An Act To Amend the Maine Certificate of Need Act of 2002 An Act To
Maine Legislature, Session 125, LD 0360
Committee Amendment CA_B_H626 (House)
Amends: 22 MRSA §328, 22 MRSA §329, 22 MRSA §333, 22 MRSA §333-A, 22 MRSA §334-A, 22 MRSA §335, 22 MRSA §337, 22 MRSA §339

COMMITTEE AMENDMENT .;3" to H.P. 286, L.D. 360, Bill, 
Repeal the Maine Certificate of Need Act of2002" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Amend the Maine Certificate of Need Act of 2002' 
"An Act To 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'PART A 
Sec. A-I. 22 MRSA §328, sub-§16, as amended by PL 2009, c. 383, §3, is 
further amended to read: 
16. Major medical equipment. "Major medical equipment" means a single unit of 
medical equipment or a single system of components with related functions used to 
provide medical and other health services that costs $1,600,000 $3,200,000 or more. 
"Major medical equipment" does not include medical equipment acquired by or on behalf 
of a clinical laboratory to provide clinical laboratory services if the clinical laboratory is 
independent of a physician's office and a hospital and has been determined to meet the 
requirements of the United States Social Security Act, Title XVIII, Section 1861(s), 
paragraphs 10 and II. In determining whether medical equipment costs more than the 
threshold provided in this subsection, the cost of studies, surveys, designs, plans, working 
drawings, specifications and other activities essential to acquiring the equipment must be 
included. If the equipment is acquired for less than fair market value, the term "cost" 
includes the fair market value. Beginning January 1, 2013 and annually thereafter, the 
threshold amount for review must be updated by the commissioner to reflect the change 
in the United States Department of Labor, Bureau of Labor Statistics Consumer Price 
Index medical care services index, with an effective date of January 1st each year. 
Sec. A-2. 22 MRSA §328, sub-§17-A, as amended by PL 2009, c. 383, §4, is 
further amended to read: 
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to H.P. 286, L.D. 360 
17-A. New health service. "New health service" means: 
A. The obligation of any capital expenditures by or on behalf of a new or existing 
health care facility of $110,000 $1,000,000 or more that is associated with the 
addition of a health service that was not offered on a regular basis by or on behalf of 
the health care facility within the I2-month period prior to the time the services 
would be offered; 
B. The addition of a health service that is to be offered by or on behalf of a new or 
existing health care facility that was not offered on a regular basis by or on behalf of 
the health care facility within the I2-month period prior to the time the services 
would be offered and that, for the 3rd fiscal year of operation, including a partial first 
year following addition of that service, is projected to entail incremental annual 
operating costs directly attributable to the addition of that health service of at least 
$400,000 $1,000,000. 
For the purposes of this paragraph, the compensation 
attributable to the health care practitioner is not included in the calculation of 3rd-
year operating costs; or 
C. The addition in the private office of a health care practitioner, as defined in Title 
24, section 2502, subsection I-A, of new technology that costs $1,600,000 
$3,200,000 or more. The department shall consult with the Maine Quality Forum 
Advisory Council established pursuant to Title 24-A, section 6952, prior to 
determining whether a project qualifies as a new technology in the office of a private 
practitioner. With regard to the private office of a health care practitioner, "new 
health service" does not include the location of a new practitioner in a geographic 
area. 
Beginning January 1, 2013 and annually thereafter, the threshold amounts for review in 
paragraphs A, Band C must be updated by the commissioner to reflect the change in the 
United States Department of Labor, Bureau of Labor Statistics Consumer Price Index 
medical care services index, with an effective date of January 1st each year. 
"New health service" does not include a health care facility that extends a current service 
within the defined primary service area of the health care facility by purchasing within a 
12-month time period new equipment costing in the aggregate less than the threshold 
provided in section 328, subsection 16; 
Sec. A-3. 22 MRSA §329, sub-§2-A, ~, as amended by PL 2009, c. 383, §5, is 
further amended to read: 
B. 
