An Act To Improve Rural Health Care
Maine Legislature, Session 129, LD 1350
Committee: Health and Human Services
Sponsors: JACKSON, PERRY, CARPENTER, DAVIS, LUCHINI, HIGGINS, HUBBELL, MADIGAN, MAXMIN, STEARNS
Amends: 36 MRSA §5122

Legislative Document
No. 1350
S.P. 418
In Senate, March 21, 2019
An Act To Improve Rural Health Care
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by President JACKSON of Aroostook.
Cosponsored by Representative PERRY of Calais and
Senators: CARPENTER of Aroostook, DAVIS of Piscataquis, LUCHINI of Hancock, 
Representatives: HIGGINS of Dover-Foxcroft, HUBBELL of Bar Harbor, MADIGAN of 
Waterville, MAXMIN of Nobleboro, STEARNS of Guilford.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  36 MRSA §5122, sub-§2, ¶QQ is enacted to read:
QQ.  For taxable years beginning on or after January 1, 2019, to the extent included 
in federal adjusted gross income, student loan payments made by the taxpayer's 
employer directly to a lender on behalf of a qualified health care employee.  As used 
in this paragraph, "qualified health care employee" means an individual who is 
employed by a hospital located in this State and who is licensed under Title 32, 
chapter 31, subchapter 3 or 4; chapter 36, subchapter 4; or chapter 48, subchapter 2.
Sec. 2.  Reimbursement for rural hospitals and nonrural hospitals.  The 
Department of Health and Human Services shall amend its rule Chapter 101: MaineCare 
Benefits Manual, Chapter III, Section 45 in order to provide 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.  The department shall also 
amend its rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 45 in order 
to provide MaineCare 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.
The department shall adopt routine technical rules under the Maine Revised Statutes, 
Title 5, chapter 375, subchapter 2-A to establish a definition of "rural hospital" that 
reflects the regional access to hospital care and the population density of the public health 
district in which the hospital is located, as long as the following hospitals are considered 
rural hospitals:
1.  Northern Light A.R. Gould Hospital in Presque Isle;
2.  Cary Medical Center in Caribou;
3.  Franklin Memorial Hospital in Farmington;
4.  Northern Light Inland Hospital in Waterville;
5.  Northern Light Maine Coast Hospital in Ellsworth; and
6.  Northern Maine Medical Center in Fort Kent.
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 the department's total annual 
obligation to acute care critical access hospitals to require MaineCare reimbursement of 
100% for outpatient nonemergency room hospital-based costs and 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 prospective payment system 
reimbursement methodology to require that, effective January 1, 2019, rural health clinics 
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 and to begin annual 
adjustments based on the Medicare Economic Index for primary care services beginning 
in 2020. 
SUMMARY
This bill provides that, for taxable years beginning on or after January 1, 2019, 
student loan payments made by a taxpayer's employer directly to a lender on behalf of a 
qualified health care employee are not included in federal adjusted gross income for 
Maine income tax purposes.  The bill also directs the Department of Health and Human 
Services to amend its rule Chapter 101: MaineCare Benefits Manual, Chapter II and 
Chapter III regarding reimbursement to rural and nonrural hospitals, acute care critical 
access hospitals and rural health clinics.