Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 500 - RULES GOVERNING THE MAINE CERTIFICATION OF HEALTHCARE COOPERATIVE AGREEMENTS
Section 144-500-1 - DEFINITIONS

Universal Citation: 10 ME Code Rules ยง 144-500-1

Current through 2024-38, September 18, 2024

As used in these rules, unless the context indicates otherwise, the following terms have the following meanings:

1.1 ANTITRUST LAW means federal or state laws that prohibitcontracts, combinations or conspiracies in restraint of trade; monopolies; mergers and acquisitions which tend to substantially reduce competition; and unfair methods of competition, as well as unfair acts and practices in the conduct of trade or commerce. See 10 M.R.S.A. Chapter 201, and 15[DEGREE]U.S.C. chapter 1.

1.2 CERTIFICATE OF PUBLIC ADVANTAGE ("COPA" or the "CERTIFICATE") (also referred to as a "certified cooperative agreement") means the written approval of a cooperative agreement issued by the department with the intent to provide state action immunity to the parties to the agreement under applicable federal antitrust laws. See 22 M.R.S.A. §§1844.

1.3 CERTIFIED COOPERATIVE AGREEMENT. See Section 1.2 of these rules. See 22 M.R.S.A. §1848(5).

1.4 COOPERATIVE AGREEMENT means an agreement that names the parties to the agreement and describes the nature and scope of the cooperation and is:

1.4.1 An agreement entered into by the following:
1.4.1.1 two or more hospitals; or

1.4.1.2 two or more healthcare providers.

1.4.1.3 For the purposes of these rules, an agreement between one or more hospitals and one or more healthcare providers is not a cooperative agreement. See 22 M.R.S.A. §1843(1).

and

1.4.2 An agreement to accomplish the following:
1.4.2.1 The sharing, allocation, or referral of the following:
1.4.2.1.1 patients,

1.4.2.1.2 personnel;

1.4.2.1.3 instructional programs;

1.4.2.1.4 medical or mental health services;

1.4.2.1.5 support services;

1.4.2.1.6 facilities; or

1.4.2.1.7 medical, diagnostic or laboratory facilities, procedures, equipment or other services traditionally offered by hospitals or healthcare providers. See 22 M.R.S.A. §1843(1)(A).

1.4.2.2 The coordinated negotiation and contracting with payors or employers; see 22 M.R.S.A. §1843(1)(B). or

1.4.2.3 The merger of two or more hospitals; or two or more health care providers. See 22 M.R.S.A. §1843(1)(C).

1.5 COVERED ENTITY means a hospital or other healthcare provider. See 22 M.R.S.A. §1843(2).

1.6 DEPARTMENT (DHHS) means the Maine Department of Health and Human Services.

1.7 ECONOMIST, for the purposes of these rules, means an individual experienced in the field of healthcare economics by education, training and experience with knowledge of economic analysis principles and techniques as they relate to antitrust issues and healthcare cooperative agreements.

1.8 ENFORCEABLE CONDITIONS, for the purposes of these rules, means reasonably enforceable conditions that the department determines are subject to future measurement or evaluation in order to assess compliance with the conditions. See 22 M.R.S.A. §1844(5)(C).

1.9 HEALTHCARE PROVIDER means the following:

1.9.1 a licensed community mental health services provider;

1.9.2 a physician licensed under Title 32, chapter 36 or 48 and operating in this State; or

1.9.3 a corporation or business entity engaged primarily in the provision of physician healthcare services. See 22 M.R.S.A. §1843(3).

1.10 HEALTH SERVICE AREA means the proposed primary and secondary service areas for both inpatients and outpatients of all facilities or entities involved in the cooperative agreement.

1.11 HOSPITAL means:

1.11.1 An acute care institution licensed and operating in this State as a hospital pursuant to 22 M.R.S.A. §1811 or the parent corporation of such an institution; or

1.11.2 A hospital subsidiary or hospital affiliate in the State that provides medical services or medically related diagnostic and laboratory services or engages in ancillary activities supporting those services. See 22 M.R.S.A. §1843(4).

1.12 MERGER means a transaction by which ownership or control over substantially all of the stock, assets or activities of one or more covered entities is placed under the control of another covered entity.

1.12.1 For the purposes of these rules, a merger between one or more hospitals and one or more healthcare providers is not a merger. See 22 M.R.S.A. §1843(5).

1.13 PERSON means an individual, trust, estate, partnership, corporation, association, joint stock company, insurance company or similar entity, and the State or a political subdivision or instrumentality of the State, including a municipal corporation of the State; or any other legal entity recognized by State law.

1.14 RELATED PARTY, for the purposes of these rules, includes but is not limited to the following:

1.14.1 A COPA applicant's father, mother, stepfather, stepmother, brother, sister, stepbrother, stepsister, son, daughter, stepson, stepdaughter, grandparent, grandson, granddaughter, father-in-law, mother-in-law, brother-in-law, sister-in-law, son-in-law, daughter-in-law, the spouse of any of the above, and a COPA applicant's spouse;

1.14.2 Any person where 25 percent or more of any class of voting securities is owned, controlled or held in the aggregate by any person(s) referred to in Section 1.13 of these rules;

1.14.3 Any person referred to in Sections 1.13 of these rules that serves as a trustee, general partner, limited partner, managing member, or director of a COPA applicant;

1.14.4 Any person acting on behalf of any person referred to in Sections 1.13 of these rules; and

1.14.5 Any corporation or its parent or subsidiary corporation that owns, is owned by, or otherwise controls or is controlled by, a party to the COPA application.

1.15 UNANTICIPATED CIRCUMSTANCES, for the purposes of these rules, includes but is not limited to the failure to realize anticipated benefits of the agreement or the realization of unanticipated anticompetitive effects from the cooperative agreement. See 22 M.R.S.A. §1848(5)(A).

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