotiated Charges Fields. “Standard Negotiated Charges Fields” are rates that a hospital has negotiated with a third party payer for an item or service and the related percentage and algorithm.

1. Registration and Submission Requirements
   1. Registration. Each Hospital shall complete an online registration form, or update an existing one, via the MHDO Hospital Data Portal web interface (https://mhdo.maine.gov/hospital_portal) by April 30, 2026, and January 30^th of each year thereafter. It is the responsibility of the reporting entity to complete, as needed, all company and contact information, provide website URL to find price transparency files and timeframe relevant to the file.
   2. Submission method. Pursuant to federal requirements, each Hospital must ensure that updated machine-readable files are posted on a public website at the URL provided in registration. Hospitals shall provide notice to MHDO 30 days prior to changing the URL where price transparency data are uploaded.
   3. Submission deadline. Hospitals shall publish updated files annually by November 1^st.
2. Format and Content of Hospital Price Transparency Data

1. Hospitals covered under this chapter shall upload files in accordance with the requirements of this section and the Hospital Price Transparency rule. Hospitals that engage third parties to develop files on their behalf warrant the completeness and accuracy of all data submitted.

1. 1. File content. Each Hospital shall include the required data elements as established by CMS.
   2. File format and name. Each Hospital must conform files to the CMS CSV “tall” template layout, data specifications, and data dictionary. The file must use the naming convention specified by CMS. Hospitals will be required to attest to the use of the CMS Validator Tool prior to posting files on their website to confirm compliance with CMS format requirements.
   3. Codes. Any codes used by the hospital for purposes of accounting or billing for the item or service, including, but not limited to, Current Procedural Terminology (CPT) code, the Healthcare Common Procedure Coding System (HCPCS) code, the Diagnosis Related Group (DRG), the National Drug Code (NDC), or other common payor identifiers shall be included within eligible values for the field.
      1. When used, NDCs shall be provided in a standard 11-digit format with no hyphens, spaces, or other non-numeric characters.
      2. When revenue center codes are used, CPT codes, HCPCS codes, and NDCs shall be reported where applicable. When provided, CPT and HCPCS codes shall be assigned to the correct revenue centers.
      3. Submitted codes shall be valid, non-deprecated codes of the submitted type as of a year prior to file updated date.
      4. Values in the Modifiers field shall be valid, standard two-digit HCPCS modifiers. When submitting more than one modifier, modifiers shall be separated by commas. When the Modifiers field is present, at least one submitted code on the record must be a CPT or HCPCS code.
      5. The Service Description shall be identical across payers and plans when representing the same service or Charge Description Master value.
      6. Each code representing a single service should have a unique service description.
      7. When the individual item or service is provided in the hospital inpatient setting, no submitted code on the record shall be a CPT, HCPCS, or CDT code.
      8. When the individual item or service is provided in the outpatient department setting, no submitted code on the record shall be a DRG, MS-DRG, R_DRG, S_DRG, APS-DRG, or APR-DRG code.
      9. CPT codes shall be submitted with code_type label as CPT and not HCPCS, and MS-DRG, R_DRG, S_DRG, APS-DRG, or APR-DRG codes shall be submitted with code_type label as specific as possible and not DRG.
   4. Charges.
      1. Dollar Amounts- Fields specified to contain a dollar amount shall be correctly formatted to include two decimal places.
      2. Any record with a Standard Negotiated Charge Field shall also have the related Standard Hospital Charge Field present on the same row.
      3. Service-plan combinations without negotiated charges or where individual service reimbursement is bundled into a DRG rate should not be provided as separate items in the transparency files unless they have an applicable separate charge.
   5. Payer and Plan Specific Identification – MHDO will provide hospitals with standardized Payer and Plan name information to use for data submissions. Hospitals shall list only valid Payer Name and Plan Name information when providing negotiated charges for a description of service. Non-standardized Payer and Plan names will be flagged as being out of compliance.

1. Determination of Material Compliance; Notice
   1. Standards. Files will be validated based on formatting requirements established in the Hospital Price Transparency rule and sections 2 and 3 above. The MHDO will download all updated files quarterly and validate files no later than 60 days after the file download date in accordance with the following schedule:

1. 1. Notification. Upon completion of this validation, the MHDO shall notify any hospital that is not in material compliance. This notification will identify the elements of the file that do not satisfy the standards.
   2. Corrective action plan. The MHDO may require a hospital to develop a corrective action plan to correct any deficiencies in compliance within 60 days.
   3. Enforcement. The failure to report hospital price transparency data 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. Additionally, the MHDO may report non-compliance to the CMS to assist its monitoring and enforcement under 45 CFR §180.70(a)(2)(i, ii).

1. Extensions to Data Submission Requirements. If a hospital, 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 practicable after the hospital has determined that an extension is required.

STATUTORY AUTHORITY: PL 2023, Chapter 584; 22 M.R.S. Ch 1683 §§ 8704(1, 4), 8705-A, §1718-I(1,2,4)

APAO ACCESSIBILITY CHECK (Word):

March 3, 2026

1. EFFECTIVE DATE: March 8, 2026 (filing 2026-057)