An Act To Increase Access to Health Coverage and Qualify Maine for Federal Funding
Maine Legislature, Session 126, LD 1066
Committee Amendment CA_A-SA_A_S221 (Senate)
Amends: 22 MRSA §3173-C

SENATE AMENDMENT "A "to COMMITTEE AMENDMENT "A" to H.P. 759, 
L.D. 1066, Bill, "An Act To Increase Access to Health Coverage and Qualify Maine for 
Federal Funding" 
Amend the amendment in Part A by inserting after section 4 the following: 
'Sec. A-S. 
Repeal. 
The Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraphs H and I are repealed December 31, 2016.' 
Amend the amendment in Part B by striking out all of section 1 and inserting the 
following: 
'Sec. B-l. Obtaining f(~deral approval for enhanced federal match. The 
Commissioner of Health and Human Services shall take all steps necessary to secure an 
enhanced Federal Medical Ass:istance Percentage for services provided to the MaineCare 
childless adult waiver populatllOn in the State equal to that available under the federal 
Patient Protection and Affordable Care Act for newly eligible Medicaid individuals. By 
July 1, 2013, the commissiom:r shall prepare and submit to the federal Department of 
Health and Human Services, Centers for Medicare and Medicaid Services in a fonnat 
required by the Secretary of the federal Department of Health and Human Services an 
analysis of the benefits available under the MaineCare childless adult waiver population 
as of December 1, 2009 and .all necessary infonnation to certify that members of the 
childless adult population were not eligible on December 1, 2009 to receive full benefits, 
benchmark coverage as described in Section 1937(b)(1), subparagraph (A), (B) or (C) of 
the United States Social Security Act or benchmark equivalent coverage as described in 
United States Code, Section 1397(b)(2). In preparing and submitting this analysis, the 
commissioner shall compare the services available to the childless adult population, 
specifically hearing services, to those of the 3 benchmark plans specified by the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
and shall indicate to the secretary whether hearing services were a covered service for the 
childless adult population as of December 1, 2009 and whether they are a covered service 
under the 3 benchmark plans. The Commissioner of Health and Human Services shall 
submit information certified by an actuary for the purpose of certifying the benefits 
available to the childless adult population on December 1, 2009 if required to do so by 
the secretary. If the secretary does not require information certified by an actuary for that 
purpose, the commissioner may not pursue the services of an actuary or submit 
SENATE AMENDMENT 
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SENATE AMENDMENT 'A' to COMMITTEE AMENDMENT "A" to H.P. 759, L.D. 1066 
information certified by an actuary for the purpose of certifying the benefits available to 
the childless adult population on December 1, 2009. 
If the secretary requires the 
submission of additional information to demonstrate that members of the childless adult 
population otherwise qualify as "newly eligible" individuals as described in Section 
1905(y)(2) of the United States Social Security Act, in order for the State to secure an 
enhanced Federal Medical Assistance Percentage as set forth in Section 1905(y)(1) of the 
United States Social Security Act, the Department of Health and Human Services shall 
provide all required information to the secretary within 30 days of the secretary's sending 
notification that additional information is required.' 
Amend the amendment in Part C by striking out all of sections 1 and 2 and inserting 
the following: 
'Sec. C-l. 
Research organization evaluation. 
