An Act To Amend Principles of Reimbursement for Nursing Facilities and for Residential Care Facilities
Maine Legislature, Session 128, LD 0517
Committee Amendment CA_A_S91 (Senate)
Amends: 22 MRSA §1720

COMMITTEE AMENDMENT "A "to S.P. 178, L.D. 517, Bill, "An Act To 
Amend Principles of Reimbursement for Nursing Facilities and for Residential Care 
Facilities" 
Amend the bill by striking out all of section 1 and inserting the following: 
'Sec. 1. 22 MRSA §1720, as enacted by PL 2005, c. 242, §I, is amended to read: 
§1720. Nursing facility medical director reimbursement 
The department shall include in its calculation of reimbursement for services 
provided by a nursing facility an allowance for the cost of a medical director in a base 
year amount not to exceed $10,000 $22,000, with that amount being subject to an annual 
cost-of-living adjustment.' 
Amend the bill in section 2 in §7863 in subsection I in the 3rd line (page 1, line 12 in 
L.D.) by striking out the following: "$2,000,000" and inserting the following: '$500,000' 
Amend the bill in section 2 in §7863 in subsection I in the 6th line (page 1, line 15 in 
L.D.) by striking out the following: "$2,000,000" and inserting the following: '$500,000' 
Amend the bill in section 2 in §7863 in subsection I in the last line (page 1, line 19 in 
L.D.) by striking out the following: "$2,000,000" and inserting the following: '$500,000' 
Amend the bill in section 2 in §7863 in subsection 3 in the 2nd line (page I, line 39 in 
L.D.) by inserting after the following: "rules" the following: 'or local ordinances' 
Amend the bill by adding after section 2 the following: 
'Sec. 3. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Nursing Facilities 0148 
Initiative: Provides funding for nursing facilities to increase the cap on the allowance for 
the cost of a medical director from $10,000 to $22,000. 
COMMITTEE AMENDMENT 
R. cA S. 
COMMITTEE AMENDMENT" A" to S.P. 178, L.D. 517 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
SUMMARY 
2017-18 
$26,448 
$26,448 
2017-18 
$57,401 
$57,401 
2017-18 
$5,352 
$5,352 
2018-19 
$28,862 
$28,862 
2018-19 
$62,609 
$62,609 
2018-19 
$5,839 
$5,839 
This amendment changes the allowance for a nursing facility medical director from 
$10,000 to $22,000. The bill proposes to remove the allowance cap entirely. 
The 
amendment changes the amount above which a residential care facility would need 
Department of Health and Human Services approval for new construction, acquisitions 
and renovations to $500,000 rather than $2,000,000 as in the bill. It also clarifies that 
residential facilities may be reimbursed for costs to comply with changes in local 
ordinances in addition to federal or state laws. 
The amendment also adds an 
appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/04/17 fe.ac 
LD 517 
LR 975(02) 
An Act To Amend Principles of Reimbursement for Nursing Facilities and for Residential Care 
Facilities 
Fiscal Note for Bill as Amended by Committee Amendment 'pt ( S- q ~ 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Federal Expenditures Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2017-18 
$26,448 
$26,448 
$57,401 
$5,352 
$57,401 
$5,352 
FY 2018-19 
$28,862 
$28,862 
$62,609 
$5,839 
$62,609 
$5,839 
Projections 
FY 2019-20 
$28,862 
$28,862 
$62,609 
$5,839 
$62,609 
$5,839 
Projections 
FY 2020-21 
$28,862 
$28,862 
$62,609 
$5,839 
$62,609 
$5,839 
The bill includes General Fund appropriations to the Department of Health and Human Services of $26,448 in fiscal 
year 2017-18 and $28,862 in fiscal year 2018-19 for nursing facilites to increase the cap on the cost of a Medical 
Director from $10,000 to $22,000. Federal Expenditures Fund allocations will also be required for the FMAP match 
and Other Special Revenue Funds allocations for the increased nursing facilities tax. 
This bill also requires the Department of Health and Human Services to pennit capital expenditures by residential care 
facilities (RCF) that are less than $500,000 without prior approval and to provide an extraordinary circumstance 
allowance in pennitted reimbursement to RCF's. Costs incurred by an RCF to comply with federal or state laws, 
regulations and rules shall be considered reasonable and necessary costs. These additional changes to the Residential 
Care Facilities will increase costs that will largely be necessitated by decisions of the RCFs that cannot be projected 
by the department. Since new construction, acquisitions, and renovations apply to room and board and not direct care, 
which cannot be reimbursed with federal funds per 42 CPR 440.182, it is also expected that these costs would be 
reimbursed entirely by the General Fund. 
LR0975(02) - Fiscal Note - Page 1 of 1