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: Health and Human Services
Sponsors: CLAXTON, MOORE
Amends: 22 MRSA §3174-V

Legislative Document
No. 1787
S.P. 625
In Senate, December 9, 2021
An Act To Improve the Quality and Affordability of Primary Health 
Care Provided by Federally Qualified Health Centers
(EMERGENCY)
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
203.
Received by the Secretary of the Senate on December 7, 2021.  Referred to the Committee 
on Health and Human Services pursuant to Joint Rule 308.2 and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator CLAXTON of Androscoggin.
Cosponsored by Senator: MOORE of Washington.
Emergency preamble.  Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, current MaineCare reimbursement rates for services delivered by federally 
qualified health centers are based on costs of providing services 20 years ago and have not 
been adjusted sufficiently to keep pace with increases in the costs, intensity and scope of 
services offered; and
Whereas, MaineCare reimbursement rates for services delivered by federally 
qualified health centers are substantially lower than the rates paid to certain primary care 
practices that offer fewer services and fewer programs designed to reduce the need for more 
expensive specialty and acute care than federally qualified health centers; and
Whereas, the Department of Health and Human Services is currently engaged in a 
process of radically revising its payment method for primary care services without 
considering the current inadequacy of federally qualified health center rates or the fact that 
federally qualified health centers are currently delivering many of the services and 
programs that the department is seeking to encourage by reforming its payment system; 
and
Whereas, the current design of the department’s proposed payment reforms, which it 
intends to implement before the adjournment of the Second Regular Session of the 130th 
Legislature, will reduce payments to many federally qualified health centers; and
Whereas, in order to preserve and improve the advanced primary care model 
pioneered by federally qualified health centers in Maine, MaineCare payments for those 
services must be increased in order to reflect the current costs of providing services before 
the department establishes an alternative payment model for federally qualified health 
centers; and
Whereas, in the judgment of the Legislature, these facts create an emergency within 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore,
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §3174-V, first ¶, as amended by PL 2003, c. 20, Pt. K, §11, is 
further amended to read:
Beginning in fiscal year 2003-04, the The reimbursement requirements listed in 
subsections 1 and 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.  Reimbursement rates and adjustments.  Notwithstanding any provision of law to 
the contrary, beginning July 1, 2021, total payments to each federally qualified health 
center for services provided under the MaineCare program may not be less than the total 
amount the federally qualified health center would have received in accordance with the 
payment method in effect as of June 30, 2021, adjusted for inflation in accordance with the 
United States Department of Health and Human Services, Centers for Medicare and 
Medicaid Services, Medicare Economic Index as published in the Federal Register.  For 
purposes of this subsection, “payment method” means the method by which the department 
determines how much to pay the federally qualified health center for services provided, 
including, but not limited to, the prospective payment system set forth in 42 United States 
Code, Section 1396a(bb)(3), payments calculated under the department’s health home 
programs and payments calculated for primary care case management services.
Sec. 3.  22 MRSA §3174-V, sub-§4 is enacted to read:
4.  Rebasing.  The department shall establish a federally qualified health center’s base 
year beginning January 1, 2019 and in every subsequent calendar year the prospective 
payment system set forth in 42 United States Code, Section 1396a(bb)(3) is in effect.  
Rebasing under this subsection must include an adjustment to base year costs that reflects 
the following:
A. The difference between the prospective payment system rate in the base year and 
the actual reasonable costs incurred in that calendar year;
B. The amount determined in paragraph A adjusted for inflation in accordance with the 
United States Department of Health and Human Services, Centers for Medicare and 
Medicaid Services, Medicare Economic Index as published in the Federal Register;
C. Findings made by the department relating to the change in the scope of services 
provided by the federally qualified health center that consider:
(1) The costs arising from changes in the type, intensity, duration or quantity of 
services provided; and
(2) The costs arising from changes in the characteristics of the population receiving 
a service that affects the cost of the service; and
D. Additional costs retroactive to the date that the cost increases were first incurred by 
the federally qualified health center.
Sec. 4.  22 MRSA §3174-V, sub-§5 is enacted to read:
5.  Alternative value-based payment.  The department may, subject to 42 United 
States Code, Section 1396a(bb)(6) and any other requirements under federal law, develop 
a value-based payment model to replace the prospective payment system set forth in 42 
United States Code, Section 1396a(bb)(3).  In developing a value-based payment model in 
accordance with this subsection, the department shall consult with federally qualified 
health centers in this State to the extent provided in 42 United States Code, Section 
1396a(bb)(6).
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 major substantive rules as defined in Title 5, 
chapter 375, subchapter 2-A.
Sec. 6.  Retroactivity. That section of this Act that enacts the Maine Revised 
Statutes, Title 22, section 3174-V, subsection 3 applies retroactively to July 1, 2021. That 
section of this Act that enacts Title 22, section 3174-V, subsection 4 applies retroactively 
to January 1, 2019.
Emergency clause.  In view of the emergency cited in the preamble, this legislation 
takes effect when approved.
SUMMARY
This bill provides that:
1. Beginning July 1, 2021, the total MaineCare payments to a federally qualified health 
center may not be lower than the total amount the federally qualified health center would 
have received in accordance with the payment method in effect as of June 30, 2021, 
adjusted for inflation;
2. The rebasing of reimbursement rates must be based on a change in the scope of 
services provided by a federally qualified health center, actual costs incurred and other 
factors;
3. The Department of Health and Human Services may develop alternative value-based 
payment models in accordance with federal law; and
4. Rules adopted to implement this legislation are major substantive rules.