The following acquisitions of major medical equipment do not require a 
certificate of need: 
(1) 
Major medical equipment being replaced by the owner, as long as tHe 
replaeemeat 60st is less thea $2,000,000; and 
(2) The use of major medical equipment on a temporary basis in the case of a 
natural disaster, major accident or major medical equipment failure. 
Sec. A-4. 22 MRSA §329, sub-§3, as amended by PL 2009, c. 383, §6 and 
affected by § 16, is further amended to read: 
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3. Capital expenditures. Except as provided in subsection 6, the obligation by or 
on behalf of a new or existing health care facility of any capital expenditure of 
$3,lQQ,QQQ $10,000,000 or more. Capital expenditures in the case of a natural disaster, 
major accident or equipment failure or for replacement equipment that is not major 
medical equipment as defined in section 328, subsection 16 or for parking lots and 
garages, information and communications systems or physician office space or projects 
directed solely at reducing energy costs through energy efficiency, renewable energy 
technology or smart grid technology and that have been certified as likely to be 
cost-effective by the Efficiency Maine Trust pursuant to Title 35-A, section 10122 do not 
require a certificate of need. Beginning January 1, 2013 and annually thereafter, the 
threshold amount for review must be updated by the commissioner to reflect the change 
in the United States Department of Labor, Bureau of Labor Statistics Consumer Price 
Index medical care services index, with an effective date of January 1st each year; 
Sec. A-S. 22 MRSA §329, sub-§4-A, as enacted by PL 2007, c. 440, §4, is 
amended to read: 
4-A. 
New health care facility. 
The construction, development or other 
establishment of a new health care facility. 
The following requirements apply to 
certificate of need for new health care facilities. 
A. A new health care facility that is a nursing facility must obtain a certificate of 
need: 
(1) Ifit requires a capital expenditure of more than $5,000,000; or 
(2) If it proposes to add new nursing facility beds to the inventory of nursing 
facility beds within the State, in which case it must satisfy all applicable 
requirements of section 334-A. 
B. A new health care facility other than a nursing facility must obtain a certificate of 
need: 
. (1) If it requires a capital expenditure of more than $10,000,000; or 
(2) If it is a new health service; 
Sec. A-6. 3S-A MRSA §10122 is enacted to read: 
§10122. Health care facility program 
The trust shall develop and implement a process to review projects undertaken by 
health care facilities that are directed solely at reducing energy costs through energy 
efficiency, renewable energy technology or smart grid technology and to certifY those 
projects that are likely to be cost-effective. If a project is certified as likely to be 
cost-effective by the trust. the review process serves as an alternative to the certificate of 
need process established pursuant to Title 22, section 329, subsection 3. 
PARTB 
Sec. B-1. 22 MRSA §329, sub-§6, as repealed and replaced by PL 2009, c. 652, 
Pt. A, §29, is amended to read: 
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COMMITTEE AMENDMENT~" to H.P. 286, L.D. 360 
6. Nursing facilities. The obligation by a new or existing nursing facility, when 
related to nursing services provided by the nursing facility, of any capital expenditures of 
$5H),QQQ $5,000,000 or more and, heginning January I, 2QIQ, the ehligatien hy a nursing 
facility, v.'h6H related te RUfsing senrices pre>fiaea by the Rursing faeility, ef any capital 
eXfJenaitures ef$I,QQQ,QQQ er ffiere. Beginning January 1. 2013 and annually thereafter, 
the threshold amount for review must be updated by the commissioner to reflect the 
change in the United States Department of Labor. Bureau of Labor Statistics Consumer 
Price Index medical care services index, with an effective date of January 1st each year. 
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 in 
section 328, subsection 16; 
D. Information systems, communication systems, parking lots and garages; and 
E. Certain energy-efficient improvements, as described in section 334-A, subsection 
4. 
