An Act To Provide an Alternative Method of Calculating Minimum Staffing Levels in Nursing Homes
Maine Legislature, Session 125, LD 1700
Committee: Health and Human Services
Sponsors: STRANG BURGESS, McCORMICK, EVES, FOSSEL, O'CONNOR, SANBORN, SANDERSON, SIROCKI, CRAVEN, FARNHAM
Amends: 22 MRSA §1812-C

Legislative Document 
No. 1700 
H.P. 1252 
House of Representatives, December 23, 2011 
An Act To Provide an Alternative Method of Calculating Minimum 
Staffing Levels in Nursing Homes 
(EMERGENCY) 
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
203. 
Received by the Clerk of the House on December 21, 2011.  Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401. 
HEATHER J.R. PRIEST 
Clerk 
Presented by Representative STRANG BURGESS of Cumberland. 
Cosponsored by Senator McCORMICK of Kennebec and 
Representatives: EVES of North Berwick, FOSSEL of Alna, O'CONNOR of Berwick, 
SANBORN of Gorham, SANDERSON of Chelsea, SIROCKI of Scarborough, Senators: 
CRAVEN of Androscoggin, FARNHAM of Penobscot. 
Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, nursing facilities are required by applicable rules to provide adequate staff 
to meet residents' needs at all times and are subject to effective sanctions to ensure that 
such staffing is provided continuously; and 
Whereas, in addition to the requirement of staffing to meet needs, the current rules 
of the Department of Health and Human Services require fixed ratios of staff to residents, 
specific to each of 3 8-hour shifts per day; and 
Whereas, these fixed-ratio requirements do not ensure quality care but may impose 
arbitrary staffing costs on facilities at times when such staffing is not required to meet 
needs, even though, over a 24-hour period, more than these minimum ratios may be 
maintained in order to meet all residents' needs; and 
Whereas, the fixed-ratio requirements specific to each shift may therefore impose 
unnecessary costs on facilities and thus on the MaineCare program, while placing 
unnecessary stress on the limited supply of qualified nursing staff and thereby 
inadvertently creating barriers to high-quality service at other times of day when more 
staff may be desirable; 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 §1812-C, sub-§6, as enacted by PL 1987, c. 195, §2, is 
repealed and the following enacted in its place: 
6.  Rules; maintenance of approved staffing pattern.  The department shall adopt 
rules governing staffing patterns in accordance with this subsection. 
A.  The department shall revise its rules or adopt rules to require documentation when 
any nursing facility receives reimbursement for an approved staffing pattern that 
exceeds the minimum staffing level and fails to meet that approved staffing level for 
one year.  
B.  Rules adopted by the department governing licensing and functioning of nursing 
facilities may not contain minimum numerical staffing requirements that are specific 
to each 8-hour shift but may specify numerical ratios on the basis of average direct 
care hours per resident in a 24-hour period or greater. The department may adopt 
additional rules other than rules imposing numerical ratios as needed to encourage 
person-centered care, increase quality and improve efficiency while requiring that at 
all times of the day staffing remains adequate to meet residents' needs. In adopting 
rules to implement this paragraph, the department may consider and modify as 
appropriate the definitions of direct care hours and other variables relevant to 
computing practical, meaningful staffing standards. Rules adopted or amended 
pursuant to this paragraph are major substantive rules as defined in Title 5, chapter 
375, subchapter 2-A. 
Failure to meet the minimum staffing requirements as set forth in department rules 
governing the licensure of nursing facilities is cause for licensure sanctions permitted 
under law and rules. 
Sec. 2.  PL 1999, c. 731, Pt. BBBB, §11 is repealed. 
Sec. 3.  Stakeholder working group.  As soon as practicable following the 
effective date of this Act, the Department of Health and Human Services shall convene a 
working group to formulate recommended amendments to its rules to comply with the 
requirements of the Maine Revised Statutes, Title 22, section 1812-C, subsection 6, 
paragraph B. The department shall invite the participation of the Maine Long-Term Care 
Ombudsman Program, the Maine Health Care Association, LeadingAge of Maine and 
New Hampshire, the Alzheimer's Association, Maine Chapter and other interested 
stakeholders identified by the department. The department shall provide staffing 
assistance to the working group using existing resources and shall assist the working 
group in completing its analysis and recommendations within 90 days of the working 
group's first convening. The department shall issue proposed rules to comply with Title 
22, section 1812-C, subsection 6, paragraph B that are consistent with the 
recommendations of the working group within 30 days following the issuance of those 
recommendations. 
Emergency clause.  In view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
SUMMARY 
Currently, nursing home staffing ratios are calculated based on individual 8-hour 
shifts. This bill requires the Department of Health and Human Services to develop 
alternative staffing ratios that encourage person-centered care, increase quality and 
improve efficiency by developing a standard calculated over a 24-hour period. Nursing 
homes would still ultimately be required to staff according to residents' needs. 
The bill directs the department to convene a working group to develop such a 
standard and to invite the participation of representatives of the Maine Long-Term Care 
Ombudsman Program, the Maine Health Care Association, LeadingAge of Maine and 
New Hampshire, the Alzheimer's Association, Maine Chapter and other interested 
stakeholders. The bill provides that amendments to the licensing rules are major 
substantive rules.