An Act to Implement Regulatory Reform and To Address Staffing Issues in Long-term Care Facilities LR0505(02)
Maine Legislature, Session 121, LD 1607
Committee Amendment CA_A_H525 (House)
Amends: 22 MRSA §334, 22 MRSA §1812-C

COMMITTEE AMENDMENT "/1,, to H.P. 
Act 
To 
Implement Regulatory Reforms 
Issues in Long-term Care Facilities" 
1181, L.D. 1607, Bill, "An 
and 
To 
Address Staffing 
Amend the bill by striking out everything after the title 
and before the summary and inserting in its place the following: 
'Emergency preamble. Whereas, Acts of the Legislature do not 
become effective until 90 days after adjournment unless enacted 
as emergencies: and 
Whereas, long-term 
care facilities 
and 
programs 
operate 
within a highly regulated system that inflates the cost of care 
for elderly and disabled persons: and 
Whereas, implementation of regulatory reform and staffing 
changes in long-term care facilities will provide regulatory 
relief beginning immediately upon implementation: and 
Whereas, in the judgment of the Legislature, these facts 
create an emergency within the meaning of the Constitution of 
Maine 
and 
require 
the 
following 
legislation 
as 
immediately 
necessary for the preservation of the public peace, health and 
safety: now, therefore, 
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. 
Nursinq facility projects 
Nursing facility projects that propose to add new nursing 
facility beds to the inventory of nursing facility beds within 
Page l-LR0505(2) 
COMMITTEE AMENDMENT 
c. 
~. 
~. 
COMMITTEE AMENDMENT .. -If. to H.P. 1181, L.D. 1607 
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 1, 2003, 
in 
evaluating 
whether 
a 
project 
will 
increase 
MaineCare 
expendi tures for a nursing facility for the purposes of this 
section, the department shall: 
1. 
Sgyare footage. 
Allow gross square footage per licensed 
bed of not less than 500 
square 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 equipment. 
Sec. 2. 22 MRSA §1812-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 eeB.e£-~],.s...-e;E facilities 
licensed to provide assisted living eB-eB.e-6ame-~£em46e6 services 
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 a 
facility licensed to provide 
assisted living services under section 7801 in which 2 or more 
staff are required to be awake and on duty during a night shift, 
one of the staff may be shared with a nursing facility located in 
the same building without prior approval from the department, 
subject to the following provisions. 
A. 
Prior notice must be given to the department. 
B. 
The assisted living program shall maintain its state 
minimum 
staffing ratio, 
and 
the 
nursing facility shall 
maintain its state minimum staffing ratio and its federal 
licensed nurse staffing requirement. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT 'il' to H,P. 1181, L.D. 1607 
C. 
The assisted housing program and the nursing facility 
shall each post a notice informing the public that, although 
staffing is shared on the night shift, compliance with the 
minimum staffing reguirements is maintained. 
D. 
The department may suspend the facility's ability to 
share staffing under this subsection if the most recent 
survey for either level of care indicates deficiencies that 
are related to resident care and that arise from the sharing 
of staff. 
Sec. 3. Review of long-term care assessment system. 
The long-term 
care ombudsman program shall initiate a review of the long-term 
care assessment system being used in this State and shall submit 
a report with recommendations to the Joint Standing Committee on 
Health and Human Services by January 15, 2004. 
In conducting the 
review, the long-term care ombudsman program shall consult with 
consumers, 
consumer 
advocates, 
providers 
of 
home-based 
and 
community-based care, providers of facility-based care and the 
Department 
of 
Human 
Services. 
The 
study 
must 
consider 
assessments and reassessments, the living and care arrangements 
of the consumer at the time of the assessment and whether the 
consumer 
intends to pay privately or 
through 
an assistance 
program. 
The 
Joint Standing Committee 
on Health 
and 
Human 
Services may submit legislation to the Second Regular Session of 
the 121st Legislature regarding the long-term care assessment 
system. 