Sec. B-2. 22 MRSA §333, sub-§l, ~A-l, as enacted by PL 2007, c. 440, §8, is 
amended to read: 
A-I. Beginning with anniversary dates occurring after July 1, 2007, annually provide 
notice to the department no later than 30 days after the anniversary date of the 
effective date of the license reduction of the nursing facility's intent to retain these 
reserved beds, subjeet te the time liffiitatiens set furth in suhseetien 2, paragraph B; 
and 
Sec. B-3. 22 MRSA §333, sub-§l, ~, as enacted by PL 2001, c. 664, §2, is 
amended to read: 
B. Obtain a certificate of need to convert beds back under section 335, except that, if 
no construction is required for the conversion of beds back, the application must be 
processed in accordance with subsection 2. 
The department in its review shall 
evaluate the impact that the nursing facility beds to be converted back would have on 
those existing nursing facility beds and facilities within 30 miles of the applicant's 
facility and shall determine whether to approve the request based on current 
certificate of need criteria and methodology. 
Sec. B-4. 22 MRSA§333, sub-§2, ~, as amended by PL 2007, c. 440, §9, is 
further amended to read: 
B. CeRversien ef heds hask under this sectien must he requested within 4 years ef 
the effeotive date ef the IiceRse reduetieR. If the nursing facility fails to provide the 
annual notices required by subsection 1, paragraph B, the nursing facility's ability to 
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COMMITTEE AMENDMENT:B" to H.P. 286, L.D. 360 
convert beds back under this section lapses, and the beds must be treated as lapsed 
beds for purposes of this section and sections 333-A and 334-A. 
Sec. B-S. 22 MRSA §333-A, sub-§I, as amended by PL 2009, c. 429, §2, is 
further amended to read: 
1. Nursing facility MaineCare funding pool. Except as set forth in subsection ~ 
3-A and section 334-A, savings to the MaineCare program as a result of 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. +he For 
those nursing facility projects that propose to add new nursing facility beds to the 
inventory of beds within the State, 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 RW'sing faeility such projects FeqHiring revie'", 
tmder this ehapter, e~{6ept as set forth in stlbseetion 3 and unless such projects are 
approved under applicable provisions of section 334-A. Nursing facility projects that do 
not add new nursing facility beds to the inventory of beds within the State are not subject 
to the nursing facility MaineCare funding pool. 
Sec. B-6. 22 MRS A §333-A, sub-§2, as amended by PL 2007, c. 681, §4, is 
further amended to read: 
2. Procedure. The balance of the nursing facility MaineCare funding pool must be 
used for development of additional nursing facility beds in areas of the State where 
additional beds are needed to meet the community need. The department must assess 
needs throughout the State and issue requests for proposals for the development of 
additional beds in areas where need has been identified by the department, except in the 
event of an emergency, when the department may use a sole source process. Proposals 
must be evaluated based on consideration of quality of care and cost, and preference must 
be given to existing nursing facilities in the identified need area that may increase 
licensed capacity by adding on to or renovating the existing facility. Prejeets that exeeed 
the re:'1iev.' thresholds require a eertifieate of need, but no additional assessment of need 
will be 60ndtleted as part of that proeess. Exeept as set forth in seetion 334 A, stlbseetion 
2, a prejeet reqtliring eertifieate of need approval may not inerease MaineCare eosts 
beyond the total a-moUHt appropriated for nursing faeility eare plus the a .... ailable balanee 
of the ntlFSiBg faeility MaineGare funding pool. 
Sec. B-7. 22 MRSA §333-A, sub-§3, as amended by PL 2011, c. 90, Pt. J, §4, is 
repealed. 
Sec. B-8. 22 MRS A §333-A, sub-§3-A is enacted to read: 
3-A. Transfers between nursing facility and residential care facility. A nursing 
facility may delicense and sell or transfer beds to a residential care facility for the purpose 
ofperrnitting the residential care facility to add MaineCare-funded beds to meet identified 
needs for such ,beds. Such a transfer does not require a certificate of need but is subj ect to 
prior approval of the department on an expedited basis. When the average then current 
occupancy rate for existing state-funded residential care beds within 30 miles of the 
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COMMITTEE AMENDMEN::8" to H.P. 286, L.D. 360 
applicant facility is 80% or less, the department in its review under section 335 shall 
evaluate the impact that the proposed additional state-funded residential care beds would 
have on these existing state-funded residential care beds and facilities. 
