An Act To Implement Regulatory Reforms and To Address Staffing Issues in Long-term Care Facilities
Maine Legislature, Session 121, LD 1607
Committee: Health and Human Services
Sponsors: COLWELL, MARTIN, KANE, DAGGETT, TURNER
Amends: 22 MRSA §334, 22 MRSA §3

Legislative Document 
No. 1607 
H.P. 1181 
House of Representatives, May 7,2003 
An Act To Implement Regulatory Reforms and To Address Staffing 
Issues in Long-term Care Facilities 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Speaker COLWELL of Gardiner. 
Cosponsored by Senator MARTIN of Aroostook and 
7lJ~ 
1I7.11!p£~ 
MILLICENT M. MacFARLAND 
Clerk 
Representative: KANE of Saco, Senators: President DAGGETT of Kennebec, TURNER of 
Cumberland. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA §334, as enacted by PL 2001, c. 664, §2, is 
amended to read: 
§334. 
Nursing facility projects 
Nursing facility projects that propose to add new nursing 
facility beds to the inventory of nursing facility beds within 
the 
State 
may 
be 
grouped 
for 
competitive 
review 
purposes 
consistent with appropriations made available for that purpose by 
the 
Legislature. 
A 
nursing 
facility 
project 
that 
proposes 
renovation, 
replacement 
or other actions 
that will 
increase 
Medicaid costs may be approved only if appropriations have been 
made by the Legislature expressly for the purpose of meeting 
those costs, except that the department may approve, without a 
prior appropriation for the express purpose, projects to reopen 
beds 
previously 
reserved 
by 
a 
nursing 
facility 
through 
a 
voluntary reduction pursuant to section 333, if the annual total 
of reopened beds approved does not exceed 100. 
Beginning with all applications pending on January L 
2003, 
in 
evaluating 
whether 
a 
project 
will 
increase 
MaineCare 
expenditures for a nursing facility for the purposes of this 
section, the department shall: 
1. 
Sqyare footage. 
Allow gross sguare footage per licensed 
bed of not less 
than 
sguare feet unless 
the 
applicant 
specifies a smaller allowance for the project; and 
2. 
Replacement 
of 
equipment. 
Exclude 
the 
projected 
incremental cost associated with replacement of eguipment. 
Sec. 2. 22 MRS A §I8I2-C, sub-§6-A, as enacted by PL 1995, c. 
670, Pt. B, §1 and affected by Pt. D, §5, is amended to read: 
6-A. 
Shared staffing. 
The department shall permit staff in 
nursing facilities to be shared with other levels of assisted 
living on 
the 
same 
premises 
as 
long as 
there is 
a 
clear, 
documented audit trail and the staffing in the nursing facilities 
remains adequate to meet the needs of residents. 
Staffing to be 
shared may be based on the average number of hours used per week 
or month within the assisted living program. 
In an assisted 
housing program licensed under section 7801 with 2 or more staff 
reguired to be awake and on duty during a night shift, up to 1/2 
of the staff may be shared on an emergency or episodic basis with 
a nursing facility in the same or an adjacent building without 
prior approval from the department. 
Sec.3. 22 MRSA §3I74-I, sub-§4 is enacted to read: 
4. 
Procedures applicable to reassessment. 
The requirements 
of this subsection apply to reassessment required by rule of the 
department when a person has received long-term care services 
after 
assessment 
by 
the 
department 
or 
a 
designee 
of 
the 
department. 
A. 
When 
a 
patient is 
scheduled 
for 
discharge 
from 
a 
hospital, a hospital, registered nurse or licensed practical 
nurse 
may 
perform a 
reassessment using the 
reassessment 
mechanism 
adopted 
by 
the 
department 
for 
reassessment 
purposes 
taking 
into 
account 
prior 
care 
plans 
and 
assessments and the patient's current needs. 
B. 
When a person resides in that person's own home and: 
(1) 
Is financially eligible for services under the 
MaineCare program, the department or a designee of the 
department shall perform the reassessment using the 
reassessment mechanism adopted by the department for 
reassessment purposes: or 
(2) 
Is not financially eligible for services under the 
MaineCare 
program, 
a 
long-term 
care 
facility, 
registered nurse 
or 
licensed practical nurse 
shall 
perform 
the 
reassessment 
using 
the 
reassessment 
mechanism adopted by the department for reassessment 
purposes. 
C. 