The Office of Fiscal and 
Program Review shall contract with a private, nonpartisan research organization to 
evaluate the impact of the MaineCare expansion authorized in Part A on programs and 
services that do not currently receive Federal Medical Assistance Percentage matching 
funds or do not qualify for enhanced Federal Medical Assistance Percentage matching 
funds under the federal Patient Protection and Affordable Care Act, with the goal of 
identifying and maximizing General Fund savings. The Commissioner of Health and 
Human Services, the Commissioner of Corrections and the Executive Director of the 
State Board of Corrections shall provide to the research organization information and 
assistance requested for preparation of the evaluation. In evaluating the programs and 
services under this Part, the research organization shall at a minimum evaluate the impact 
on the following programs and services: the state-funded Mental Health Services -
Community, Office of Substance Abuse and General Assistance - Reimbursement to 
Cities and Towns programs; the elderly low-cost drug program under the Maine Revised 
Statutes, Title 22, section 254-D; services provided for individuals between 21 and 64 
years of age who are currently eligible for MaineCare under medically needy, spend-
down criteria; services provided under the Maine HIV/AIDS Section 1115 Demonstration 
Waiver; services provided for parents participating in family reunification activities; 
services provided for disabled individuals between 21 and 64 years of age with incomes 
below 139% of the federal poverty level; services provided to individuals awaiting a 
MaineCare disability determination for whom the applications are subsequently granted; 
services provided to individuals who would have been considered eligible on the basis of 
a disability but for whom the full determination process was not completed; medical 
services provided to persons in the care and custody of the Department of Corrections or 
a county correctional facility; and the amount of payment for services that hospitals 
received during calendar years 2014 and 2015 as a result of the expansion of MaineCare 
eligibility pursuant to Part A. In addition, the research organization shall evaluate any 
savings and the impact on health outcomes achieved through initiatives implemented 
pursuant to the State Innovation Models Initiative grant. 
Sec. C-2. Report. The research organization that conducts the evaluation under 
section 1 shall report no later than March 1st in 2014 and 2015 and February 15th in 2016 
to the joint standing committee of the Legislature having jurisdiction over appropriations 
and financial affairs, the joint standing committee of the Legislature having jurisdiction 
over health and human services matters and the joint standing committee of the 
Legislature having jurisdiction over criminal justice and public safety matters on the 
SENA TE AMENDMENT 
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SENATE AMENDMENT" A" to COMMITTEE AMENDMENT "A" to H.P. 759, L.D. 1066 
amount of General Fund savings resulting from the MaineCare expansion authorized in 
Part A and identified in section 1. 
The reports must include the amount of savings 
realized during calendar years 2014 and 2015 by service area or program, the amount 
deposited in the MaineCare Stabilization Fund pursuant to section 3 and the amount of 
savings projected to be achieved through state fiscal year 2020-21 by service area or 
program.' 
Amend the amendment in Part C in section 3 in the 5th line (page 4, line 7 in 
amendment) by striking out the following: "section 4" and inserting the following: 
'section 6' 
Amend the amendment in Part C in section 3 in the 8th line (page 4, line lOin 
amendment) by striking out the following: "section 4" and inserting the following: 
'section 6' 
Amend the amendment in Part C by inserting after section 3 the following: 
'Sec. C-4. Review and responsibility. Following receipt of the reports from the 
research organization as required under section 2, the joint standing committee of the 
Legislature having jurisdiction over health and human services matters shall review the 
infonnation provided in the rep,orts and shall detennine if the net cost to the General Fund 
of providing coverage under the MaineCare program to individuals pursuant to Part A, 
section 3 exceeds the savings to the General Fund, including any amount deposited in the 
MaineCare Stabilization Fund pursuant to section 3, due to the expansion of coverage for 
those individuals. Following its review of the report received on February 15,2016, the 
joint standing committee may report out a bill to the 127th Legislature regarding its 
detenninations and conclusions. 
Sec. C-S. Appropriations and allocations. The following appropriations and 
allocations are made. 
LEGISLATURE 
Legislature 0081 
Initiative: Provides funding for the Office of Fiscal and Program Review to contract with 
a private, nonpartisan research organization to evaluate the impact of Medicaid 
expansion. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2013-14 
$100,000 
$100,000 
2014-15 
$0 
$0 
Amend the amendment by inserting after Part D the following: 
'PARTE 
Sec. E-l. 22 MRSA §3173-C, sub-§7, as amended by PL 2009, c. 415, Pt. A, 
§ 12, is further amended to read: 
SENA TE AMENDMENT 
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SENATE AMENDMENT" A" to COMMITTEE AMENDMENT "A" to H.P. 759, L.D. 1066 
7. 
