Resolve, Directing the Department of Health and Human Services To Create a More Equitable, Transparent Resource Allocation System for Nursing Facilities Based on Residents' Needs
Maine Legislature, Session 126, LD 1245
Committee: Health and Human Services
Sponsors: STUCKEY, CRAVEN, FARNSWORTH, SANBORN

Legislative Document 
No. 1245 
H.P. 879 
House of Representatives, March 27, 2013 
Resolve, Directing the Department of Health and Human Services 
To Create a More Equitable, Transparent Resource Allocation 
System for Nursing Facilities Based on Residents' Needs 
(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, residents' acuity in Maine's nursing facilities has increased significantly 
since the State tightened its MaineCare eligibility rules in the mid-1990s, making Maine's 
acuity and costs of care among the highest in the country; and 
Whereas, Maine's nursing facility reimbursement rates annually lag behind the 
actual costs of caring for Maine's high-acuity patients by approximately $30,000,000 due 
to rate limits derived from 2005 data and arbitrary peer group averages that do not 
adequately take into account resident need; and 
Whereas, state funding for Maine's nursing facilities is disproportionately and 
unsustainably reliant upon private pay, Medicare and provider tax revenues, which is 
causing a growing number of high-acuity, high-cost nursing facilities to need changes in 
reimbursement to take place as soon as possible; and 
Whereas, all nursing facilities currently collect and report MaineCare acuity based 
on a resource utilization group scale; and 
Whereas, a growing number of nursing facilities are facing critical and 
unsustainable financial challenges and need changes in reimbursement to take place as 
soon as possible; 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 
Sec. 1.  Department of Health and Human Services to amend rules on 
reimbursement of nursing facilities.  Resolved:  That the Department of Health 
and Human Services shall amend its rules in the MaineCare Benefits Manual, Chapter III, 
Section 67 to eliminate the current peer grouping method of establishing upper limits for 
reimbursement and establish a rate-setting method that: 
1.  Determines patient acuity using the existing measures of acuity, resource 
utilization groups and data already collected and reported to the Department of Health 
and Human Services for all MaineCare patients and sets rates as a uniform percentage of 
Medicare resource utilization group rates adjusted for urban and rural markets but based 
on General Fund appropriations available for MaineCare; 
2.  Determines standards for exceptions for qualified providers with: 
A.  Demonstrated atypical nursing services and other operating costs related to high 
acuity and high turnover and high medical costs; and 
B.  Specialized or atypical service delivery in areas where access to care is in 
jeopardy; 
3.  Does not limit or allocate reimbursement for any provider based on the availability 
of the provider's non-MaineCare revenues; and 
4.  Publishes on a publicly accessible website the reimbursement rates and any related 
exception adjustments of all providers; and be it further 
Sec. 2.  General Fund; appropriation for exceptions and quality 
outcomes.  Resolved:  That the Department of Health and Human Services shall 
establish a pool of up to 10% of the available General Fund appropriations for payment to 
nursing facilities serving MaineCare patients to reward qualified providers that meet the 
standards pursuant to section 1, subsection 2. 
Emergency clause.  In view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
SUMMARY 
This resolve instructs the Department of Health and Human Services to eliminate  the 
current nursing home reimbursement peer group limits and establish a capitated system 
that treats all facilities equally by setting MaineCare rates as a percentage of the existing 
Medicare acuity-based resource utilization group rates.  It also requires the department to 
publish on a publicly accessible website its reimbursement rates and any related 
exception adjustments of all providers.  Availability of MaineCare funds will be used to 
determine the base percentage and a pool available for exceptions and rewards.  Up to 
10% of available funds are allowed in the pool.