An Act To Promote Greater Staffing Flexibility without Compromising Safety or Quality in Nursing Facilities
Maine Legislature, Session 126, LD 1246
Committee: Health and Human Services
Sponsors: STUCKEY, CRAVEN, FARNSWORTH, SANBORN
Amends: 22 MRSA §1812-C

Legislative Document 
No. 1246 
H.P. 880 
House of Representatives, March 27, 2013 
An Act To Promote Greater Staffing Flexibility without 
Compromising Safety or Quality in Nursing Facilities 
(EMERGENCY) 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Representative STUCKEY of Portland. 
Cosponsored by Senator CRAVEN of Androscoggin and 
Representatives: FARNSWORTH of Portland, SANBORN of Gorham. 
Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, Maine's typical nursing facility resident reflects an acuity that is among 
the highest in the country; and 
Whereas, Maine's minimum staffing rules were established years ago when resident 
acuity was vastly different from today; and 
Whereas, the current minimum staffing rules do not require nursing facilities to 
staff based on resident acuity or need; and 
Whereas, establishing acuity-based staffing standards would give providers 
patient-centered staffing flexibility, a benchmark for staffing to resident need, a threshold 
for quality and safety that relates to Maine's high resident acuity and a basis for a more 
appropriate allocation of resources according to resident need; and 
Whereas, the acuity measurement tools used to achieve acuity-based staffing are 
already required and being used by all Maine's nursing home providers and can be easily 
translated to nationally established quality thresholds in support of acuity-based staffing 
in addition to state oversight; 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-§5-A is enacted to read: 
5-A.  Required staffing pattern.  A staffing pattern in a nursing home must be in 
conformity with this subsection and with rules adopted by the department.  Rules adopted 
pursuant to this subsection are major substantive rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
A.  The rules adopted by the department must specify the number of hours of nursing 
care per patient day to achieve minimum staffing standards, based on a 24-hour 
period of time, required to meet resident needs and to meet thresholds for safety, 
quality and the prevention of resident harm. 
B.  The rules adopted by the department must also specify that the number of hours of 
nursing care required to meet resident needs be specific to resident acuity as 
determined by the resource utilization group category that is assigned to each 
resident. 
Sec. 2.  Rulemaking.  The Department of Health and Human Services shall adopt 
rules to implement this Act.  Notwithstanding the Maine Revised Statutes, Title 22, 
section 1812-C, subsection 5-A, the initial rules adopted by the department to implement 
this Act are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A; any 
amendments to the initial rules adopted pursuant to this Act are major substantive rules in 
accordance with Title 22, section 1812-C, subsection 5-A.  The initial rules adopted by 
the department to establish nursing home staffing ratios must be in accordance with this 
section. 
1.  The required hours of care by a registered nurse, licensed practical nurse and 
certified nursing assistant and the total hours of care per patient day for each resource 
utilization group category must be derived from the national nursing home staff time 
measurement study, known as the "Staff Time and Resource Intensity Verification 
project," initiated by the federal Centers for Medicare and Medicaid Services and 
adjusted upwards to reflect the State's acuity. 
2.  The State's upward acuity adjustment and staffing threshold must be derived by 
adding a uniform measure of times expressed in terms of hours per patient day to each 
resource utilization group category that ensures that the total nursing hours per patient 
day are not lower than that level that, according to data from the federal Centers for 
Medicare and Medicaid Services' online survey, certification and reporting system, 
reflects higher levels of deficiencies for resident harm than is approved by the 
Department of Health and Human Services and the long-term care ombudsman program 
established pursuant to the Maine Revised Statutes, Title 22, section 5106, subsection 
11-C. 
3.  A nursing home must apply its actual census and resident-specific hours per 
patient day per resource utilization group score derived pursuant to subsection 2 to 
establish its facility-specific staffing threshold on a daily basis. 
4.  Survey and oversight procedures must include a tool for collecting resident census 
and resident acuity according to resource utilization groups, and compare the facility-
specific staffing threshold with actual staffing. 
5.  A nursing home shall submit staffing information and data to the Department of 
Health and Human Services at the request of the department. 
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 adopt acuity-
based staffing, calculated over a 24-hour period and tied to a quality and safety threshold 
established by federally gathered data relevant to resident harm.  Nursing homes would 
still ultimately be required to staff according to residents' needs. 
The bill provides that changes to the licensing rules are major substantive rules.