An Act To Clarify and Amend MaineCare Reimbursement Provisions for Nursing and Residential Care Facilities
Maine Legislature, Session 129, LD 1758
Committee Amendment CA_A_S265 (Senate)

COMMITTEE AMENDMENT " fr " to S.P. 588, L.D. 1758, Bill, "An Act To 
Clarify and Amend MaineCare Reimbursement Provisions for Nursing and Residential 
Care Facilities" 
Amend the bill by striking out everything after the enacting clause and before the 
emergency clause and inserting the following: 
'Sec. 1. PL 2017, c. 460, Pt. B, §3, sub-§1 is amended to read: 
1. Special wage allowance for fiscal year 2018-19 and subsequent fiscal years. 
For the state fiscal year ending June 30, 2019, a special supplemental allowance must be 
made to provide for increases in wages and wage-related benefits in both the direct care 
cost component and routine care cost component as follows. An amount equal to 10% of 
allowable wages and associated benefits and taxes as reported on each facility's as-filed 
cost report for its fiscal year ending in calendar year 2016 must be added to the cost per 
resident day in calculating 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 it does not cause reimbursement to 
exceed the facility's allowable costs in that fiscal year. The supplemental allowance for 
the state fiscal year ending June 30, 2019 provided pursuant to this subsection must 
continue in each successive fiscal year until the fiscal year in which the rebasing under 
the Maine Revised Statutes, Title 22, section 1708, subsection 3, paragraph F is based on 
2019 as-filed cost report data and has incorporated the costs of wages and allowable 
benefits and taxes of a facility. 
Sec. 2. PL 2017, c. 460, Pt. B, §3, sub-§§1-A and 1-B are enacted to read: 
1-A. Additional special wage allowance for fiscal year 2019-20 and subsequent 
fiscal years. 
For the state fiscal year ending June 30, 2020, an additional special 
supplemental allowance must be made to provide for increases in contract labor, wages 
and allowable benefits and taxes in both the direct care component and routine care 
component as follows. An amount equal to 10% of allowable contract labor, wages and 
allowable benefits and taxes as reported on each facility's as-filed cost report for its fiscal 
year ending in calendar year 2017 must be added to the cost per resident day in 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "H "to S.P. 588, L.D. 1758 
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calculating each facility's prospective rate, notwithstanding any otherwise applicable caps 
or limits on reimbursement to the contrary. This additional supplemental allowance must 
be allowed and paid at final audit to the full extent that it does not cause reimbursement 
to exceed the facility's allowable costs in that fiscal year. The additional supplemental 
allowance for fiscal years ending in calendar year 2020 must be paid in each successive 
state fiscal year until the fiscal year in which a rebasing under the Maine Revised 
Statutes, Title 22, section 1708, subsection 3, paragraph F is based on 2020 as-filed cost 
report data and has incorporated the costs of contract labor, wages and allowable benefits 
and taxes of a facility. For the purposes of this subsection, "contract labor" includes 
nursing, housekeeping, dietary, laundry and related services. 
1-B. 
No limitation. 
The increases in reimbursement rates that result from 
implementation of this Act are not limited to only wage and wage-related costs. 
Sec. 3. PL 2017, c. 460, Pt. B, §4, sub-§1 is amended to read: 
1. Special wage allowance for fiscal year 2018-19 and subsequent fiscal years. 
For the state fiscal year ending June 30, 2019, a special supplemental allowance must be 
made to provide for increases in wages and wage-related benefits in the direct care, 
personal care services and routine cost components as follows. An amount equal to 10% 
of wages and associated benefits and taxes as reported on each facility's as-filed cost 
report for its fiscal year ending in calendar year 2016 must be added to the cost per 
resident day in calculating 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 it does not cause reimbursement to 
exceed the facility's allowable costs in each component that is cost settled in that fiscal 
year. The supplemental allowance for the state fiscal year ending in June 30, 2019 
provided pursuant to this subsection must continue in each successive fiscal year until the 
fiscal year in which the re based rates have incorporated the costs of wages and allowable 
benefits and taxes that were reported on each facility's as-filed cost report for its fiscal 
year ending in calendar year 2019. 
Sec. 4. PL 2017, c. 460, Pt. B, §4, sub-§§1-A and 1-B are enacted to read: 
1-A. Additional special wage allowance for fiscal year 2019-20 and subsequent 
fiscal years. 