Copayments. 
Notwithstanding any other provision of law, the following 
copayments per service per day are imposed and reimbursements are reduced, or both, to 
the following levels: 
A. Outpatient hospital services, $3; 
B. Home health services, $3; 
C. Durable medical equipment services, $3; 
D. Private duty nursing and personal care services, $5 per month; 
E. Ambulance services, $3; 
F. Physical therapy services, $2; 
G. Occupational therapy services, $2; 
H. Speech therapy services, $2; 
I. Podiatry services, $2; 
J. Psychologist services, $2; 
K. Chiropractic services, $2; 
L. Laboratory and x-ray services, $1; 
M. Optical services, $2; 
N. Optometric services, $3; 
O. Mental health clinic services, $2; 
P. Substance abuse services, $2; 
Q. Hospital inpatient services, $3 per patient day; 
R. Federally qualified health center services, $3 per patient day, effective July I, 
2004; and 
S. Rural health center services, $3 per patient day. 
The department may adopt rules to adjust the copayments set forth in this subsection. 
The rules may adjust amounts to ensure that copayments are deemed nominal in amount 
and may include monthly limits or exclusions per service category. The need to maintain 
provider participation in the Medicaid program to the extent required by 42 United States 
Code, Section 1396a(a)(30)(A) or any successor provision of law must be considered in 
any reduction in reimbursement to providers or imposition of copayments. 
For an adult when the adult's family income is above 100% of the nonfarm income 
official poverty line, the department shall adopt rules to adjust the copayments 
established under this subsection to reflect the maximum allowable amounts authorized 
under 42 United States Code, Section 13960; to increase copayments as authorized by 42 
United States Code, Section 13960(h); and in compliance with Section 13960(b)(3) to 
impose a copayment for services received at a hospital emergency room of up to twice 
the amount established as the copayment for outpatient services if the services are not 
emergency services. The department shall track aggregate copayments in compliance 
SENATE AMENDMENT 
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SENATE AMENDMENT "A' to COMMITTEE AMENDMENT "A" to H.P. 759, L.D. 1066 
with 42 Code of Federal Regulations, Section 447.68 and, by rule, make adjustments to 
copayments to ensure compliance with federal law. 
Sec. E-2. Contingent effective date. Those sections of this Act that enact the 
Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H and I take 
effect 30 days after the United States Department of Health and Human Services, Centers 
for Medicare and Medicaid Services confirms in writing to the Commissioner of Health 
and Human Services that the enhanced Federal Medical Assistance Percentage set forth in 
Section 1905(y)(l) of the United States Social Security Act is applicable to the 
individuals who received coverage as of December 1, 2009, who are described in Title 
22, section 3174-G, subsection 1, paragraph F and who are defined in Section 1905(y)(2) 
of the United States Social Security Act. Upon receipt of confirmation from the federal 
Centers for Medicare and Medicaid Services, the Commissioner of Health and Human 
Services shall notify in writing the President of the Senate, the Speaker of the House of 
Representatives and the Revisor of Statutes and shall provide them with a copy of the 
written confirmation.' 
Amend the amendment by relettering or renumbering any nonconsecutive Part letter 
or section number to read consecutively. 
SUMMARY 
This amendment repeals the expansion of medical coverage under the MaineCare 
program on December 31, 2016. 
This amendment requires the Commissioner of Health and Human Services to 
provide certain information to the Secretary of the United States Department of Health 
and Human Services to enable the secretary to make the determination as to the eligibility 
of the State to obtain an enhanced Federal Medical Assistance Percentage for services for 
MaineCare members eligible as childless adults. The amendment provides in Part E that 
until the secretary confirms that the State will get the enhanced reimbursement rate, 
which is 100% federal Medicaid reimbursement for calendar years 2014, 2015 and 2016 
and as further set forth in the fc!deral Patient Protection and Affordable Care Act, for the 
childless adult popUlation in MaineCare, including persons who were members under that 
eligibility grouping on December 1, 2009, the expansion of medical coverage under the 
MaineCare program will not take effect. The amendment requires the commissioner, 
upon receiving confirmation from the United States Department of Health and Human 
Services, Centers for Medicarl~ and Medicaid Services, to notify the President of the 
Senate, the Speaker of the House of Representatives and the Revisor of Statutes and to 
provide them with a copy of the: written confirmation. 
