An Act To
Maine Legislature, Session 124, LD 1260
Committee Amendment CA_A_H535 (House)
Amends: 22 MRSA §329, 22 MRSA §333-A, 22 MRSA §334-A

COMMITTEE AMENDMENT "A " to H.P. 879, L.D. 1260, Bill, "An Act To 
Amend the Certificate of Need Act of2002 for Nursing Facility Projects" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRSA §329, sub-§6, as enacted by PL 2001, c. 664, §2, is repealed 
and the following enacted in its place: 
6. Nursing facilities. The obligation by a nursing facility, when related to nursing 
services provided by the nursing facility, of any capital expenditures of $51 0,000 or more 
and beginning January 1, 2010, the obligation by a nursing facility, when related to 
nursing services provided by the nursing facility, of any capital expenditures of 
$1,000,000 or more. 
A certificate of need is not required for the following: 
A. A nursing facility converting beds used for the provision of nursing services to 
beds to be used for the provision of residential care services. If such a conversion 
occurs, MaineCare and other public funds may not be obligated for payment of 
services provided in the converted beds unless approved by the department pursuant 
to the provisions of sections 333-A and 334-A; 
B. Capital expenditures in the case of a natural disaster, major accident or equipment 
failure; 
C. 
Replacement equipment, other than major medical equipment as defined III 
section 328, subsection 16; and 
D. Infonnation systems, communication systems, parking lots and garages. 
Sec. 2. 
MRSA §333-A, sub-§l, as enacted by PL 2007, c. 440, § 11, IS 
amended to read: 
1. 
Nursing facility MaineCare funding pool. 
Savings Except as set forth in 
subsection 3 and section 334-A, savings to the MaineCare program as a result of 
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COMMITTEE AMENDMENT ,A" to H.P. 879, L.D. 1260 
delicensing of nursing facility beds on or after July 1, 2005, including savings from 
lapsed beds but excluding savings from reserved beds, must be credited to the nursing 
facility MaineCare funding pool, which must be maintained by the department to provide 
for the development of new beds or other improvements requiring a certificate of need. 
The balance of the nursing facility MaineCare funding pool, as adjusted to reflect current 
costs consistent with the rules and statutes governing reimbursement of nursing facilities, 
serves as a limit on the MaineCare share of all incremental 3rd-year operating costs of 
nursing facility projects requiring review under this chapter, except as set forth in 
subsection 3 and section 334-A. subsection 2. 
Sec. 3. 22 MRSA §334-A, sub-§l, as enacted by PL 2007, c. 440, §13, is 
repealed and the following enacted in its place: 
1. 
Projects that expand current bed capacity. 
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 funds available 
from the nursing facility MaineCare funding pool. Such projects may not be grouped for 
competitive review if approved under paragraph B or C. A nursing facility project that 
proposes to add new beds is subject to review. Any related renovation, replacement or 
other actions may also be subject to review if such actions are above the applicable 
thresholds for review. Such projects may be approved only if: 
A. Sufficient funds are available from the nursing facility MaineCare funding pool or 
are added to the pool by an act of the Legislature, except that the department may 
approve, without available funds from the pool, 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; 
B. The petitioner, or one or more nursing facilities under· common ownership or 
control, has agreed to delicense a sufficient number of beds from the total number of 
currently licensed or reserved beds, or is otherwise reconfiguring its operations, so 
that the MaineCare savings associated with such actions are sufficient to fully offset 
any incremental MaineCare costs that would otherwise arise from implementation of 
the certificate of need project and, as a result, there are no net incremental MaineCare 
costs arising from implementation of the certificate of need project; or 
C. The petitioner, or one or more nursing facilities under common ownership or 
control, has acquired bed rights from another nursing facility or facilities that agree to 
delicense beds or that are ceasing operations or otherwise reconfiguring their 
operations, and that the MaineCare revenues associated with these acquired bed 
rights and related actions are sufficient to cover the additional requested MaineCare 
costs associated with the project. 
Certificate of need projects described in this subsection are not subject to or limited by 
the nursing facility MaineCare funding pool. 
Sec. 4. 
MRSA §334-A, sub-§2, as enacted by PL 2007, c. 440, §13, is 
amended to read: 
2. Projects to relocate beds. Nursing facility projects that do not add new nursing 
facility beds to the inventory of nursing facility beds within the State, but instead propose 
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COMMITTEE AMENDMENT ·A "to H.P. 879, L.D. 1260 
to relocate beds from one facility to another or more nursing facilities to one or more 
existing or new facility nursing facilities: 
A. May also propose renovation, replacement or other actions requiring certificate of 
need review; and 
B. May be approved by the department upon a showing by the petitioner that the 
petitioner has acquired bed rights from another nursing facility or facilities that agree 
to delicense beds, or that are ceasing operations or otherwise reconfiguring their 
operations, and that the MaineCare revenues associated with these acquired bed 
rights and related actions are sufficient to cover the additional requested MaineCare 
costs associated with the project. 