For the state fiscal year ending June 30, 2020, an additional special 
supplemental allowance must be made to provide for increases in contract labor, wages 
and allowable benefits and taxes in the direct care, personal care services and routine care 
cost components as follows. An amount equal to 10% of allowable contract labor, wages 
and allowable benefits and taxes as reported on each facility's as-filed cost report for its 
fiscal year ending in calendar year 2017 must be added to the cost per resident day in 
calculating each facility's prospective rate, notwithstanding any otherwise applicable caps 
or limits on reimbursement to the contrary. The additional supplemental allowance must 
be allowed and paid at final audit to the full extent that it does not cause reimbursement 
to exceed the facility's allowable costs in that fiscal year. The supplemental allowance 
must be paid in each fiscal year after state fiscal year 2019-20 until the fiscal year in 
which rates have been rebased using 2020 or a later calendar year as a base year and the 
rebased rates have incorporated the costs of contract labor, wages and allowable benefits 
and taxes that were reported on each facility's as-filed cost report for its fiscal year ending 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" 1\ "to S.P. 588, L.D. 1758 / 
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in calendar year 2020. For purposes of this subsection, "contract labor" includes nursing, 
housekeeping, dietary, laundry and related services. 
1-B. 
No limitation. 
The increases in reimbursement rates that result from 
implementation of this Act are not limited to only wage and wage-related costs. 
Sec. 5. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care - Payments to Providers 0147 
Initiative: Provides appropriations and allocations for residential care facility wage 
allowances. 
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 
2019-20 
$4,105,583 
$4,105,583 
2019-20 
$8,904,769 
$8,904,769 
2019-20 
$907,699 
$907,699 
2020-21 
$4,130,636 
$4,130,636 
2020-21 
$8,879,717 
$8,879,717 
2020-21 
$907,699 
$907,699 
Initiative: Provides appropriations and allocations for nursing facility wage allowances. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
2019-20 
$10,967,325 
$10,967,325 
2019-20 
$23,374,065 
COMMITTEE AMENDMENT 
2020-21 
$7,399,924 
$7,399,924 
2020-21 
$15,632,951 
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COMMITTEE AMENDMENT" I~\-" to S.P. 588, L.D. 1758 
FEDERAL EXPENDITURES FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
PNMI Room and Board Z009 
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$23,374,065 
$15,632,951 
2019-20 
$2,192,004 
$2,192,004 
2020-21 
$1,470,183 
$1,470,183 
Initiative: Provides appropriations and allocations for residential care facility wage 
allowances. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
2019-20 
$1,210,265 
$1,210,265 
2019-20 
$16,283,173 
$32,278,834 
$3,099,703 
2020-21 
$1,210,265 
$1,210,265 
2020-21 
$12,740,825 
$24,512,668 
$2,377,882 
$51,661,710 
$39,631,375 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment removes the sections of the bill that require additional cost-of-living 
adjustments to nursing facilities and residential care facilities and supplemental 
allowances for facilities with a high proportion of MaineCare residents and facilities with 
specialty beds. It retains the requirements for the 10% one-time supplemental payment 
provided in Public Law 2017, chapter 460, Part B to nursing facilities and residential care 
facilities to continue in successive years until rebasing incorporates the increase, but the 
amendment removes the retroactive requirement to include contract labor. It retains the 
requirement to grant an additional 10% increase that is carried forward until rebasing 
incorporates the increase, but it removes the language relating to requiring increases to go 
to routine care cost components of the rates. It removes the specific prohibition upon the 
Department of Health and Human Services to require a nursing facility or residential care 
COMMITTEE AMENDMENT 
COMMITTEEAMENDMENT" /+"toS.P.588,L.D.1758 ( 
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facility to demonstrate how increased reimbursement is applied to wages and benefits to 
direct care workers but specifies that the increased reimbursement is not limited to only 
wages and wage-related costs. It removes the retroactivity section of the bill but retains 
the emergency provision of the bill. It adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/04/19 feac 
LD 1758 
LR 1523(02) 
An Act To Clarify and Amend MaineCare Reimbursement Provisions for Nursing and Residential 
Care Facilities 
Fiscal Note for Bill as Amended by Committee Amendment "if ( ,:-' 
;: (£.• 
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 
FY 2019-20 
$16,283,173 
$16,283,173 
$32,278,834 
$3,099,703 
$32,278,834 
$3,099,703 
FY 2020-21 
$12,740,825 
$12,740,825 
$24,512,668 
$2,377,882 
$24,512,668 
$2,377,882 
Projections 
FY 2021-22 
$12,740,825 
$12,740,825 
$24,512,668 
$2,377,882 
$24,512,668 
$2,377,882 
Projections 
FY2022-23 
$5,340,901 
$5,340,901 
$8,879,717 
$907,699 
$8,879,717 
$907,699 
The bill includes General Fund appropriations to the Department of Health and Human Services of $16,283, 173 in 
fiscal year 2019-20 and $12,740,825 in fiscal year 2020-21 for residential care facility and nursing facility wage 
allowances. 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 1, 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, ,rq, 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 bill, 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. 
LR1523(02) - Fiscal Note - Page I of I