Beds and 
MaineCare resources transferred pursuant to this subsection are not subject to the nursing 
facility MaineCare funding pool. 
Sec. B-9. 22 MRSA §334-A, sub-§l, as repealed and replaced by PL 2009, c. 
429, §3, is repealed. 
Sec. B-IO. 22 MRSA §334-A, sub-§l-A is enacted to read: 
I-A. 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 considered under either of the following 2 options: 
A. These projects may be grouped for competitive review purposes consistent with 
funds available from the nursing facility MaineCare funding pool and may be 
approved if 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; or 
B. Petitioners proposing such projects may elect not to participate in a competitive 
review under paragraph A and the projects may be approved if: 
(1) The petitioner. or one or more nursing facilities or residential care facilities 
or combinations thereof 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 the operations of such facilities. 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 
(2) The petitioner, or one or· more nursing facilities or residential care facilities 
or combinations thereof under common ownership or control, has acquired bed 
rights from another nursing facility or facilities or residential care facility or 
facilities or combinations thereof that agree to delicense beds or that are ceasing 
operations or otherwise reconfiguring their operations, and 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. 
With respect to the option described in this paragraph. when the average then current 
occupancy rate for existing nursing facility beds at facilities within 30 miles of the 
applicant facility exceeds 85%. the department in its review under section 335 shall 
evaluate the impact that the proposed additional nursing facility beds would have on 
those existing nursing facility beds and facilities and shall determine whether to 
approve the request based on current certificate of need criteria and methodology. 
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COMMITTEE AMENDMEN&" to H.P. 286, L.D. 360 
Certificate of need projects described in this paragraph are not subject to or limited 
by the nursing facility MaineCare funding pool. 
Sec. B-ll. 22 MRSA §334-A, sub-§2,~, as amended by PL 2009, c. 429, §4, 
is further amended to read: 
B. May be approved by the department upon a showing by the petitioner that the 
fletitioRer has aCqMired eed rights froFR aBother Rl:H'siRg facility or facilities that agree 
to delieeRse eeds, or that are eeasiRg ofleratioRs or otherwise recoRfigtHiRg their 
ofleratioRs, aBd that the MaiReCare re .. 'eRues associated '.vith these acquired eed 
rights aBd related aetioRs are suffieieRt to coyer the additioRal reqMested MaiReCare 
eosts assoeiated '.vith the project fulfills all pertinent requirements and the review 
criteria set forth in section 335. 
Sec. B-12. 22 MRSA §334-A, sub-§2-A, as enacted by PL 2009, c. 429, §5, is 
amended 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, transfer of ownership or 
other actions requiring certificate of need review, such as capital expenditures for 
equipment and renovations that are above applicable thresholds, or that prepose actioRs 
that do Rot require a certificate of Reed, such as the additioR of resideRtial eare beds to be 
fuRded by the MaiReCare flrogram, may be approved by the department upon a showing 
that" the project fulfills all pertinent requirements and the review criteria set forth in 
section 335. 
A. The petitioRer, or one or FRore Rl:H'siRg facilities uRder commOR oVlilershifl or 
coRtrol, has agreed to delicease a suffieieat ftUIllber of beds from the total RUFReer of 
curreatly lieeRsed or reserved beds, or is otherwise reeoRfigt:lriRg its ofleratioRs, so 
that the MaiReCare SaYiRgs associated with sueh actioRs are suffieieat to fully offset 
any iRcremeRtal MaiReCare costs that would otherwise arise from iFRfllemeRtatioR of 
ilie certificate of Reed project aBd, as a result, there are RO Ret iRcremeRtal MaiReCare 
costs arisiRg from iFRfllemerrtatioR of the certificate of Reed project; or 
B. The petitioRer, or one or more Hl:H'sing facilities uRder commOR oVlilershifl or 
cORtrol, has aCqMired bed rights from aRother Hl:H'sing facility or facilities that agree to 
deliceRse beds or that are ceasiRg operatioRs or otherwise recoRfiguriRg their 
operatioRs, and that the MaiReCare reyenues associated with these acquired bed 
rights aBd related actioRs are suffieieRt to eover the additioRal requested MaiReCare 
costs associated with the proj ect. 
