An Act To Implement the Recommendations of the Commission To Study Long-tenn Care Facilities
Maine Legislature, Session 126, LD 1776
Committee Amendment CA_A-SA_A_S521 (Senate)

SENATE AMENDMENT "A "to COMMITTEE AMENDMENT "A" to S.P. 704, 
L.D. 1776, Bill, "An Act To Implement the Recommendations of the Commission To 
Study Long-tenn Care Facilities" 
Amend the amendment by inserting after the 3rd indented paragraph after the title the 
following: 
'Amend the bill in section 2 by striking out all of subsection 4 (page 3, lines 6 to 15 in 
L.D.)' 
Amend the amendment by inserting after the 5th indented paragraph after the title the 
following: 
'Amend the bill in section 2 in subsection 6 in the first line (page 3, line 22 in L.D.) 
by striking out the following: "2014" and inserting the following: '2015" 
Amend the amendment by inserting after the 7th indented paragraph after the title the 
following: 
'Amend the bill in section 2 by rcnumbering the subsections to read consecutively. 
Amend the bill by striking out all of section 3 (page 3, lines 30 to 40 in L.D.) and 
inserting the following: 
'Sec. 3. Savings arising from recoveries in excess of projections. Resources 
to fund the reimbursement relief requirement under sections 1 and 2 must be identifIed 
and made available as follows. 
1. 
The Department of Health and Human Services shall immediately take all 
necessary actions to collect all remaining cost-of-care overpayments to nursing facilities 
and private nonmedical institutions that were paid when the department's computer 
systems, when providing reimbursement owed by the department, failed to take into 
account the financial contributions paid by residents in the nursing facilities and private 
nomnedical institutions and miscalculated the amounts payable under the MaincCare 
program. 
2. The Commission To Continue the Study of Long-term Care Facilities established 
under section 5, in addition to its other powers and duties, shall gather and evaluate all 
infom1ation necessary to detennine the extent that collections of cost-of-care 
Page I - 126LR2744(OS)-1 
SENA TE AMENDMENT 
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SENATE AMENDMENT "A" to COMMITTEE AMENDMENT "A" to S.P. 704, L.D. 1776 
overpayments, and other savings initiatives of the Depaliment of Health and Human 
Services completed on the effective date of this section or in progress on the effective 
date of this section, have resulted in savings in excess of amounts projected to be saved in 
developing and repOliing budget information, referred to in this section as "available 
savings," to the Legislature or the Governor. The department shall assist the commission 
by providing requested information and making available appropriate staff for discussion 
and analysis of such information. The commission may also request and usc information 
that may be compiled and submitted to it by associations representing providers of 
long-term care in the State. The available savings identified by the commission must 
provide a minimum of $8,000,000 in General Fund savings in fiscal year 2014-15.' , 
Amend the amendment by striking out all of section 7 (page 1, lines 33 and 34 and 
'Sec. 7. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEAL TH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care - Payments to Providers 0147 
Initiative: Deappropriates funds for recovery of overpayments to providers due to errors 
in calculating cost-of-care and for continued proper application of cost-of-care rules. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Nursing Facilities 0148 
2013-14 
$0 
$0 
2014-15 
($8,000,000) 
($8,000,000) 
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 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2014-15 
$9,007,083 
$9,007,083 
2014-15 
$14,570,124 
$14,570,124 
Nursing Facilities 0148 
Initiative: Adjusts funds to reflect additional nursing home provider tax revenue. 
SENA TE AMENDMENT 
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SENATE AMENDMENT" A" to COMMITTEE AMENDMENT "A" to S.P. 704, LD. 1776 
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 
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 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
$0 
$0 
2014-15 
($1,414,632) 
($1,414,632) 
2014-15 
$1,414,632 
$1,414,632 
2014-15 
$378,292 
$378,292 
2014-15 
$611,945 
$611,945 
2014-15 
($29,257) 
$15,182,069 
$1,414,632 
$16,567,444 
This amendment removes the provisions that require the Department of Health and 
Human Services to amend rules governing principles of reimbursement for nursing 
facilities as they relate to the inclusion of the costs of health insurance for nursing facility 
personnel. It delays by one year the supplemental payment to nursing facilities with a 
high percentage of MaineCare residents. It requires the Commission To Continue the 
SENA TE AMENDMENT 
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SENATE AMENDMENT" f\" to COMMITTEE AMENDMENT "A" to S.P. 704, L.D. 1776 
Study of Long-term Care Facilities to determine the extent that collections of cost-of-care 
overpayments and other savings initiatives of the department have resulted in savings in 
excess of amounts projected to be saved in developing and reporting budget information 
to the Legislature or the Governor. 
These savings must provide a minimum of 
$8,000,000 in General Fund savings in fiscal year 2014-15. This amendment replaces the 
appropriations and allocations section in the committee amendment. 
FISCAL NOTE REQUIRED 
(See attached) 
SPONSORED BY: ~ 
C!!eu;~ 
(Senator CRA YEN) 
COUNTY: Androscoggin 
SENATE AMENDMENT 
, 
Approved: 04/10114 
~ac 
LD 1776 
LR 2744(05) 
An Act To Implement the Recommendations of the Commission To Study Long-term Care Facilities 
Fiscal Note for Senate Amendment "A' to Committee Amendment "A" 
Sponsor: Sen. Craven of Androscoggin 
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 
($12,086,114) 
($12,086,114) 
($8,114,611) 
($756,102) 
($756,102) 
The amendment makes no changes to the bill's two separate commissions. 
Fiscal Detail and Notes 
Projections 
FY 2015-16 
($3,104,218) 
($3,104,218) 
($6,244,378) 
($581,837) 
($581,837) 
Projections 
FY 2016-17 
($3,101,218) 
($3,101,218) 
$146,755,622 
($581,837) 
($581,837) 
This fiscal note reflects the incremental impact of the amendment. As a result of changes made to the nursing home 
reimbursement initiative the total appropriation for the initiative is reduced by $4.1 million in fiscal year 2014-15 in 
the Nursing Facilities program in the Department of Health and Human Services. The revised estimated impact is 
summarized in the table below. 
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 
LR2744(05) - Fiscal Note - Page 1 of 2 
2014-15 
Total Costs 
$0 
$0 
$0 
$7,919,211 
$10,501,442 
$5,156,554 
$23,577,207 
State Share 
$0 
$0 
$0 
$3,025,376 
$4,011,866 
$1,969,958 
$9,007,200 
The amendment also includes a deappropriation of $8 million in fiscal year 2014-15 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. 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, additional recoveries or savings above 
these amounts would be necessary to meet the $8 million deappropriation. 
LR2744(05) - Fiscal Note - Page 2 of2 
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