Current through 2024-38, September 18, 2024
4.1
Review
by Department. The department shall review and evaluate the COPA
application in accordance with the standards set forth in these rules. See
22 M.R.S.A.
§1844(4)(A).
4.2
Standard for Approval: Benefits
Outweigh Disadvantages. The department shall issue a certificate for a
cooperative agreement if it determines that the applicants have demonstrated by
a preponderance of the evidence that the likely benefits resulting from the
agreement outweigh any disadvantages attributable to a reduction in competition
likely to result from the cooperative agreement. See
22 M.R.S.A.
§1844(5).
4.3
Potential Benefits Evaluated.
In evaluating the potential benefits of a cooperative agreement, the
department shall consider whether one or more of the following benefits are
likely to result from the cooperative agreement:
4.3.1 Enhancement of the quality of care
provided to citizens of the State;
4.3.2 Preservation of hospitals or other
healthcare providers and related facilities in geographical proximity to the
communities traditionally served by those facilities;
4.3.3 Gains in the cost efficiency of
services provided by the hospitals or other healthcare providers;
4.3.4 Improvements in the utilization of
hospital or other healthcare resources and equipment;
4.3.5 Avoidance of duplication of hospital or
other healthcare resources; and
4.3.6 Continuation or establishment of needed
educational programs for healthcare providers. See
22 M.R.S.A.
§1844(5)(A).
4.4
Potential Disadvantages
Evaluated. The department's evaluation of any disadvantages attributable
to a reduction in competition likely to result from a cooperative agreement may
include, but is not limited to, the following factors:
4.4.1 The extent of any likely adverse impact
on the ability of health maintenance organizations, preferred provider
organizations, managed healthcare service agents or other healthcare payors to
negotiate optimal payment and service arrangements with hospitals or other
healthcare providers;
4.4.2 The
extent of any disadvantages attributable to reduction in competition among
covered entities or other persons furnishing goods or services to, or in
competition with, covered entities that is likely to result directly or
indirectly from the cooperative agreement;
4.4.3 The extent of any likely adverse impact
on patients or clients in the quality, availability and price of healthcare
services;
4.4.4 The extent of any
likely adverse impact on the access of persons enrolled in in-state educational
programs for health professions to existing or future clinical training
programs; and
4.4.5 The
availability of arrangements that are less restrictive to competition and
achieve the same benefits or a more favorable balance of benefits over
disadvantages attributable to any reduction in competition likely to result
from the cooperative agreement. See
22 M.R.S.A.
§1844(5)(B).
4.5
Enforceable
Conditions. The issued certificate may include the following:
4.5.1
Conditions to Ameliorate
Disadvantages. In evaluating a cooperative agreement pursuant to the
standards in Sections 4.4 of these rules, the department shall consider the
extent to which any likely disadvantages may be ameliorated by any reasonably
enforceable conditions (Section 1.8) that the department may include in the
issued certificate to ameliorate any likely disadvantages of the type specified
in Section 4.4 of these rules. See
22 M.R.S.A.
§1844(5)(C)(1).
4.5.2
Conditions to Enhance Benefits.
In evaluating a cooperative agreement, the department shall consider the
extent to which the likely benefits or favorable balance of benefits over
disadvantages may be enhanced by any reasonably enforceable conditions (Section
1.8) that the department may include in the issued certificate if the
additional conditions are proposed by the COPA applicants, designed to achieve
public benefits, which may include but are not limited to the benefits listed
in Section 4.3 of these rules. See
22 M.R.S.A.
§1844(5)(C)(2).
4.5.3
Continuing Supervision Plan.
The department may include a continuing supervision plan in the issued
certificate, in accordance to Section
6 of these rules.