Certificate of need projects described in this subsection are not subject to or limited by 
the nursing facility MaineCare funding pool. 
Sec. B-13. 22 MRSA §334-A, sub-§2-B is enacted to read: 
2-B. Emergencies and necessary nursing facility projects. If the department 
determines that an emergency exists, it may approve a necessary nursing facility 
certificate of need application on an expedited basis when the applicant proposes capital 
expenditures for renovations and improvements that are necessary: 
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COMMIITEE AMENDMENT ~"to H.P. 286, L.D. 360 
A. To achieve compliance with code and related regulatory requirements; 
B. To comply with the federal Health Insurance Portability and Accountability Act 
of 1996 and related patient privacy standards; 
C. To address other patient safety requirements and standards; or 
D. To address other necessary and time-sensitive patient safety or compliance issues. 
Certificate of need projects described in this subsection are not subject to or limited by 
the nursing facility MaineCare funding pool. 
Sec. B-14. 22 MRSA §334-A, sub-§3, amended by PL 2009, c. 430, §§2 to 4, is 
further amended to read: 
3. Evaluating costs. Beginning with all applications pending on January 1, 2003 
February 15,2012, in evaluating whether a project will increase MaineCare expenditures 
for a nursing facility for the purposes of this section, the department shall: 
A. Allow gross square footage per licensed bed of not less than 500 square feet 
unless the applicant specifies a smaller allowance for the projectt~ 
B. "BKclude the projeeted ineremental cost assoeiated ',llith replacement of equipment; 
ana 
C. Exelude the incremental cost of energy efficient improvements as defined in the 
rules governing MaineCare reimeUFsement for nursing faeilities. 
Sec. B-15. 22 MRSA §335, sub-§l, as amended by PL 2011, c. 90, Pt. J, §5, is 
further amended to read: 
1. Basis for decision. Based solely on a review of the record maintained under 
subsection 6, the commissioner shall.approve an application for a certificate of need if the 
commissioner determines that the project: 
A. Meets the conditions set forth in subsection 7; 
C. Ensures high-quality outcomes and does not negatively affect the quality of care 
delivered by existing service providers; 
D. Does not result in inappropriate increases in service utilization, according to the 
principles of evidence-based medicine adopted by the Maine Quality Forum, as 
established in Title 24-A, section 6951, when the principles adopted by the Maine 
Quality Forum are directly applicable to the application; and 
E. Can ee funded "'lithin the capital inT,zestmont fund or, in the case of a nursing 
faeility, is consistent with the nursing facility MainoCare funding pool and other 
provisions of seetions 333 A and 334 A. 
F. In the case of a nursing facility project that proposes to add new nursing facility 
beds to the inventory of nursing facility beds within the State, is consistent with the 
nursing facility MaineCare funding pool and other applicable provisions of sections 
333-A and 334-A. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT .1). to H.P. 286, L.D. 360 
PARTC 
Sec. C-l. Rule amendment. No later than January 1, 2012, the Department of 
Health and Human Services shall amend its rules on certificate of need under the Maine 
Revised Statutes, Title 22, chapter 103-A to permit applications to be filed at any time, 
rather than on a cycle, and to allow applicants to waive having a technical assistance 
meeting. 
Sec. C-2. Review of certificate of need. The Department of Health and Human 
Services shall convene a stakeholder group no later than October 15, 2011 to review ways 
to improve the certificate of need process under the Maine Revised Statutes, Title 22, 
chapter 103-A and the rules that implement certificate of need laws. The department 
shall make any necessary recommendations for changes in law or rule for the benefit of 
the regulated entities and the people of the State to the Legislature no later than January 
15, 2012. The department shall invite participants from a range of groups, including, but 
not limited to, the Maine Medical Association, the Maine Hospital Association, the 
Maine Health Care Association, private attorneys who have practiced in the field of 
certificate of need law, an association of not-for-profit, long-term care providers of 
services to the elderly in Maine and New Hampshire and a physician-owned 
multi-specialty medical practice based in Portland. 
