An Act To Address Severe and Ongoing Shortfalls in the Funding of Direct Care Workers in Long-term Care Settings and To Establish the Commission To Study Long-tenn Care Workforce Issues
Maine Legislature, Session 128, LD 1466
Committee Amendment CA_A_S186 (Senate)

COMMITTEE AMENDMENT "A" to S.P. 512, L.D. 1466, Bill, "An Act To 
Address Severe and Ongoing Shortfalls in the Funding of Direct Care Workers in Long-
term Care Settings and To Establish the Commission To Study Long-tenn Care 
Workforce Issues" 
Amend the bill in section 1 by striking out all of subsection 2 (page 1, lines 33 to 35 
in L.D.) and inserting the following: 
'2. Rate increases for fiscal year 2018-19 and thereafter. For the state fiscal year 
ending June 30, 2019 and each year thereafter, the MaineCare payment rates for personal 
I 7 
care and related services under each of the provisions under this section calculated under 
subsection I must be increased by an inflation adjustment cost-of-living percentage 
change in reimbursement in accordance with the United States Department of Labor, 
Bureau of Labor Statistics, Consumer Price Index medical care services index.' 
. Amend the bill in section 2 by striking out all of subsection 2 (page 2, lines 8 to 11 in 
L.D.) and inse1ting the following: 
'2. Rate increases for fiscal year 2018-19 and thereafter until completion of rate 
study. For the state fiscal year ending June 30, 2019 and each year thereafter until the 
completion of the rate study under subsection 3, the MaineCare payment rates attributable 
to wages and salaries for personal care and related services under each of the provisions 
under this section calculated under subsection 1 must be increased by an inflation 
adjustment cost-of-living percentage change in reimbursement in accordance with the 
United States Depaiiment of Labor, Bureau of Labor Statistics, Consumer Price Index 
medical care services index. 
3. Rate study. Cost-of-living increases as described in subsection 2 must continue 
on an annual basis until the Depaiiment of Health and Human Services has completed a 
rate study conducted by a 3rd pmiy, including participation of providers, for adult family 
care services, adult day services or homemaker services and the rates in the rate study 
have been implemented.' 
Page I - 128LR1387(02)-1 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A "to S.P. 512, L.D. 1466 
Amend the bill in section 3 by striking out all of subsection 2 (page 2, lines 30 to 41 
in L.D.) and inserting the following: 
'2. Rate increases for fiscal year 2018-19 and thereafter until completion of rate 
study. For the state fiscal year ending June 30, 2019 and each year thereafter until the 
completion of the rate study under subsection 3, an additional extraordinary circumstance 
supplemental allowance must be made as required by section 34 of the Principles of 
Reimbursement for Nursing Facilities equal to the amount of an inflation adjustment cost-
s 
of-living percentage change in reimbursement in accordance with the United States 
Department of Labor, Bureau of Labor Statistics, Consumer Price Index medical care 
services index of the portion of each facility's prospective and final prospective rate that 
is attributable to wages and wage-related benefits in both the direct care cost component 
and the routine care cost component. This supplemental allowance must be provided as 
part of each facility's prospective rate, notwithstanding any otherwise applicable caps or 
limits on reimbursement. This supplemental allowance must also be allowed and paid at 
final audit to the full extent that the facility has reported increased costs for wages and 
wage-related benefits, notwithstanding any otherwise applicable caps or limits on 
reimbursement, including without limitation the amount of the supplemental allowance 
added to prospective payment rates. 
3. Rate study. Cost-of-living increases as described in subsection 2 must continue 
on an annual basis until the Department of Health and Human Services has completed a 
rate study conducted by a 3rd pmty, including pmiicipation of providers, for nursing 
facilities and the rates in the rate study have been implemented.' 
Amend the bill in section 4 by striking out all of subsection 2 (page 3, lines 17 to 29 
in L.D.) and inse1iing the following: 
'2. Rate increase for fiscal year 2018-19 and thereafter until completion of rate 
study. For the state fiscal year ending June 30, 2019 and each year thereafter until the 
completion of the rate study under subsection 3, additional reimbursement by a 
supplemental payment in the amount of an inflation adjustment cost-of-living percentage 
change in reimbursement in accordance with the United States Department of Labor, 
Bureau of Labor Statistics, Consumer Price Index medical care services index over the 
payment rate calculated under subsection 1 of the portion of the facility's per diem rate 
that is attributable to wages, wage-related benefits and workers' compensation must be 
added to the per diem rate until the department adjusts the direct care pricer, the routine 
limit and the personal care services limit, as applicable, to incorporate this increase going 
forward. This increase must be provided as pmi of each facility's per diem rate 
notwithstanding any otherwise applicable caps or limits on reimbursement. This 
7 
supplemental payment must also be allowed and paid at final audit to the full extent that 
8 
the facility has rep01ied increased costs for wages, wage-related benefits and workers' 
compensation, 
notwithstanding 
any 
otherwise 
applicable 
caps 
or 
limits 
on 
reimbursement, including without limitation the amount of the supplemental payment 
added to prospective payment rates. 
3. Rate study. Cost-of-living increases as described in subsection 2 must continue 
on an annual basis until the Depmiment of Health and Human Services has completed a 
rate study conducted by a 3rd pmty, including participation of providers, for residential 
care facilities and the rates in the rate study have been implemented.' 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A" to S.P. 512, L.D. 1466 
Amend the bill in section 5 in subsection 9 in the first line (page 5, line 30 in L.D.) by 
striking out the following: "October 15" and inse1iing the following: 'December 2' 
Amend the bill by inse1iing after section 5 the following: 
'Sec. 6. Appropriations and allocations. 
