An Act To Improve the Quality and Affordability of Primary Health Care Provided by Federally Qualified Health Centers
Maine Legislature, Session 130, LD 1787
Committee Amendment CA_A_S509 (Senate)
Amends: 22 MRSA §3174-V

CO:MivlITTEE AMENDMENT" A "to S.P. 625, L.D. 1787, "An Act To Improve the 
Quality and Affordability of Primary Health Care Provided by Federally Qualified Health 
Centers" 
Amend the bill by striking out everything after the enacting clause and before the 
emergency clause and inserting the following: 
'Sec. 1. 22 MRSA §3174-V, first 1, as amended by PL 2003, c. 20, Pt. K, §11, is 
further amended to read: 
Beginning in fiseal year 2003 04, the The reimbursement requirements listed in 
subseetioas 1 aad 2 set forth in this section apply to payments for certain federally qualified 
health centers as defined in 42 United States Code, Section 1395x, subsection(aa)(1993). 
Sec. 2. 22 MRSA §3174-V, sub-§3 is enacted to read: 
3. Updated base year option. No later than December 31, 2022, the department shall 
provide an alternative, updated prospective payment method for each federally qualified 
health center that is the same as the prospective payment system set forth in 42 United 
States Code, Section 1396a(bb)(3), except that the base year for determining the costs of 
providing services must be the average of the reasonable costs incurred in the center's fiscal 
years ending in 2018 and 2019, adjusted for any change in scope adjustments approved 
since the base year and for inflation measured by the federally qualified health center 
market basket percentage published by the United States Department of Health and Human 
Services, Centers for Medicare and Medicaid Services. Each federally qualified health 
center must be given the option to be reimbursed under the method provided by this 
subsection or under the method provided by federal law. After December 31, 2022, the 
department may update the base year described in this subsection to a more recent base 
year. 
Sec. 3. 22 MRSA §3174-V, sub-§4 is enacted to read: 
4. Change in scope adjustments. The department's method for adjusting for changes 
5 
in the scope of services provided by a federally qualified health center under the payment 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT ''I\- "to S.P. 625, L.D. 1787 { S Sb'j) 
model provided under subsection 3 or 42 United States Code, Section 1396a(bb)(3) must 
adjust the center's reimbursement rate to reflect changes in its costs of providing services 
whenever the center establishes that it has experienced a material change in either: 
A. The type, intensity, duration or quantity of services provided; or 
B. The characteristics of the population receiving a service that affect the cost of the 
service. 
An adjustment under this subsection must reflect costs incurred retroactive to the date that 
the department received the federally qualified health center request for the adjustment, 
unless the department determines that the change in scope was due to conditions or events 
that were beyond the control of the federally qualified health center, in which case the 
adjustment must be retroactive to the more recent of the date that the federally qualified 
health center incurred the cost increases requiring an adjustment and the date that is one 
year prior to the date the department received the federally qualified health center change 
in scope request. 
Sec. 4. 22 MRSA §3174-V, sub-§5 is enacted to read: 
5. Alternative payment model. The following requirements apply to any alternative 
payment model developed by the department for payments to federally qualified health 
centers. 
A. The alternative payment model must be consistent with the requirements of 42 
United States Code, Section 1396a(bb). 
B. As long as federal law continues to require that the department allow a federally 
qualified health center to elect to use the prospective payment system set forth in 42 
United States Code, Section 1396a(bb)(3), the alternative payment model developed 
under this subsection must be an additional option and not a replacement of the updated 
base year option provided in subsection 3. 
C. In developing the alternative payment model, the department shall consult with 
federally qualified health centers and provide a reasonable opportunity for dialogue 
and exchange of data before any rule implementing such a model is proposed. 
Sec. 5. 22 MRSA §3174-V, sub-§6 is enacted to read: 
6. Rulemaking. The department may adopt rules to implement subsections 3 to 5. 
Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2-A. 
Sec. 6. Rebasing process. The Department of Health and Human Services shall 
confer regularly with a statewide association of federally qualified health centers as it 
develops rates to implement the updated base year option required by the Maine Revised 
Statutes, Title 22, section 3174-V, subsection 3 and shall provide each federally qualified 
health center in the State with draft rates implementing the option and working papers 
supporting those rates. No later than December 31, 2022, the department shall issue final 
rate letters implementing the option for each federally qualified health center electing the 
option, effective retroactive to July 1, 2022. 
