An Act To Implement the Recommendations of the Commission To Study Long-term Care Facilities
Maine Legislature, Session 126, LD 1776
Committee Amendment CA_A_S497 (Senate)

COMMITTEE AMENDMENT" A " to S.P. 704, L.D. 1776, Bill, "An Act To 
Implement the Recommendations of the Commission To Study Long-term Care 
Facilities" 
Amend the bill in section 1 in subsection 3 by striking out all of paragraph F (page 2, 
lines 10 and 11 in L.D.) and inserting the following: 
'F. Establish a nursing facility's base year every 2 years and increase the rate of 
reimbursement beginning July 1, 2014 and every year thereafter.' 
Amend the bill in section 2 in subsection 1 in the first line (page 2, line 18 in L.D.) by 
inserting after the following: "year" the following: 'every 2 years' 
Amend the bill in section 2 in subsection 1 in the 2nd line (page 2, line 19 in L.D.) by 
striking out the following: "2 years" and inserting the following: 'year' 
Amend the bill in section 2 by striking out all of subsection 5 and inserting the 
following: 
'5. The rule must be amended in Sections 91 and 91.1 to provide for ongoing, annual 
rate changes beginning July 1, 2014 to adjust for inflation and to set the inflation 
adjustment cost-of-living percentage change in nursing facility reimbursement each year 
in accordance with the United States Department of Labor, Bureau of Labor Statistics 
Consumer Price Index medical care services index.' 
Amend the bill in section 2 by inserting after subsection 7 the following: 
'The rate of reimbursement for nursing facilities that results from amending the rules 
to reflect rebasing the nursing facility's base year pursuant to this section may not result 
for any nursing facility in a rate of reimbursement that is lower than the rate in effect on 
April1,2014.' 
Amend the bill by striking out all of section 7 and inserting the following: 
'Sec. 7. Appropriations and allocations. 
The following appropriations and 
allocations are made. 
COMMITTEE AMENDMENT 
o~s 
~ 
COMMITTEE AMENDMENT" A "to S.P. 704, L.D. 1776 
HEAL TH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Nursing Facilities 0148 
Initiative: Provides funding for increased reimbursements under the MaineCare program 
for nursing facilities. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Nursing Facilities 0148 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2014-15 
$13,821,246 
$13,821,246 
2014-15 
$22,357,658 
$22,357,658 
Initiative: Adjusts funds to reflect additi,onai nursing home provider tax revenue. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Nursing Facilities 0148 
Initiative: Provides funds for increased nursing home costs. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
COMMITTEE AMENDMENT 
2014-15 
($2,170,734 ) 
($2,170,734 ) 
2014-15 
$2,170,734 
$2,170,734 
2014-15 
$406,345 
$406,345 
O~s 
\1-' 
COMMITTEE AMENDMENT" A" to S.P. 704, L.D. 1776 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
SUMMARY 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
$0 
$0 
2014-15 
$939,022 
$939,022 
2014-15 
$12,056,857 
$23,296,680 
$2,170,734 
$37,524,271 
This amendment is the unanimous report of the committee. This amendment clarifies 
that the rules regarding the principles of reimbursement for nursing facilities must 
establish a nursing facility's base year every 2 years and increase the rate of 
reimbursement beginning July 1, 2014 and every year thereafter. The amendment also 
clarifies that the rate of reimbursement for nursing facilities that results from amending 
the rules to reflect rebasing the nursing facility's base year may not result for any nursing 
facility in a rate of reimbursement that is lower than the rate in effect on April 1, 2014. 
The amendment also clarifies that the rules regarding the principles of reimbursement for 
nursing facilities must be amended in Sections 91 and 91.1 to provide for ongoing, annual 
rate changes beginning July 1, 2014 to adjust for inflation and to set the inflation 
adjustment cost-of-Iiving percentage change in nursing facility reimbursement each year 
in accordance with the United States Department of Labor, Bureau of Labor Statistics 
Consumer Price Index medical care services index. 