The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Developmental Services - Community 0122 
Initiative: Provides appropriations for an increase to rates for certain services. 
GENERAL FUND 
All Other 
GENERAL FUND TOT AL 
2017-18 
$66,990 
$66,990 
Long Term Care - Office of Aging and Disability Services 0420 
2018-19 
$96,465 
$96,465 
Initiative: Provides appropriations for an increase to rates for ce1iain services. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Medical Care - Payments to Providers 0147 
2017-18 
$929,673 
$929,673 
2018-19 
$1,421,378 
$1,421,378 
Initiative: Provides appropriations and allocations for an increase to rates for cetiain 
set'Vtces. 
GENERAL FUND 
All Other 
GENERAL FUND TOT AL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2017-18 
$6,405,351 
$6,405,351 
2017-18 
$20,085,327 
$20,085,327 
COMMITTEE AMENDMENT 
2018-19 
$9,585,335 
$9,585,335 
2018-19 
$35,811,906 
$35,811,906 
I 
COMMITTEE AMENDMENT" A" to S.P. 512, L.D. 1466 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOT AL 
Nursing Facilities 0148 
2017-18 
$773,294 
$773,294 
2018-19 
$1,214,774 
$1,214,774 
Initiative: Provides appropriations and allocations for an increase to rates for certain 
services. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
PNMI Room and Board Z009 
2017-18 
$18,901,499 
$18,901,499 
2017-18 
$1,661,427 
$1,661,427 
2018-19 
$24,563,125 
$24,563,125 
2018-19 
$2,609,923 
$2,609,923 
Initiative: Provides appropriations for an increase to rates for certain services. 
GENERAL FUND 
2017-18 
2018-19 
All Other 
$1,031,058 
$1,619,699 
GENERAL FUND TOT AL 
$1,031,058 
$1,619,699 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLYDHS) 
DEPARTMENT TOTALS 
2017-18 
2018-19 
GENERAL FUND 
$27 ,334,571 
$37 ,286,002 
FEDERAL EXPENDITURES FUND 
$20,085,327 
$35,811,906 
OTHER SPECIAL REVENUE FUNDS 
$2,434,721 
$3,824,697 
DEPARTMENT TOTAL - ALL FUNDS 
$49,854,619 
$76,922,605 
SUMMARY 
This amendment, which is the majority report of the committee, makes the following 
changes to the bill. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to S.P. 512, L.D. 1466 
1. Instead of the 10% increase proposed in the bill, the amendment provides that rate 
increases for fiscal year 2018-19 for all services in the bill must be paid according to the 
inflation adjustment cost-of-living percentage change to reimbursement in accordance 
with the United States Depaitment of Labor, Bureau of Labor Statistics, Consumer Price 
Index medical care services index. 
2. The amendment provides that rate increases for fiscal year 2019-20 and annually 
thereafter for those services must be paid using the same adjustment as fiscal year 2018-
until a rate study has been completed by the Department of Health and Human 
Services, conducted by a 3rd party and including the participation of providers, and the 
rates in the rate study have been implemented. 
3. It changes the date of the repo1i from the Commission To Study Long-te1m Care 
Workforce Issues from October 15, 2017 to December 2, 2017. 
4. It adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/22/17 wac 
LD 1466 
LR 1387(02) 
An Act To Address Severe and Ongoing Shortfalls in the Funding of Direct Care Workers in Long-
term Care Settings and To Establish the Commission To Study Long-term Care Workforce Issues 
Fiscal Note for Bill as Amended by Committee Amendment A" ( S ~ / t3lo) 
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 
Legislative Cost/Study 
Fiscal Note Required: Yes 
Fiscal Note 
Legislative Cost/Study 
FY 2017-18 
$27,334,571 
$27,334,571 
$20,085,327 
$2,434,721 
$20,085,327 
$2,434,721 
FY 2018-19 
$37,286,002 
$37,286,002 
$35,811,906 
$3,824,697 
$35,811,906 
$3,824,697 
Projections 
FY 2019-20 
$47,277,606 
$47,277,606 
$47,987,727 
$4,993,336 
$47,987,727 
$4,993,336 
Projections 
FY 2020-21 
$55,530,669 
$55,530,669 
$61,827,858 
$6,161,975 
$61,827,858 
$6,161,975 
The general operating expenses of this study are projected to be $2,750 in fiscal year 2017-18. The Legislature's 
proposed budget includes $10,000 in fiscal year 2017-18 for legislative studies. Whether this amount is sufficient to 
fund all studies will depend on the number of studies authorized by the Legislative Council and the Legislature. The 
additional costs of providing staffing assistance to the study during the interim can be absorbed utilizing existing 
budgeted staff resources. 
Fiscal Detail and Notes 
The bill includes General Fund appropriations to the Department of Health and Human Services of $27,334,571 in 
fiscal year 2017-18 and $3 7 ,286,002 in fiscal year 2018-19 for an increase to rates for certain services. Federal 
Expenditures Fund allocations are also included for the FMAP match and Other Special Revenue Funds allocations 
for the healthcare provider tax and the service provider tax. 
Additional costs to the Department of Labor related to the Commissioner or the commissioner's designee participating 
on the commission can be absorbed within existing budgeted resources. 
LR1387(02) - Fiscal Note - Page 1 of 1