Resolve, To Classify Employee Health Insurance as a Fixed Cost for MaineCare Reimbursement in Nursing Homes
Maine Legislature, Session 130, LD 1112
Committee Amendment CA_A_S226 (Senate)

CO:M1v11TTEE AMENDMENT" /J "to S.P. 374, L.D. 1112, "Resolve, To Classify 
Employee Health Insurance as a Fixed Cost for MaineCare Reimbursement in Nursing 
Homes" 
Amend the resolve by inserting 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 funding for the Department of Health and Human Services to amend 
its rule Chapter 101: MaineCare Benefits Manual, Chapter ill, Section 67, Principles of 
Reimbursement for Nursing Facilities no later than January 1, 2022 to move health 
insurance costs for personnel from direct care and routine cost components to fixed costs 
components. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
All Other 
2021-22 
$4,185,382 
$4,185,382 
2021-22 
$8,928,816 
$8,928,816 
2021-22 
$837,076 
COMMITTEE AMENDMENT 
2022-23 
$8,433,546 
$8,433,546 
2022-23 
$17,794,851 
$17,794,851 
2022-23 
$1,674,153 
COMMITTEE AMENU:MENT" l4--" to S.P. 374, L.D. 1112 U;>-~ 
OTHER SPECIAL REVENUE FUNDS TOT AL 
$837,076 
$1,674,153 
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 REQUJRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/05/21 frac:.. 
LD 1112 
LR858(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 "4' Cs. z-zi) 
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 2021-22 
$4,185,382 
$4,185,382 
$8,928,816 
$837,076 
$8,928,816 
$837,076 
FY2022-23 
$8,433,546 
$8,433,546 
$17,794,851 
$1,674,153 
$17,794,851 
$1,674,153 
Projections 
FY2023-24 
$8,454,473 
$8,454,473 
$17,773,924 
$1,674,153 
$17,773,924 
$1,674,153 
Projections 
FY2024-25 
$8,454,473 
$8,454,473 
$17,773,924 
$1,674,153 
$17,773,924 
$1,674,153 
The bill includes General Fund appropriations to the Department of Health and Human Services of $4,185,382 in 
fiscal year 2021-22 and $8,433,546 in fiscal year 2022-23 for the Department of Health and Human Services to 
amend its rule Chapter 101: MaineCare Benefits Manual, Chapter ill, Section 67, Principles of Reimbursement for 
Nursing Facilities no later than January 1, 2022 to move health insurance costs for personnel from direct care and 
routine cost components to fixed costs components. Federal Expenditures Fund allocations are also included for the 
FMAP match and Other Special Revenue Funds allocations for the Health Care Provider Tax, 
The Upper Payment Limit (UPL) analysis for Nursing Facilities (NF) indicates that currently the NF payments in 
MaineCare are lower than Medicare by $25 .1 million. The inclusion of Health Insurance as a fixed cost is estimated 
to increase the payments by $27.9 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 with this change the NF costs will likely go over the 
UPL threshold. However, based on the language in statute (Title 22 §1708 sub-§3, ,re) 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 
pavments to NF's to remain below the federallv reauired limits.