Long-term care facilities that are providing services to 
a 
person 
determined to 
be 
eligible 
for 
long-term 
care 
services under the MaineCare or a state-funded program after 
an 
assessment 
or 
reassessment 
under 
this 
section shall 
perform 
ongoing 
quarterly 
evaluation 
of 
that 
person's 
long-term 
care 
needs 
using 
the 
reassessment 
mechanism 
adopted 
by 
the 
department 
for 
reassessment 
purposes. 
Quarterly 
evaluations 
under 
this 
paragraph 
replace 
the 
periodic reassessments required by the department by rule 
prior to the effective date of this paragraph. 
D. 
The department may sample and review records and data on 
reassessments 
under 
this 
subsection 
reported 
by 
each 
long-term care facility to ensure that errors are avoided or 
corrected. 
A facility may be assessed a penalty as provided 
in the 
department's 
rules 
for 
errors 
in completing or 
reporting the results of these reassessments. 
E. 
By January 1, 2004 the department shall adopt rules to 
implement the provisions of this subsection. Rules adopted 
pursuant to this paragraph are routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 4. Training specification. 
By January I, 2004, the State 
Board of Nursing, after consultation with the Department of Human 
Services, shall adopt rules specifying the educational programs 
for training nursing assistants for certification on the Maine 
Registry of Certified Nursing Assistants established under the 
Maine Revised Statutes, Title 22, section 1812-G. 
With regard to 
nursing assistants 
working 
in long-term 
care facilities 
and 
residential care facilities, the rules must establish 2 levels of 
certification for certified nursing assistants. 
The Certified 
Nursing Assistant Level 
I 
must be consistent with the minimum 
requirements under federal regulations and must require at least 
hours of training. 
The Certified Nursing Assistant Level II 
must 
require at least 150 
hours 
of training 
and 
successful 
completion of a training course in a related personal care field 
that is approved by the Department of Human Services, Bureau of 
Elder and Adult Services. 
Rules adopted pursuant to this section 
are routine technical rules as defined in the. Maine Revised 
Statutes, Title 5, chapter 375, subchapter 2-A. 
Sec. 5. Nursing facility administrator rules. 
By January 1, 2004, 
the Nursing Home Administrators Licensing Board shall amend the 
rules 
regarding 
the 
postsecondary 
education 
required 
for 
administrators licensed pursuant to the Maine Revised Statutes, 
Title 32, chapter 2 to provide for the substitution of 5 years or 
more of experience as a director of nursing at a licensed nursing 
facili ty in place of the postsecondary educational requirement. 
Rules adopted pursuant to this section are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 6. 
Report on improvements to nursing facility inspection 
activities. 
The Department of Human Services, in consul tation wi th 
the Maine Health Care Association, the State Board of Nursing and 
the long-term care ombudsman program, shall by January 15, 2004 
present a report to the Joint Standing Committee on Health and 
Human Services on initiatives to improve and simplify the State's 
nursing facility inspection process. 
The report must include 
specific 
recommendations 
and, 
as 
appropriate, 
propose 
draft 
legislation regarding the fOllowing: 
1. 
Paperwork reduction; 
2. 
Elimination of duplication in nursing facility resident 
medication 
reviews 
by 
both registered nurses 
and 
registered 
pharmacists; 
3. 
Guidelines 
and 
limitations 
on 
the 
use 
of 
mandated 
incident reports against providers during the survey process; 
4. 
The use of civil monetary penalties to fund education 
and training programs; 
5. 
Ways to maximize the use of common space in facilities 
that have both residential care and nursing facility residents; 
6. 
Improvements to the existing informal dispute resolution 
process to ensure timeliness and impartiality and to increase the 
proportion of 
disputes 
resolved at the 
state 
level without 
Ii tigation; 
7. 
Fostering 
more 
positive 
and 
productive 
provider-department communications 
and relations and promoting 
department responsiveness to legislative policy directives; and 
8. 
Recommendations 
on 
appropriate 
by 
the parties 
section. 
any 
other 
preparing 
the 
issues 
report 
considered 
under 
this 
Sec. 7. Long-term care assessment rules. 
By January 1, 
2004, 
the Department of Human Services shall amend the rules regarding 
medical assessment for long-term care services reimbursed under 
the MaineCare program as they pertain to assessments for home 
health 
care 
services. 
The 
new 
rules 
must 
streamline 
the 
assessment 
process 
for 
home 
health care 
services, 
eliminate 
unnecessary regulatory burdens and utilize as much as possible 
appropriate assessment mechanisms being used for other purposes 
or programs. 
