Resolve, To Classify Employee Health Insurance as a Fixed Cost for MaineCare Reimbursement in Nursing Homes
Maine Legislature, Session 129, LD 1126
Committee Amendment CA_A_S87 (Senate)

COMMITTEE AMENDMENT " ft " to S.P. 346, L.D. 1126, "Resolve, To Classify 
Employee Health Insurance as a Fixed Cost for MaineCare Reimbursement in Nursing 
Homes" 
Amend the resolve by adding after section 1 the following: 
'Sec. 2. 
Appropriations and allocations. Resolved: 
That the following 
appropriations and allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Nursing Facilities 0148 
Initiative: Provides appropriations and allocations for the Department of Health and 
Human Services to amend its rule Chapter 101: MaineCare Benefits Manual, Chapter III, 
Section 67, Principles of Reimbursement for Nursing Facilities no later than January 1, 
2020 to include the costs of health insurance in the fixed costs component of 
reimbursement. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2019-20 
$2,798,184 
$2,798,184 
2019-20 
$5,963,617 
2020-21 
$5,642,972 
$5,642,972 
2020-21 
$11,880,629 
$5,963,617 
$11,880,629 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A "to S.P. 346, L.D. 1126 ( s..-;:fl! 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOT AL 
2019-20 
$559,264 
$559,264 
2020-21 
$1,118,528 
$1,118,528 
Amend the resolve by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 04/26/19 feac:.. 
LD 1126 
LR 1962(02) 
Resolve, To Classify Employee Health Insurance as a Fixed Cost for MaineCare Reimbursement in 
Nursing Homes 
Fiscal Note for Bill as Amended by Committee Amendment "P:' ( 5-251) 
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 
FY2019-20 
$2,798,184 
$2,798,184 
$5,963,617 
$559,264 
$5,963,617 
$559,264 
FY2020-21 
$5,642,972 
$5,642,972 
$11,880,629 
$1,118,528 
$11,880,629 
$1,118,528 
Projections 
FY 2021-22 
$5,646,701 
$5,646,701 
$11,876,900 
$1,118,528 
$11,876,900 
$1,118,528 
Projections 
FY 2022-23 
$5,646,701 
$5,646,701 
$11,876,900 
$1,118,528 
$11,876,900 
$1,118,528 
The bill includes General Fund appropriations to the Department of Health and Human Services (DHHS) of 
$2,798,184 in fiscal year 2019-20 and $5,642,972 in fiscal year 2020-21 to amend its rule Chapter 101: MaineCare 
Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities no later than January I, 
2020 to include the costs of health insurance in the fixed costs component of reimbursement. Federal Expenditures 
Fund allocations are also included for the FMAP match. 
The Upper Payment Limit (UPL) analysis for Nursing Facilities (NF) indicates that currently the NF payments in 
MaineCare are lower than Medicare by $12.5 million. The annual cost of living adjustments (COLA) for the NF's will 
go into effect on July I, 2019 and are estimated to increase the payments by $10.6 million. The impact of this change 
on the UPL will be limited by an increase to the Medicare rates to which the MaineCare rates are compared, but 
between the COLA and the cost from this bill, the NF costs will likely go over the UPL threshold. However, based on 
the language in statute (Title 22 § 1708 sub-§3, 1C) the DHHS must establish reimbursement rates that "are consistent 
with federal requirements relative to limits on reimbursement under the federal Social Security Act, Title XIX." Thus, 
the estimate of costs above includes all increases associated with the health insurance moving to fixed costs, with a 
federal match. If this does create a UPL issue, the DHHS will limit the payments to NF's to remain below the federally 
required limits. 
LR1962(02) - Fiscal Note - Page 1 of 1