An Act To Assist Nursing Homes in the Management of Facility Beds
Maine Legislature, Session 129, LD 1577
Committee: Health and Human Services
Sponsors: PERRY
Amends: 22 MRSA §333, 22 MRSA §1720

Legislative Document
No. 1577
H.P. 1139
House of Representatives, April 16, 2019
An Act To Assist Nursing Homes in the Management of Facility 
Beds
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative PERRY of Calais.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §333, sub-§1, as amended by PL 2011, c. 648, §2, is further 
amended to read:
1.  Procedures.  A nursing facility that voluntarily reduces the number of its licensed 
beds at any time prior to July 1, 2007, for any reason except to create private rooms may 
convert the beds back and thereby increase the number of nursing facility beds to no more 
than the previously licensed number of nursing facility beds, after obtaining a certificate 
of need in accordance with this section, as long as the nursing facility has been in 
continuous operation without material change of ownership.  For purposes of this section 
and sections 333-A and 334-A, beds voluntarily removed from service prior to July 1, 
2007 and available to be reinstated under this section are referred to as "reserved beds."  
Reserved beds remain facility property until they lapse as provided for in this section or 
are transferred.  To reinstate reserved beds under this subsection, the nursing facility must 
shall:
A.  Give notice of the number of beds it is reserving no later than 30 days after the 
effective date of the license reduction; 
A-1.  Annually provide notice to the department no later than July 1st of each year of 
the nursing facility's intent to retain these reserved beds, subject to the limitations set 
forth in subsection 2, paragraph B.  Notice provided under this paragraph preserves 
the reserved beds through June 30th of the following year.  The annual notice on 
reserved beds may be filed by an individual nursing facility or by multiple nursing 
facilities through a membership organization approved by the department by a single 
filing; and
B.  Obtain a certificate of need to convert beds back under section 335, except that, if 
no construction is required for the conversion of beds back, the application must be 
processed in accordance with subsection 2.  The department in its review shall 
evaluate the impact that the nursing facility beds to be converted back would have on 
those existing nursing facility beds and facilities within 30 miles of the applicant's 
facility and shall determine whether to approve the request based on current 
certificate of need criteria and methodology.
Sec. 2.  22 MRSA §333, sub-§2, ¶A, as enacted by PL 2001, c. 664, §2, is 
amended to read:
A.  Review of applications that meet the requirements of this section must be based 
on the requirements of section 335, subsection 7, except that the determinations 
required by section 335, subsection 7, paragraph B must be based on the historical 
costs of operating the beds and must consider whether the projected costs are 
consistent with the costs of the beds prior to closure, adjusted for inflation 
applications that seek to reopen reserved beds must be approved if the projected 
incremental costs of reopening and operating the reserved beds are consistent with 
the facility's costs of operating its other beds.  Applicants are not required to 
demonstrate that any increases in MaineCare costs are offset by other MaineCare 
savings.  The costs of ongoing operation of both the reopened beds and the 
complement of facility beds at the time the reserved beds are reopened must be 
recognized as allowable costs and incorporated into the facility's MaineCare payment 
rates; and
Sec. 3.  22 MRSA §1720, as enacted by PL 2005, c. 242, §1, 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 incurred by the facility for a 
medical director in a base year amount not to exceed $10,000, with that amount being 
subject to an annual cost-of-living adjustment.
Sec. 4.  Cost of computer and cloud-based software systems a fixed cost.  
Beginning October 1, 2019, the cost incurred by a nursing facility for the acquisition, 
including set-up costs, use and maintenance, of computer or cloud-based software 
systems must be included as a fixed cost by the Department of Health and Human 
Services in its rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 67, 
Principles of Reimbursement for Nursing Facilities.  Costs included pursuant to this 
section must include without limitation the costs of hardware, if any, software and 
software support.
Sec. 5.  Bed hold reimbursement for adult family care services.  The 
Department of Health and Human Services shall amend its rule Chapter 101: MaineCare 
Benefits Manual, Chapter III, Section 2, Adult Family Care Services, no later than 
December 15, 2019 to provide reimbursement for up to 30 bed hold days per calendar 
year when the resident is absent from the facility.
Sec. 6.  Cost of health insurance a fixed cost.  The Department of Health and 
Human Services shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter 
III, Section 67, Principles of Reimbursement for Nursing Facilities no later than 
December 15, 2019 to include the cost of health insurance for employees attributable to 
MaineCare residents as a fixed cost.
Sec. 7.  Partial reimbursement to nursing facilities for certain bad debt.  
The Department of Health and Human Services shall amend its rule Chapter 101: 
MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for 
Nursing Facilities no later than December 15, 2019 to include reimbursement for 50% of 
a nursing facility's charges for a maximum of 6 months for a newly admitted resident who 
is determined to be financially ineligible for MaineCare after the resident is admitted to 
the nursing facility and the charges remain unpaid after reasonable efforts are made by 
the nursing facility to collect the debt based on these charges.
SUMMARY
This bill restores the ability of nursing facilities to voluntarily reduce the number of 
their licensed beds and then later increase the number of their licensed beds to the prior 
level after obtaining a certificate of need and meeting certain conditions.
The bill modifies the process to obtain certificate of need approval to reopen reserved 
beds.  Applications that seek to reopen reserved beds must be approved if the projected 
incremental costs of reopening and operating the reopened beds are consistent with the 
facility's costs of operating its other beds.  Applicants are not required to demonstrate that 
any increases in MaineCare costs are offset by other MaineCare savings.  The costs of 
ongoing operation of both the restored beds and the complement of facility beds at the 
time the reserved beds are reopened must be recognized as allowable costs and 
incorporated into the facility's MaineCare payment rates.
The bill requires the Department of Health and Human Services to include in its 
calculation of reimbursement for services provided by a nursing facility the cost incurred 
by the facility for a medical director.
The bill requires the cost incurred by a nursing facility for the acquisition, use and 
maintenance of computer or cloud-based software systems to be included as a fixed cost.
The bill requires the Department of Health and Human Services to amend its rules 
governing adult family care services to provide reimbursement for up to 30 bed hold days 
per calendar year when a resident is absent from a facility.
The bill requires the Department of Health and Human Services to amend its rules 
governing principles of reimbursement for nursing facilities to include the cost of health 
insurance for employees attributable to MaineCare residents as a fixed cost.  It also 
requires the department to amend these rules to include reimbursement for 50% of a 
nursing facility's charges for a maximum of 6 months for a newly admitted resident who 
is determined to be financially ineligible for MaineCare after the resident is admitted to 
the nursing facility and the charges remain unpaid after reasonable efforts are made by 
the nursing facility to collect the debt based on these charges.