Sec. C-3. Effective date. Notwithstanding any other provision of this Act, section 
of this Part takes effect December 1, 2011 and section 2 of this Part takes effect October 
1,2011. 
PARTD 
Sec. D-l. 22 MRSA §337, sub-§2,~, as amended by PL 2009, c. 383, §10, is 
further amended to read: 
B. Within W li days of filing the letter of intent, the applicant shall schedule a 
meeting with the department staff in order to assist the department in understanding 
the application and to receive technical assistance concerning the nature, extent and 
format of the documentary evidence, statistical data and financial data required for 
the department to evaluate the proposal. 
The department may not accept an 
application for review until the applicant has satisfied this technical assistance 
requirement. 
Sec. D-2. 22 MRSA §337, sub-§5, as amended by PL 2009, c. 383, §1l, is 
further amended to read: 
5. Public notice; public informational meeting. Within.w ~ business days of the 
filing of a certificate by an applicant that a complete certificate of need application is on 
file with the department, public notice that the application has been filed and that a public 
informational meeting must be held regarding the application must be given by 
publication in a newspaper of general circulation in Kennebec County and in a newspaper 
published within the service area in which the proposed expenditure will occur. The 
notice must also be provided to all persons who have requested notification by means of 
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"to H.P. 286, L.D. 360 
asking that their names be placed on a mailing list maintained by the department for this 
purpose. This notice must include: 
A. A brief description ofthe proposed expenditure or other action; 
B. A description ofthe review process and schedule; 
C. A statement that any person may examine the application, submit comments in 
writing to the department regarding the application and examine the entire record 
assembled by the department at any time from the date of publication of the notice 
until the application process is closed for comment; and 
D. The time and location of the public informational meeting and a statement that 
any person may appear at the meeting to question the applicant regarding the project 
or the department regarding the conditions that the applicant must satisfy in order to 
receive a certificate of need for the project. 
The department shall make an electronic or stenographic record of the public 
informational meeting. 
A public informational meeting is not required for the simplified review and approval 
process in section 336. 
Sec. D-3. 22 MRSA §339, sub-§2, ~, as enacted by PL 2001, c. 664, §2, is 
amended to read: 
B. 
The commissioner, or the commissioner's designee, shall hold a public hearing if 
persons residing or located within the health service area to be served by the 
applicant request, in writing, that such a public hearing be held and the request is 
received by the commissioner no later than W 12. days following the informational 
hearing on the application conducted pursuant to section 337, subsection 5. 
Sec. D-4. 22 MRSA §339, sub-§S, as enacted by PL 2001, c. 664, §2, is amended 
to read: 
5. 
Reviews. 
To the extent practicable, a review must be completed and the 
commissioner shall make a decision within 9G 45 days after the application has been 
certified as complete by the applicant. 
The department shall establish criteria for 
determining when it is not practicable to complete a review within 9G 45 days. Whenever 
it is not practicable to complete a review within 9G 45 days, the department may extend 
the review period for up to an additional @ 30 days. 
Sec. D-S. 22 MRSA §339, sub-§6, as enacted by PL 2001, c. 664, §2, is amended 
to read: 
6. Public necessity. The department may delay action on an otherwise complete 
application for up to -I-8G 90 days from the time the application has been certified as 
complete by the applicant if the department finds that a public necessity exists. The 
department shall provide written notice of the delay to the applicant and any other person 
who has requested in writing information regarding the application. For purposes of this 
subsection, the department shall find that a public necessity exists if: 
A. The application represents a new service or technology not previously provided 
within the State; 
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COMMITTEE AMENDMENT 13 "to H.P. 286, L.D. 360 
B. The application represents a potential significant impact on health care system 
costs; 
C. The application represents a new service or technology for which a health care 
system need has not been previously established; or 
D. 
