An Act To Improve Rural Health Care
Maine Legislature, Session 129, LD 1350
Committee Amendment CA_A_S259 (Senate)

FffiST REGULAR SESSION 
COMMITTEE AMENDMENT "(\-" to S.P. 418, L.D. 1350, Bill, "An Act To 
Improve Rural Health Care" 
Amend the bill in section 1 in paragraph QQ in the 2nd line (page 1, line 4 in L.D.) 
by inserting after the following: "income" the following: 'and not subtracted under 
paragraph FF' 
Amend the bill by striking out all of sections 3 and 4 and inserting the following: 
'Sec. 3. 
Reimbursement for acute care critical access hospitals. 
The 
Department of Health and Human Services shall amend its rule Chapter 101: MaineCare 
Benefits Manual, Chapter III, Section 45 regarding acute care critical access hospital 
physician services to require MaineCare reimbursement of 100% for all hospital-based 
physician costs. 
Sec. 4. Reimbursement for rural health clinics. The Department of Health 
and Human Services shall amend its rule Chapter 101: MaineCare Benefits Manual, 
Chapter II, Section 103 regarding the department's reimbursement methodology to 
provide an alternative payment methodology option that, effective January 1, 2020, is the 
same as the existing methodology except that rural health clinics may be reimbursed on 
the basis of 100% of the average of the reasonable costs of providing MaineCare-covered 
services during calendar years 2016 and 2017 as long as reimbursement is no less than 
reimbursement received under the prospective payment system described in Section 
1902(bb) of the United States Social Security Act. Each rural health clinic must be given 
the option to be reimbursed under the methodology required by this section or under the 
existing prospective payment system methodology. 
Sec. 5. State plan amendments; rulemaking. The Department of Health and 
Human Services shall submit any necessary state plan amendments to implement the 
requirements of this Act to the United States Department of Health and Human Services, 
Centers for Medicare and Medicaid Services no later than January 1, 2020. 
Upon 
approval, the department shall amend its rules within 180 days of approval. Rules 
adopted pursuant to this section are routine technical rules as defined in the Maine 
Revised Statutes, Title 5, chapter 375, subchapter 2-A. 
COMMITTEE AMENDMENT 
t,.. tl-~· 
COMMITTEE AMENDMENT" I\ "to S.P. 418, L.D. 1350 ( s- 2, c;c,, 
Sec. 6. Appropriations and allocations. The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Revenue Services, Bureau of 0002 
Initiative: Provides one-time funding for computer programming to update the individual 
income tax return. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
ADMINISTRATIVE AND FINANCIAL 
SERVICES, DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
2019-20 
$0 
$0 
2019-20 
$0 
$0 
2020-21 
$11,000 
$11,000 
2020-21 
$11,000 
$11,000 
HEAL TH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care -Payments to Providers 0147 
Initiative: Provides appropriations and allocations to allow for MaineCare reimbursement 
of 100% for all hospital-based physician costs. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Medical Care -Payments to Providers 0147 
2019-20 
$371,768 
$371,768 
2019-20 
$793,942 
$793,942 
2020-21 
$753,736 
$753,736 
2020-21 
$1,577,684 
$1,577,684 
Initiative: Provides appropriations and allocations to allow for MaineCare reimbursement 
for rural hospitals at 100% of inpatient hospital-based physician costs, outpatient 
emergency room hospital-based physician costs, outpatient nonemergency room hospital-
based physician costs and graduate medical education costs and to allow for MaineCare 
COMMITTEE AMENDMENT 
'(\. (t. ~· 
COMMITTEE AMENDMENT" ft" to S.P. 418, L.D. 1350 ( '.:)- 2 S cl) 
reimbursement for nonrural hospitals at 93.3% of inpatient hospital-based physician 
costs, 93.4% of outpatient emergency room hospital-based physician costs and 83.8% of 
outpatient nonemergency room hospital-based physician costs. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2019-20 
$263,428 
$263,428 
2019-20 
$562,573 
