Provider Resources | MaineHealth Accountable Care Organization

Providers are eligible to participate in the ACO who are a MD, DO or Primary Care NP and a member of the medical staff of MaineHealth Franklin Hospital, MaineHealth Lincoln Hospital, MaineHealth Maine Medical Center, MaineHealth Memorial Hospital, MaineHealth Mid Coast Hospital, MaineHealth Pen Bay Hospital, MaineHealth Stephens Hospital, St. Mary’s Regional Medical Center or MaineHealth Waldo Hospital. To begin the process of joining the MaineHealth ACO, please email us to request an application packet.

Participants 

• Providers Participating in the MaineHealth ACO (updated monthly) (webpage) 

Annual Compliance Training Documents

• Annual Compliance Training (PDF)
• Annual Compliance Training Attestation Form (PDF)
• Attestation Fax Cover (PDF)

Compliance and Privacy Manual Policies

• Code of Ethical Conduct (PDF)
• Beneficiary Avoidance and Referrals (PDF)
• Stark and Anti-Kickback Statute (PDF)
• Beneficiary Incentives (PDF)
• Compliance Plan Policy and Procedure (PDF)
• Conflict of Interest Policy (PDF)
• Privacy and Security Statement (PDF)
• Compliance and Privacy Committee (PDF)

Chronic Kidney Disease Resources 

• KDIGO Guidelines for Primary Care Providers - MHMG
• KDIGO Guidelines for Primary Care Providers - St. Mary's
• KDIGO Guidelines for Primary Care Providers - Private Practices

COPD Resources

• COPD Assist: Diagnosis, Treatment and Referral Resources for PCPs
• Improving the Care of Patients with Lung Health Issues

Colorectal Cancer Resources 

• Colon Cancer Screenings

Diabetes Resources

• Diabetes Education Support
• Diabetes Prevention - Episode 1

End-of-Life Resources

• Code Status Discussions with Patients: Video and Pocket Guide
• MaineHealth Regional Palliative Care Contacts and Resources

Heart Failure Resources

• ACO Insider: Target Weight at the Center of Heart Failure (video recording)
• ACO Insider: Advanced Heart Failure: When and How to Refer (video recording) - available upon request. Please contact ContactMHACO@mmc.org
• Heart Failure and Diuretics: Tricks of the Trade
• Heart Failure Fundamentals: Target Weight 

Hypertension Resources

• Peer-to-Peer Hypertension Control
• St. Mary's "Obtaining Accurate Blood Pressure" Protocol
• Test Your BP Taking Skills
• Hypertension Control Toolkit

Adolescent & Pediatric Resources

• ACO Insider: Adolescent Well-Care Visit
• Child Health
• Let's Go! 5-2-1-0
• Pediatric Referral Guidelines

Tobacco Resources

• MaineHealth Center for Tobacco Independence

ACO Insider: Annual Wellness Visits and Clinical Documentation (video recording) 

MaineHealth Annual Wellness Visit Webpage (webpage)

Making Annual Wellness Visits Work (PDF)

Reimbursable Preventative Services (webpage)

2025 Resources

Beneficiary Information Notice
Beneficiary Information Notice without Portal
Beneficiary Information Notice (Spanish)
Beneficiary Information Notice without Portal (Spanish)
Voluntary Alignment Fact Sheet with Instructions for Beneficiaries (English)
Voluntary Alignment Fact Sheet with Instructions for Beneficiaries (Spanish)
Voluntary Alignment Fact Sheet for Practice Staff
Office Poster (PDF)
Office Poster Spanish (PDF)

Coding Documents

• Coding Release Notes
• Prev 5 - Breast Cancer Screening Coding Document
• Prev 6 - Colorectal Cancer Screening Coding Document
• HTN 2 - Controlling High Blood Pressure Coding Document
• MH 1 - Depression Remission at 12 Months Coding Document
• DM 2 - Diabetes Management Coding Document
• Care 2 - Falls Screening Coding Document
• Prev 12 - Preventive Care and Screening Depression Screening and FU Coding Document
• Prev 7 - Preventive Care and Screening Flu Immunization Coding Document
• Prev 10 - Preventive Care and Screening Tobacco Screening Coding Document
• Prev 13 - Statin Therapy CVD Coding Document

Key Measures

• Measure Release Notes
• CMS Web Interface Measures List
• Prev 5 - Breast Cancer Screening Measure
• Prev 6 - Colorectal Cancer Screening Measure
• HTN 2 - Controlling High Blood Pressure Measure
• MH 1 - Depression Remission at 12 Months Measure
• DM 2 - Diabetes Management Measure
• Care 2 - Falls Screening Falls Screening Measure
• Prev 12 - Preventive Care and Screening Depression Screening Measure
• Prev 7 - Preventive Care and Screening Flu Immunization Measure
• Prev 10 - Preventive Care and Screening Tobacco Screening Measure
• Prev 13 - Statin Therapy CVD Measure