Sec. 4. Study of educational requirements for certified nursing 
assistants. 
The State Board of Nursing shall study educational 
requirements for training certified nursing assistants and shall 
submit a report with recommendations by January 15, 2004 to the 
Joint Standing 
Committee 
on Health 
and 
Human 
Services. 
In 
performing the study, the State Board of Nursing shall consider 
appropriate 
levels of training and 
the various health care 
settings in which certified nursing assistants work. 
The Joint 
Standing 
Committee 
on Health 
and 
Human 
Services 
may 
submit 
legislation on the educational requirements for certified nursing 
assistants 
to 
the 
Second 
Regular 
Session 
of 
the 
121st 
Legislature. 
Sec. 5. 
Study of educational requirements for nursing home 
administrators. 
The Nursing Home Administrators Licensing Board 
shall 
study 
the 
educational 
requirements 
for 
nursing 
home 
administrators and shall submit a report with recommendations by 
January 15, 2004 to the Joint Standing Committee on Health and 
Human 
Services. 
In performing the 
study, 
the Nursing 
Home 
Administrators Licensing Board shall consider appropriate levels 
of 
postsecondary 
education 
and 
experience, 
including 
the 
substitution of 
relevant experience for 
some portion of the 
educational requirements. 
The Joint Standing Committee on Health 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .. A 
.. to H.P. 1181, L.D. 1607 
and Human Services may submit legislation on 
requirements 
for 
nursing 
home 
administrators 
Regular Session of the 121st Legislature. 
the educational 
to 
the 
Second 
Sec. 6. 
Report on improvements to nursing facility inspection 
activities. 
The Department of Human Services, in consultation with 
the Maine Health Care Association, the State Board of Nursing, a 
statewide organization providing legal services to older persons, 
a 
statewide 
organization 
providing 
information 
and 
advocacy 
services for older persons 
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. 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 care 
ombudsman 
program, the Maine Alzheimer's Association and other interested 
parties to form a working group to undertake a study and prepare 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,,~, to H.P. 1181, L.D. 1607 
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 persons potentially 
requ~r~ng long-term health care services for the purposes of 
determining eligibility for and coverage of such services. 
As 
part 
of 
its 
report, 
the 
working 
group 
shall 
include 
its 
recommendations 
regarding 
rev~s~on 
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 reS01:1.rces. 
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 revisions 
in the assessment and reassessment mechanisms for persons with 
cognitive needs. 
Emergency clause. 
In view of the emergency cited in the 
preamble, this Act takes effect when approved.' 
SUMMARY 
This amendment is the majority report of the committee. 
It 
amends 
the 
shared 
staffing 
provision 
of 
law, 
directs 
the 
long-term 
care 
ombudsman 
program 
to 
study. 
long-term 
care 
eligibility assessments 
and 
reassessments, 
directs 
the State 
Board 
of Nursing to 
study the educational 
requirements 
for 
certified 
nursing 
assistants 
and 
directs 
the 
Nursing 
Home 
Administrators Licensing Board to study the requirements 
for 
nursing home administrators. 
The amendment adds members to the 
group of interested parties who will 
review improvements 
to 
nursing facility inspection activities, deletes the amendment of 
rules on long-term care assessments pertaining to home health 
care services proposed in the bill and retains the study of 
assessments for cognitive needs. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 05120/03 ;tpac:.. 
Office of Fiscal and Program Review 
LD 1607 
An Act to Implement Regulatory Reform and To Address Staffing Issues 
in Long-term Care Facilities 
LR0505(02) 
Fiscal Note for Bill as Amended by Committee Amendment" " 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor cost increase - Other Special Revenue Funds 
Any additional costs to the Board of Nursing and the Nursing Home Administrators Board within the Department (' 
Professional and Financial Regulation to conduct the required studies can be absorbed utilizing existing budgeted 
resources. Any additional cost to the Department of Human Services can be absorbed utilizing existing resources. 
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