Ch. 50: Prices for Data Sets, Fees for Programming and Report Generation, Duplication Rates

SUMMARY: This Chapter lists the prices for data sets available to the public from the Maine Health Data Organization, the fees for programming and report generation, and duplicating charges. SECTION 1. DEFINITIONS A. Assessed Entity. An "assessed entity" means a health care provider, health insurance entity, third-party administrator, or retail store drug outlet, as defined by the Maine Health Data Organization Determination of Assessments Rule (90-590 C.M.R. Chapter 10) in effect at the time of the data request that has paid assessments to the MHDO for a minimum of two consecutive fiscal years. B. Clinical Data. “Clinical data” mean health care claims data, hospital data, non-hospital health care facility data, quality data, and all other data as described in 22 M.R.S.A. Sections 8708, 8708-A, and 8711. C. Commercial Entity. A "commercial entity" means a for-profit business or organization that purchases MHDO data or information for resale in any form. D. Educational Entity. An "educational entity" means any public or private elementary or secondary school, and any public or private post-secondary institution. E. Financial Data. “Financial data” means information consisting of or derived directly from data providers pursuant to 90-590 CMR Chapter 300 Maine Health Data Organization Uniform Reporting System for Hospital Financial Data. “Financial data” do not include analysis, reports, or studies if those analyses, reports, or studies have already been released as part of a general distribution of public information by the MHDO. F. Health Care Claims Data. “Health care claims data” means information consisting of or derived directly from member eligibility, medical claims, pharmacy claims, and/or dental claims files submitted by health care claims processors pursuant to the Maine Health Data Organization Uniform Reporting System for Health Care Claims Data Sets Rule (90-590 C.M.R. Chapter 243) in effect at the time of the data request

e Claims Data. “Health care claims data” means information consisting of or derived directly from member eligibility, medical claims, pharmacy claims, and/or dental claims files submitted by health care claims processors pursuant to the Maine Health Data Organization Uniform Reporting System for Health Care Claims Data Sets Rule (90-590 C.M.R. Chapter 243) in effect at the time of the data request. “Health care claims data” do not include analysis, reports, or studies containing information from health care claims data sets, if those analyses, reports, or studies have already been released in response to another request for information or as part of a general distribution of public information by the MHDO. G. Hospital Data. "Hospital data" means information consisting of or derived directly from hospital inpatient, outpatient, emergency department, or any other derived data sets filed or maintained pursuant to the Maine Health Data Organization Uniform Reporting System for Hospital Inpatient Data Sets and Hospital Outpatient Data Sets Rule (90-590 C.M.R. Chapter 241) in effect at the time of the data request. "Hospital data" do not include analysis, reports, or studies containing information from hospital data sets, if those analyses, reports, or studies have already been released in response to another request for information or as part of a general distribution of public information by the MHDO. H. MHDO. “MHDO” means the Maine Health Data Organization or its predecessor agencies. I. Non-Hospital Health Care Facility Data. “Non-hospital health care facility data” means information or data consisting of or derived directly from data sets filed or maintained pursuant to the Maine Health Data Organization Uniform Reporting System for Non-Hospital Ambulatory Service Data Sets Rule (90-590 C.M.R. Chapter 245) in effect at the time of the data request