MIPS impacts the payment adjustment applied to the physician fee schedule. The ACO gets one overall MIPS score. This score translates to a payment adjustment that will be applied to claims, two years after the reporting year (e.g., 2024 program year, submitted in 2025, impacts 2026 payments.) Practices that participate in the ACO's MSSP contract are automatically enrolled in a special MIPS payment model created for ACO participants called the MIPS APM. Because the ACO reports some categories of data on behalf of its participants, this model places a reduced reporting burden on practices, compared to those enrolled in Traditional MIPS. Specifically, the ACO reports Quality data for MIPS and MSSP, Cost is not scored, and MIPS APM participants receive full credit for Improvement Activities.

Promoting Interoperability (PI) - Each ACO participant TIN (tax ID number) is required to report for the Promoting Interoperability (PI) category unless they have an exemption or do not meet the low volume threshold. Providers that do not meet the low volume threshold may be eligible to opt-in and report to receive the ACO’s payment adjustment. Beginning in 2022 the Small Practice exception became an automatic exception (no application required). Definition of small practice is practice or clinician with 15 or fewer clinicians billing under the practice’s TIN. For the 2024 reporting period MIPS reporters must have CEHRT functionality that meets ONC’s certification criteria in 45 CFR 170.315  functionality must be in place by the first day of your MIPS reporting period and functionality must be in place by the last day of the MIPS reporting period. We Will also need to provide your EHR’s CMS identification code from the Certified Health IT Product List (CHPL), available here when you submit your data. We suggest working directly with your HIT / EHR vendor to ensure their compliance plans.

What’s new in 2024:

1. Updated the CEHRT definition to align with the Office of the National Coordinator for Health IT (ONC)’s regulations 45 CFR 170.315
2. The only clinician type that now receives automatic exemption is clinician social worker. Discontinued automatic reweighting for physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists, and registered dietitians or nutrition professionals for the Promoting Interoperability performance.
3. Increased the performance period to a minimum of 180 continuous days within the calendar year.
4. Modified the second exclusion for the Query of Prescription Drug Monitoring Program (PDMP) measure beginning with the 2024 performance period so that it reads as follows:
   Any MIPS eligible clinician who does not electronically prescribe any Schedule II opioids or Schedule III or IV drugs during the performance period.
5. Require a “yes” response for the Safety Assurance Factors for Electronic Health Record (EHR) Resilience (SAFER) Guide measure beginning with the 2024 performance period.

MIPS Promoting Interoperability Requirements

Participants must submit collected data for specific measures from each of the 4 objectives (unless an exclusion is claimed) for 90 continuous days or more during 2020:

1. e-Prescribing
2. Health Information Exchange
3. Provider to Patient Exchange
4. Public Health and Clinical Data Exchange 

Measure Specifications

e-Prescribing

• E-Prescribing (required)
• Query of Prescription Drug Monitoring Program (PDMP) (optional bonus measure- will be required for 2023 reporting))

Health Information Exchange

• Option 1
  • Support Electronic Referral Loops by Sending Health Information
  • Support Electronic Referral Loops by Receiving and Incorporating Health Information
• Option 2: Bi-Directional Exchange
• Option 3: Enabling Exchange Under TEFCA

Provider to Patient Exchange: Provide Patients Electronic Access to their Health Information

• Provider to Patient Exchange (required)

Public Health and Clinical Data Exchange

• Report to the following public health or clinical data registries:
  • Immunization Registry Reporting (required)
  • Electronic Case Reporting (required)
• Option to report one of the following public health agency or clinical data registry measures:
  • Public Health Registry Reporting, OR
  • Clinical Data Registry Reporting, OR
  • Syndromic Surveillance Reporting

View measure specifications here

Attestations Required but Not Scored

Security Risk Analysis: must conduct on 2015 CEHRT on an annual basis – Work with your IT vendor

• Risk Analysis Guidance

Actions to Limit or Restrict Interoperability of CEHRT: acted in good faith and took necessary steps to prevent limiting or restricting the compatibility or interoperability of CEHRT - SUBMIT YESONC (Office of the National Coordinator for Health Information Technology)

Direct Review Attestation: assent to federal government audit - SUBMIT YES

Safety Assurance Factors for EHR Resilience (SAFER) Guides measure

• SAFER Guides | HealthIT.gov
• High-Priority Practices Guide

HARP (HCQIS access roles and profile system) Account Information

The Quality Payment Program (QPP) portal requires you to have a login and password. Please begin here: QPP Sign In (cms.gov)

Payer Resources (PDF)  

MaineHealth ACO Contract List (PDF)

Burden of Illness Resources (webpage)

• Heat Map Quality Metrics Guide