This amendment requires the Office of Fiscal and Program Review to contract with a 
private, nonpartisan research organization to evaluate the impact of the MaineCare 
expansion authorized in Part A and changes the reporting entity to the research 
organization. This amendment adds to the services evaluated under Part C, section 1 the 
amount of payment for services that hospitals received during calendar years 2014 and 
2015 as a result of the expansion of MaineCare eligibility pursuant to Part A, section 3 
and any savings and imp~ct on health outcomes achieved through the State Innovation 
Models Initiative grant. The amendment changes the reporting dates for the reports on 
General Fund savings in Part C, section 2 to March 1st in 2014 and 2015 and February 
SENATE AMENDMENT 
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SENATE AMENDMENT "A" to COMMITTEE AMENDMENT "A" to H.P. 759, L.D. 1066 
15th in 2016, includes in savings any amount credited to the MaineCare Stabilization 
Fund and extends the years for projecting savings through fiscal year 2020-21. The 
amendment directs the joint standing committee of the Legislature having jurisdiction 
over health and human services matters to review the information provided in the reports 
from the research organization under Part C, section 2 and to determine if the net cost to 
the General Fund of providing coverage under the MaineCare program to individuals 
pursuant to Part A, section 3 exceeds the savings to the General Fund, including any 
amount deposited in the MaineCare Stabilization Fund pursuant to Part C, section 3, due 
to the expansion of coverage for those individuals. 
It adds a new Part E that amends current law on copayments in the MaineCare 
program. 
This amendment directs the Department of Health and Human Services to 
increase copayments for adults with income above 100% of the nonfarm income official 
poverty line to the maximum allowable under federal law and to increase nominal 
copayments by the annual percentage increase in the medical care component of the 
Consumer Price Index for All Urban Consumers. This amendment directs the department 
to increase MaineCare copayments for services provided in a hospital emergency room 
when the services are not emergency services. This amendment requires the department 
to track aggregate copayments in compliance with federal law. 
FISCAL NOTE REQUIRED 
SPONSORED BY: 
/' 
• "FV' 
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(Senator KATZ) 
COUNTY: Kennebec 
SENATE AMENDMENT 
• 
Approved: 06/06/13 
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LD 1066 
LR 1098(09) 
An Act To Increase Access to Health Coverage and Qualify Maine for Federal Funding 
Fiscal Note for Senate Amendment '!ft!.. to Committee Amendment "A" . / 
Sponsor: Sen. Katz of Kennebec 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2013-14 
FY 2014-15 
$100,000 
$0 
$100,000 
$0 
Projections 
FY 2015-16 
$0 
$0 
Projections 
FY 2016-17 
$0 
$0 
This amendment adds an additional General Fund appropriation of$100,000 in fiscal year 2013-14 to provide funding 
for the Office of Fiscal and Program Review to contract with a private, nonpartisan research organization to evaluate 
the impact of MaineCare expansion. The amendment's December 31, 2016 repeal of the MaineCare expansion could 
result in a decrease in fiscal year 2016-17 General Fund estimated costs of$8,946,211 and Federal Expenditures Fund 
costs of$169,978,001. However, any requirements to provide transitional MaineCare assistance for this population 
would delay the savings until the following fiscal year . 
Requiring the Department of Health and Human Services to adjust copayments could reduce MaineCare spending as a 
result of reduced net payments and reduced util ization. The amount and timing of these reductions cannot be 
determined at this time. The costs to the department to implement and administer these adjusted copayments cannot 
be determined at this time. 
LR1098(09) - Fiscal Note - Page 1 of 1