r its predecessor agencies. I. Non-Hospital Health Care Facility Data. “Non-hospital health care facility data” means information or data consisting of or derived directly from data sets filed or maintained pursuant to the Maine Health Data Organization Uniform Reporting System for Non-Hospital Ambulatory Service Data Sets Rule (90-590 C.M.R. Chapter 245) in effect at the time of the data request. “Non-hospital health care facility data” do not include analysis, reports, or studies containing information from non-hospital health care facility data sets, if those analyses, reports, or studies have already been released in response to another request for information or as part of a general distribution of public information by the MHDO. J. Non-Profit Entity. A "non-profit entity" means a governmental agency or public or private organization that has been determined to be exempt from taxation under the United States Internal Revenue Code, Section 501 (c). K. Quality Data. “Quality data” means information consisting of or derived directly from data providers pursuant to 90-590 CMR Ch. 270 Maine Health Data Organization Uniform Reporting System for Quality Data Sets. "Quality data" do not include analysis, reports, or studies if those analyses, reports, or studies have already been released as part of a general distribution of public information by the MHDO. L. Redistributor. A "redistributor" means any commercial entity, assessed entity, or non-profit entity that purchases MHDO data for inclusion in a larger composite database that is publicly released. M. Restricted Data Set. "Restricted data set" means data or information containing data elements as described in subsections 9(A) (2), (3), and (4) of the Maine Health Data Organization Release of Data to the Public Rule (90-590 C.M.R. Chapter 120) in effect at the time of the data request. N. Unrestricted Data Set

MHDO data for inclusion in a larger composite database that is publicly released. M. Restricted Data Set. "Restricted data set" means data or information containing data elements as described in subsections 9(A) (2), (3), and (4) of the Maine Health Data Organization Release of Data to the Public Rule (90-590 C.M.R. Chapter 120) in effect at the time of the data request. N. Unrestricted Data Set. "Unrestricted data set" means data or information containing none of the data elements as described in subsections 9(A) (2), (3), and (4) of the Maine Health Data Organization Release of Data to the Public Rule (90-590 C.M.R. Chapter 120) in effect at the time of the data request. SECTION 2. PROCESSING FEE A non-refundable processing fee of $25 is to be paid with all requests for data sets, files, reports, or tables as set forth in sections 3 and 4 of these rules. SECTION 3. CLINICAL DATA SET PRICES A. Maine Hospital Data Sets. The price schedules and data availability for individual record level data sets derived from data submitted by all Maine-licensed hospitals are as follows: 1. Unrestricted Data Sets. Entity Requesting Data Commercial Assessed Non-Profit/Educational Redistributor First Year Per Per Per Per Per Per Per Per Data Set Available Quarter Year Quarter Year Quarter Year Quarter Year Inpatient 1980 $375 $1,300 $202 $697 $185 $650 $1,250 $4,325 Outpatient 1998 $750 $2,600 $337 $1,170 $310 $1,100 $2,065 $7,140 Emergency Dept. 2000 $750 $2,600 $337 $1,170 $310 $1,100 $2,065 $7,140 2. Restricted Data Sets. Entity Requesting Data Commercial Assessed Non-Profit/Educational Redistributor First Year Per Per Per Per Per Per Per Per Data Set Available Quarter Year Quarter Year Quarter Year Quarter Year Inpatient 1980 $430 $1,500 $234 $810 $215 $750 $1,445 $5,000 Outpatient 1998 $860 $3,000 $387 $1,350 $360 $1,250 $2,385 $8,250 Emergency Dept. 2000 $860 $3,000 $387 $1,350 $360 $1,250 $2,385 $8,250 Practitioner Identifiers 2000 - $1,500 - $675 - $625 - $4,125 B

l Redistributor First Year Per Per Per Per Per Per Per Per Data Set Available Quarter Year Quarter Year Quarter Year Quarter Year Inpatient 1980 $430 $1,500 $234 $810 $215 $750 $1,445 $5,000 Outpatient 1998 $860 $3,000 $387 $1,350 $360 $1,250 $2,385 $8,250 Emergency Dept. 2000 $860 $3,000 $387 $1,350 $360 $1,250 $2,385 $8,250 Practitioner Identifiers 2000 - $1,500 - $675 - $625 - $4,125 B. Health Care Claims Data Set. The price schedules and data availability for individual record level data files derived from data submitted by all Maine-licensed commercial and major governmental payers related to claims paid for Maine residents are as follows: 1. Unrestricted Data Set. Entity Requesting Data Commercial Assessed Non-Profit/Educational Redistributor First Year Per Per Per Per Per Per Per Per Data Set Available Quarter Year Quarter Year Quarter Year Quarter Year Member Eligibility 2