Sec. 7. 
Appropriations and allocations. The following appropriations and 
allocations are made. 
COMMITTEE AMENDMENT 
ROS 
' 
0;\ 
COMMITTEE AMENDMENT" A "to S.P. 625, L.D. 1787 { ') • c;7..J 'J 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care - Payments to Providers 0147 
Initiative: Provides funding for the Department of Health and Human Services to provide 
for re basing of federally qualified health center prospective payment system rates to 2018-
2019 average actual costs inflated to the current year using the federally qualified health 
center market basket percentage as an alternative to the current payment method. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
FEDERAL BLOCK GRANT FUND 
All Other 
FEDERAL BLOCK GRANT FUND TOTAL 
2021-22 
2022-23 
$0 
$5,215,763 
$0 
$5,215,763 
2021-22 
2022-23 
$0 
$11,928,420 
$0 
$11,928,420 
2021-22 
2022-23 
$0 
$483,287 
$0 
$483,287 
Sec. 8. Effective date. That section of this Act that enacts the Maine Revised 
Statutes, Title 22, section 3174-V, subsection 3 takes effect July 1, 2022.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the sections of the bill regarding reimbursement rates and 
adjustments, rebasing, alternative value-based payments and rulemaking in order to 
provide for re basing of federally qualified health center rates as the primary way to address 
the issues identified in the emergency preamble and align other provisions of the bill 
accordingly to provide that: 
1. By December 31, 2022, the Department of Health and Human Services must provide 
for a rebasing offederally qualified health center prospective payment system rates to fiscal 
year 2017-18 and 2018-19 average actual costs inflated to the current year using the 
federally qualified health center market basket percentage published by the United States 
Department of Health and Human Services, Centers for Medicare and Medicaid Services, 
as an alternative to the existing payment method that relies on costs from 1999 and 2000 
inflated using the Medicare Economic Index as published in the Federal Register; 
2. Adjustments to federally qualified health center rates for changes in the scope of 
services must reflect costs incurred and must be made for material changes in type, 
intensity, duration or quantity of services provided or in the characteristics of the population 
receiving a service that affect the cost of the service; and 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" )4-" to S.P. 625, L.D. 1787 ( '°S • SO c!) 
3. The Department of Health and Human Services may develop an alternative payment 
model in addition to but not instead of the rebasing required by this legislation, as long as 
federal law provides that a federally qualified health center may elect a prospective 
payment system rate in lieu of any alternative payment model. 
The amendment sets out a timeline and interactive process with federally qualified 
health centers for completing rebasing during 2022. 
The department may adopt rules to implement the rebasing, change in scope and 
payment provisions of this legislation. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 03/28/22 feae 
LD 1787 
LR 2355(02) 
An Act To Improve the Quality and Affordability of Primary Health Care Provided by Federally 
Qualified Health Centers 
Fiscal Note for Bill as Amended by Committee Amendment '}q" ( S • ':J.) 1 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/ Allocations 
General Fund 
Federal Expenditures Fund 
Federal Block Grant Fund 
Revenue 
Federal Expenditures Fund 
Federal Block Grant Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2021-22 
FY 2022-23 
$0 
$5,215,763 
$0 
$5,215,763 
$0 
$11,928,420 
$0 
$483,287 
$0 
$11,928,420 
$0 
$483,287 
Projections 
FY 2023-24 
$5,351,895 
$5,351,895 
$12,239,751 
$495,901 
$12,239,751 
$495,901 
Projections 
FY 2024-25 
$5,488,368 
$5,488,368 
$12,551,865 
$508,546 
$12,551,865 
$508,546 
This bill includes General Fund appropriations to the Department of Health and Human Services of $5,215,763 in 
fiscal year 2022-23 for rebasing of federally qualified health center PPS rates to 2018-2019 average actual costs 
inflated to _the current year using the FQHC Market Basket as an alternative to the current payment method. Federal 
Expenditw:es Fund allocations and Federal Block Grant Fund allocations are also included in this bill for the FMAP 
match. 
LR2355(02) - Fiscal Note - Page 1 of 1