This amendment replaces the 
appropriations and allocations section in the bill. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
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Approved: 04/02114 .frac 
LD 1776 
LR 2744(02) 
An Act To Implement the Recommendations of the Commission To Study Long-term Care Facilities 
Fiscal Note for Bill as Amended by Committee Amendment ''A''(sf:..1 CJ "1) 
Committee: Health and Human Services 
~ 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Other Special Revenue Funds 
Legislative Cost/Study 
Fiscal Note Required: Yes 
Fiscal Note 
Legislative Cost/Study 
FY 2013-14 
$0 
$0 
$0 
$0 
$0 
FY 2014-15 
$12,056,857 
$12,056,857 
$23,296,680 
$2,170,734 
$2,170,734 
Projections 
FY 2015-16 
$12,056,857 
$12,056,857 
$23,296,680 
$2,170,734 
$2,170,734 
Projections 
FY 2016-17 
$12,053,857 
$12,053,857 
$23,296,680 
$2,170,734 
$2,170,734 
This bill contains two separate commissions. The general operating expenses of the Commission to Continue the 
Study of Long-tenn Care Facilities are projected to be $1,250 in fiscal year 2013-14 and $2,000 in fiscal year 2014-
15. The general operating expenses of the Blue Ribbon Commission on Long-tenn Care are also projected to be 
$1,250 in fiscal year 2013-14 and $2,000 in fiscal year 2014-15. The Legislature'S proposed budget includes $10,000 
in fiscal year 2013-14 and $10,000 in fiscal year 2014-15 forlegislative studies. Whether the amounts are sufficient 
to fund all studies will depend on the number of studies authorized by the Legislative Council and the Legislature. 
The Blue Ribbon Commission is authorized to seek outside funding for staffing and expert consultant services and 
may not meet unless these funds are raised and approved by the Legislative Council. Other staffing costs during the 
interim can be absorbed by the Legislature utilizing existing staff resources. 
Fiscal Detail and Notes 
LR2744(02) . Fiscal Note - Page 1 of2 
" 
The bill provides appropriations totaling $12,056,857 in fiscal year 2014-15 in the Nursing Facilities program in the 
Department of Health and Human Services (DHHS) for increased MaineCare payments to nursing facilities and for 
adjustments to funding to reflect increased nursing home tax collections. The increased payments to nursing homes 
are detailed in the table below. The additional $2.2 million in nursing home provider taxes that would be collected as 
a result of the increased payments are reflected in adjustments to appropriations and allocations. 
Nursing Facility Costs 
Cost of moving health insurance to fixed costs: 
Direct Cost 
Routine Cost 
Supplemental payment for MaineCare days over 70% at $AO/day 
Additional cost of Management Allowance above ceiling (no limit) 
Rebasing routine cost CAP to 110% of median by peer group 
Rebasing direct care CAP to 110% of median by peer group 
Total Impact 
2014-15 
Total Costs 
$16,843,334 
$6,271,448 
$2,904,403 
$7,919,211 
$6,639,445 
($4,39S, 93 7) 
$36,178,904 
State Share 
$6,434,659 
$2,395,881 
$1,109,569 
$3,025,376 
$2,536,467 
($L680,526) 
$13,821,427 
The original bill included a deappropriation of $10 million in the Medical Care- Payments to Providers program for 
recovery of overpayments to providers due to errors in calculating cost of care and for continued proper application of 
cost-of-care rules. While DHHS has indicated it had cost of care collections of $10.4 million in fiscal year 2012-13 
and expects to recover $13.9 million in fiscal year 2013-14 and $9.0 million in fiscal year 2014-15, DHHS has also 
indicated these recoveries have been included in their MaineCare shortfall forecast used to prepare the 2014-2015 
supplemental budget request. Accordingly, the fiscal note assumes the $10 million would not be available at this time 
for deappropriation above the amounts assumed by DHHS. 
LR2744(02) - Fiscal Note - Page 2 of2