Rules adopted pursuant to this section are routine 
technical rules as defined in the Maine Revised Statutes, Title 
5, chapter 375, subchapter 2-A. 
Sec. 8. Study and report on revised mechanism for assessing 
cognitive needs. 
The Department of Human Services shall invite the 
Maine Health Care Association, the long-term ombudsman program, 
the Maine Alzheimer's Association and other interested parties to 
form a working group to undertake a study and prepare a report 
for the Joint Standing Committee on Health and Human Services 
evaluating the current criteria and procedures 
for 
assessing 
cognitive abilities and needs of person potentially requiring 
long-term 
health 
care 
services 
for 
purposes 
of 
determining 
eligibility for and coverage of such services. 
As part of its 
report, 
the 
working 
group 
shall 
include its 
recommendations 
regarding 
revision of 
the 
mechanism 
for 
reassessing persons 
receiving long-term care services to address cognitive deficits, 
and include its recommendations regarding the mechanism employed 
to 
determine 
initial 
eligibility 
for 
such 
services. 
The 
Department 
of Human Services shall provide staff and other resources to 
support the completion of the study within existing resources. 
The working group shall submit its report and recommendations by 
January 15, 
2004. 
The Joint Standing Committee on Health and 
Human 
Services may 
report out legislation during the 
Second 
Regular 
Session 
of 
the 
121st 
Legislature 
to 
implement 
the 
recommendations 
of 
the 
working 
group 
for 
rev~s~ons in 
the 
assessment and reassessment mechanisms for persons with cognitive 
needs. 
Sec. 9. Certificate of need rules. 
By 
January 1, 
2004, 
the 
Department 
of 
Human 
Services 
shall 
adopt 
rules 
regarding 
certificate 
of 
need 
applications 
for 
nursing 
facilities 
to 
implement the provisions of the Maine Revised Statutes, Title 22, 
section 334 as amended by this Act. 
Rules adopted pursuant to 
this section are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2-A. 
Sec. 10. Rules. In adopting the rules required by the Maine 
Revised Statutes, Title 22, section 3174-1, 
sUbsection 4, 
the 
Department of Human Services shall reduce the number and extent 
of 
full 
reviews 
of provider 
records 
required prior 
to 
the 
effective date of this Act and modify the annual minimum data set 
review process required prior to the effective date of this Act 
to 
eliminate 
unnecessary 
paperwork 
while 
fulfilling 
the 
objectives of this Act. 
Sec. 11. Effective date. 
This Act takes effect October 15, 2003. 
SUMMARY 
This bill does the following. 
It clarifies shared staffing in multilevel facilities. 
It directs 
the State 
Board 
of 
Nursing 
to 
adopt 
rules 
establishing 2 levels of certified nursing assistants, Certified 
Nursing Assistant Level I and Certified Nursing Assistant Level 
II, 
for 
employment 
in 
long-term 
care 
and 
residential 
care 
facilities. 
It modifies the needs assessment processes for long-term 
care 
services. 
It allows 
reassessments 
to 
be 
performed 
by 
hospital social workers and discharge planners, the Department of 
Human Services or its designee and long-term care facilities. 
It 
modifies 
requirements 
governing 
periodic 
reassessments 
and 
requires 
the 
Department 
of 
Human 
Services 
to 
make 
further 
adjustments to the minimum data set forms and to its assessment 
mechanism. 
It 
requires 
the 
Department 
of 
Human 
Services, 
in 
consultation with the Maine Health Care Association, the State 
Board of Nursing and the long-term care ombudsman program, to 
carry out a study of various reforms to licensing and inspection 
processes and to make recommendations for improvements. 
It modifies the rules governing certificates of need for 
nursing facilities regarding square footage and replacement costs 
for equipment. 
It directs the Nursing Home Administrators Licensing Board 
to adopt rules to allow an applicant for licensure as a nursing 
home 
administrator 
to 
substitute 
nursing 
experience 
for 
postsecondary education. 
It requires amendment of Department of Human Services rules 
regarding assessments as they pertain to long-term care home 
health services. 
It requires the Department of Human Services to 
form 
a 
working group including the Maine Health Care Association, the 
long-term 
care 
ombudsman 
program 
and 
Maine 
Alzheimer's 
Association 
to 
study 
criteria 
and 
procedures 
for 
assessing 
cognitive abilities and needs of persons potentially requiring 
long-term health care services.