There are several applications for the same or similar projects before the 
department. 
PARTE 
Sec. E-l. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Nursing Facilities 0148 
Initiative: Appropriates and allocates funds for increased costs resulting from limiting the 
MaineCare cost neutrality requirements for new nursing facility construction and bed 
conversion projects. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2011-12 
$191,741 
$191,741 
2011-12 
$332,178 
$332,178 
2012-13 
$620,457 
$620,457 
2012-13 
$1,074,897 
$1,074,897 
PARTF 
Sec. F-l. Effective date. This Act takes effect February 15, 2012 except as 
otherwise indicated.' 
SUMMARY 
This amendment is the minority report of the committee. The amendment replaces 
the bill and does the following. 
Part A amends certificate of need laws, by raising thresholds for review, providing 
for later threshold increases tied to the Consumer Price Index medical care services index 
and eliminating the certificate of need requirements for the purchase of replacement 
equipment. The amendment includes a threshold of $1,000,000 for capital expenditures 
for a new health service by a new or existing health care facility. 
The amendment 
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COMMITTEE AMENDMENT ~:.B " 
to H.P. 286, L.D. 360 
exempts from the requirement of a certificate of need process certain capital expenditures 
by health care facilities that have been certified by the Efficiency Maine Trust as 
cost-effective and requires the trust to develop and implement a process for certification. 
Part B amends the certificate of need laws by increasing the threshold for nursing 
facility projects, providing for later threshold increases tied to the Consumer Price Index, 
limiting MaineCare budget neutrality requirements and the MaineCare nursing facility 
funding pool to apply solely to projects that propose to add additional nursing facility 
beds to the total inventory of beds within the State, making other changes to certificate of 
need laws and clarifying that projects need to comply with the principles of the Maine 
Quality Forum only when such standards are directly applicable to nursing facility 
projects. 
Part C requires the Department of Health and Human Services to amend its rules on 
certificate of need by January 1,2012 to permit applications to be filed at any time, rather 
than on a cycle, and to allow applicants to waive having a technical assistance meeting. It 
also requires the Department of Health and Human Services to convene a stakeholder 
group to review certificate of need laws and rules. 
. 
Part D shortens by half the time periods in the laws on the application and review 
processes for certificate of need. 
Part E adds an appropriations and allocations section. 
Part F adds an effective date of February 15,2012 except that the provision requiring 
the Department of Health and Human Services to amend its rules to permit certificate of 
need applications to be filed at any time takes effect December 1,2011 and the provision 
requiring the department to convene a stakeholder group takes effect October 1, 2011. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06113111 
;tI§ac:.. 
LD360 
LR290(03) 
An Act To Repeal the Maine Certificate of Need Act of 2002 
'Fiscal Note f~r Bill as Amended by Committee Amendmentj3" 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/ .Allocations 
General Fund 
Federal Expenditures Fund 
Revenue 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2011-12 
$191,741 
$191,741 
$332,178 
$62,911 
FY 2012-13 
$620,457 
$620,457 
$1,074,897 
$171,265 
Projections 
FY 2013-14 
$729,604 
$729,604 
$1,263,986 
$172,862 
Projections 
FY 2014-15 
$893,325 
$893,325 
$1,547,619 
$174,514 
Provides General Fund appropriations of $191 ,741 in 2011-12 and $620,457 in 2012-13 to the Nursing Facilities 
program in the Department of Health and Human Services for increased costs to the MaineCare program resulting 
from an assumed increase in nursing facility projects under Part B of the bill, primarily from bed conversions from 
nursing facilities to residential care facilities, that will not be subject to MaineCare cost neutrality provisions. Also 
assumes additional certificate of need program application revenue from the likely increase in the number of project 
applications. The potential for increased costs that may result from the increases to certificate of need thresholds in 
Part A of the bill cannot be determined at this time. 
LR0290(03) - Fiscal Note - Page 1 of 1