$562,573 
2020-21 
$534,084 
$534,084 
2020-21 
$1,117,918 
$1,117,918 
Medical Care -Payments to Providers 0147 
Initiative: Provides appropriations and allocations to allow for an alternative payment 
methodology option that, effective January 1, 2019, 
is the same as the existing 
methodology except that rural health clinics may be reimbursed on the basis of 100% of 
the average of the reasonable costs of providing MaineCare-covered services during 
calendar years 2016 and 2017 as long as reimbursement is no less than reimbursement 
received under the prospective payment system. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
DEPARTMENT TOTAL-ALL FUNDS 
2019-20 
$739,449 
$739,449 
2019-20 
$1,579,154 
$1,579,154 
2019-20 
$1,374,645 
$2,935,669 
$4,310,314 
COMMITTEE AMENDMENT 
2020-21 
$1,499,185 
$1,499,185 
2020-21 
$3,138,020 
$3,138,020 
2020-21 
$2,787,005 
$5,833,622 
$8,620,627 
f'i· cl.~· 
COMMITTEE AMENDMENT" /f "to S.P. 418,L.D.1350 ( S,· '2
1=::/t\ 
SECTION TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
SECTION TOTAL - ALL FUNDS 
2019-20 
$1,374,645 
$2,935,669 
$4,310,314 
2020-21 
$2,798,005 
$5,833,622 
$8,631,627 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SU1\1l\1ARY 
This amendment makes the following changes to the bill. 
1. It changes the reimbursement for acute care critical access hospitals to 100% for 
all hospital-based physician costs rather than facility and physician costs. 
2. 
It clarifies that rural health clinics are paid under an alternative payment 
methodology option that is the same as the current system except for rebasing costs to 
2016 and 2017 costs as long as the rural health clinics are not paid less than the current 
reimbursement rate. 
3. It requires the Department of Health and Human Services to submit any necessary 
state plan amendments to the United States Department of Health and Human Services, 
Centers for Medicare and Medicaid Services no later than January 1, 2020. Rulemaking 
must be completed by the department within 180 days ofreceiving federal approval. 
4. 
It adds language to clarify that taxpayers cannot claim a double benefit for 
educational opportunity tax credits. 
5. It adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/04/19 }Wac=.. 
LD 1350 
LR 749(02) 
An Act To Improve Rural Health Care 
Fiscal Note for Bill as Amended by Committee Amendment "ff' Ls· 2:Sc\) 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Revenue 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2019-20 
$1,374,645 
$1,374,645 
$2,935,669 
$0 
$2,936,669 
$0 
FY2020-21 
$2,931,005 
$2,798,005 
$5,833,622 
($133,000) 
$5,833,622 
($7,000) 
Projections 
FY2021-22 
$2,921,472 
$2,788,472 
$5,832,155 
($133,000) 
$5,832,155 
($7,000) 
Projections 
FY2022-23 
$2,921,472 
$2,788,472 
$5,832,055 
($133,000) 
$5,832,155 
($7,000) 
The bill includes General Fund appropriations to the Department of Health and Human Services of $1,374,645 in 
fiscal year 2019-20 and $2,787,005 in fiscal year 2020-21 for the Department of Health and Human Services to amend 
its rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 45 regarding the department's total annual 
obligation to rural and nonrural hospitals and acute care critical access hospitals and to amend its rule Chapter 101: 
MaineCare Benefits Manual, Chapter II, Section 103 regarding the department's reimbursement methodology to 
provide an alternative payment methodology option for rural health clinics. Federal Expenditures Fund allocations are 
also included for the FMAP match. 
The bill provides a subtraction modification from income tax for student loan payments made by a taxpayer's 
employer directly to a lender on behalf of a qualified health care employee. It would result in a reduction of General 
Fund revenue of$133,000 in fiscal year 2020-21 and a reduction in Local Government Fund revenue of$7,000 in 
fiscal year 2020-21. The bill includes a one-time General Fund appropriation of$11,000 in fiscal year 2020-21 for 
computer programming to update the individual income tax return. 
LR0749(02) - Fiscal Note - Page 1 of 1