Certificate of need projects described in this subsection are not subject to or limited by 
the nursing facility MaineCare funding pool. 
Sec. 5. 22 MRSA §334-A sub-§2-A is enacted to read: 
2-A. Other types of certificate of need projects. Other types of nursing facility 
projects that do not add new nursing facility beds to the inventory of nursing facility beds 
within the State and do not propose to relocate beds from one facility to another existing 
or new facility and that propose any renovation, replacement or other actions requiring 
certificate of need review, such as capital expenditures for equipment and renovations 
that are above applicable thresholds, or that propose actions that do not require a 
certificate of need, such as the addition of residential care beds to be funded by the 
MaineCare program, may be approved by the department upon a showing that: 
A. The petitioner, or one or more nursing facilities· under common ownership or 
control, has agreed to delicense a sufficient number of beds from the total number of 
currently licensed or reserved beds, or is otherwise reconfiguring its operations, so 
that the MaineCare savings associated with such actions are sufficient to fully offset 
any incremental MaineCare costs that would otherwise arise from implementation of 
the certificate of need project and, as a result, there are no net incremental MaineCare 
costs arising from implementation of the certificate of need project; or 
B. The petitioner, or one or more nursing facilities under common ownership or 
control, has acquired bed rights from another nursing facility or facilities that agree to 
delicense beds or that are ceasing operations or otherwise reconfiguring their 
operations, and that the MaineCare revenues associated with these acquired bed 
rights and related actions are sufficient to cover the additional requested MaineCare 
costs associated with the project. 
Certificate of need projects described in this subsection are not subject to or limited by 
the nursing facility MaineCare funding pool. 
Sec. 
6. 
Review of flexibility 
in MaineCare budget neutrality 
requirements. 
The Department of Health and Human Services shall work with 
stakeholders to identify possible methods for creating more flexibility in the laws 
governing nursing facility projects that are subject to MaineCare budget neutrality 
requirements, including, but not limited to, the conversion of nursing facility beds to 
residential care facility beds, transfers between nursing facilities and residential care 
facilities and transfers of ownership. In conducting this review the department shall 
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COMMITTEE AMENDMENT·A "to H.P. 879, L.D. 1260 
consider the available data and information on the adequacy of existing nursing facilities, 
residential care facilities and long-term care facilities. 
The department shall report 
recommendations, including any necessary legislation, to the Joint Standing Committee 
on Health and Human Services no later than February 15, 2010. The Joint Standing 
Committee on Health and Human Services is authorized to submit legislation related to 
the recommendations to the Second Regular Session of the 124th Legislature.' 
SUMMARY 
This amendment replaces the bill and amends the Certificate of Need Act of 2002. 
Beginning January 1, 2010, it increases the threshold amount for nursing facility projects 
to $1,000,000. It exempts from the full certificate of need approval certain nursing 
facility projects including capital expenditures under limited circumstances, nonmedical 
replacement equipment, information systems, communication systems, parking lots and 
garages. 
It changes the nursing facility MaineCare funding pool to create certain 
exceptions to the constraints of the pool. It permits certificate of need approval of 
different types of nursing facility projects as long as MaineCare neutrality is 
demonstrated. It permits nursing facilities to satisfy MaineCare neutrality requirements 
for projects that do not involve relocation of beds from one facility to another or a new 
facility when the entity proposing the changes is able to satisfy MaineCare neutrality 
requirements by delicensing beds under common ownership or acquiring beds from other 
nursing facilities. It charges the Department of Health and Human Services with working 
with stakeholders to identify possible methods for creating more flexibility in the laws 
governing nursing facility projects that are subject to MaineCare budget neutrality 
requirements. 
FISCAL ;\OTE RE0LlRED 
(See attached) 
COMMITTEE AMENDMENT 
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Approved: 06/03/09 
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LD 1260 
LR 1508(02) 
An Act To Amend the Certificate of Need Act of 2002 for Nursing Facility Projects 
Fiscal Note for Bill as Amended by Committee Amendment 14 " 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Potential current biennium cost increase - General Fund 
Fiscal Detail and Notes 
The bill's provisions increasing the certificate of need threshold for nursing facility projects and increasing the nursing 
facility projects and capital expenditures that are exempt from certificate of need could increase MaineCare nursing 
facility costs because additional costs would not be subject to the certificate of need MaineCare cost neutrality 
requirements. The number and costs of the additional projects and expenditures cannot be determined at this time. 
PL 2009, c. 213 (the 2010-2011 Biennial Budget) deappropriated $300,000 in each of 2009-10 and 2010-11 in 
baseline funding that would have been available in the nursing facility MaineCare funding pool intended for the 
development of new beds or other improvements requiring certificate of need. 
LR1508(02) - Fiscal Note - Page 1 of 1