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
Maine Legislature, Session 128, LD 1466
Committee Amendment CA_A-HA_A_H514 (House)

HOUSE AMENDMENT "4 " to 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-term Care Workforce Issues" 
Amend the amendment in page 2 by striking out all of the first paragraph and 
subsections 2 and 3 (page 2, lines 1 to 22 in amendment) and inserting the following: 
'Amend the bill in section 3 by striking out all of subsections 1 and 2 (page 2, lines 18 
to 41 in L.D.) and inserting the following: 
'1. Rate increases for fiscal year 2017-18. For the state fiscal year ending June 30, 
2018, an extraordinary circumstance supplemental allowance must be made as required 
by section 34 of the Principles of Reimbursement for Nursing Facilities equal to 10% 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 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, except that the allowance must be limited as provided in subsection 4. 
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, except that the allowance must be limited as provided in subsection 4. 
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-
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 
HOUSE AMENDMENT 
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HOUSE AMENDMENT" A 
"to COMMITTEE AMENDMENT "A" to S.P. 512, L.D. 1466 
limits on reimbursement, except that the allowance must be limited as provided in 
subsection 4. 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, except that the allowance must be limited as provided in 
subsection 4. 
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 party, including participation of providers, for nursing 
facilities and the rates in the rate study have been implemented. 
4. Upper payment limit. The supplemental allowances provided in this section to 
individual facilities must be limited as necessary to ensure that aggregate payments for 
nursing facility services do not exceed the upper payment limit established in 42 Code of 
Federal Regulations, Section 447.272, using the methods of complying with that limit set 
forth in section 10 of the Principles of Reimbursement for Nursing Facilities.'' 
Amend the amendment by striking out all of section 6 and inserting 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 TOTAL 
2017-18 
$66,990 
$66,990 
Long Term Care - Office of Aging and Disability Services 0420 
Initiative: Provides appropriations for an increase to rates for certain services. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Medical Care - Payments to Providers 0147 
2017-18 
$929,673 
$929,673 
2018-19 
$96,465 
$96,465 
2018-19 
$1,421,378 
$1,421,378 
Initiative: Provides appropriations and allocations for an increase to rates for certain 
services. 
HOUSE AMENDMENT 
HOUSE AMENDMENT ·A "to COMMITTEE AMENDMENT "A" to S.P. 512, L.D. 1466 
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 
Nursing Facilities 0148 
2017-18 
$6,405,351 
$6,405,351 
2017-18 
$30,776,608 
$30,776,608 
2017-18 
$773,294 
$773,294 
2018-19 
$9,585,335 
$9,585,335 
2018-19 
$47,473,310 
$47,473,310 
2018-19 
$1,214,774 
$1,214,774 
Initiative: Provides appropriations and allocations for an increase to rates for ce1iain 
services. 
GENERAL FUND 
2017-18 
2018-19 
All Other 
$8,210,218 
$12,901,721 
GENERAL FUND TOT AL 
$8,210,218 
$12,901,721 
OTHER SPECIAL REVENUE FUNDS 
2017-18 
2018-19 
All Other 
$1,661,427 
$2,609,923 
OTHER SPECIAL REVENUE FUNDS TOTAL 
$1,661,427 
$2,609,923 
PNMI Room and Board Z009 
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 TOTAL 
$1,031,058 
$1,619,699 
HOUSE AMENDMENT 
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"Ir' 
HOUSE AMENDMENT ·A "to COMMITIEE AMENDMENT "A" to S.P. 512, L.D. 1466 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
SUMMARY 
2017-18 
$16,643,290 
$30,776,608 
$2,434,721 
$49,854,619 
2018-19 
$25,624,598 
$47,473,310 
$3,824,697 
$76,922,605 
This amendment amends Committee Amendment 
11A
to limit increases for nursing 
facilities so as not to exceed federally established upper payment limits. 
FISCAL NOTE REQUIRED 
=) 
(~ee attac') 
SPONSOREDBY: ~~; 
(Representative PERRY) 
TOWN: Calais 
• 
HOUSE AMENDMENT 
Approved: 06/13/17 frae!. 
LD 1466 
LR 1387(04) 
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 House Amendment")(' to Committee Amendment "A" 
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 
Sponsor: Rep. Perry of Calais 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2017-18 
FY 2018-19 
Projections 
FY2019-20 
Projections 
FY2020-21 
($10,691,281) 
($11,661,404) 
($11,663,216) 
($11,661,404) 
($10,691,281) 
($11,661,404) 
($11,663,216) 
($11,661,404) 
$10,691,281 
$11,661,404 
$11,663,216 
$11,661,404 
$0 
$0 
$0 
$0 
$10,691,281 
$0 
$11,661,404 
$0 
$11,663,216 
$0 
$11,661,404 
$0 
The amendment reduces the General Fund appropriations to the Department of Health and Human Services by 
$10,691,281 in fiscal year 2017-18 and $11,661,404 in fiscal year 2018-19 due to a requirement that the rate increases 
in this bill are limited, as necessary, to ensure that aggregate payments for nursing facility services do not exceed the 
upper payment limit established in federal regulations, 42 CFR. §447.272. If the rate increase does not exceed the 
Upper Payment Limit (UPL), the payments will receive the full federal match. The original bill assumed that a large 
portion of the rate increase for Nursing Facilities would be funded 100% by General Fund dollars, as it was expected 
the increase would go well above the UPL. Federal Expenditures Fund allocations are increased by $10,691,281 in 
fiscal year 2017-18 and $11,661,404 in fiscal year 2018-19 for the increased FMAP match. 
LR1387(04) - Fiscal Note - Page 1 of 1