Resolve, to Fully Fund Nursing Homes (AFTER DEADLINE)
Maine Legislature, Session 131, LD 2287
Committee: Health and Human Services
Sponsors: JACKSON

Legislative Document
No. 2287
S.P. 1000
In Senate, April 9, 2024
Resolve, to Fully Fund Nursing Homes
(AFTER DEADLINE)
(EMERGENCY)
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
205.
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.
Emergency preamble.  Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, a workforce shortage and funding shortfalls have led to the closure of 
nursing homes and limited access to long-term care, particularly in rural areas of the State; 
and
Whereas, MaineCare reimbursement rates have not been adequate to cover the costs 
of long-term care; and
Whereas, adequate funding is needed to prevent closures of nursing homes and 
preserve access to long-term care for the State’s oldest and most vulnerable adults; 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
Sec. 1.  Amendment of Principles of Reimbursement for Nursing Facilities 
rule.  Resolved:  That, no later than July 1, 2024, the Department of Health and Human 
Services shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter III, 
Section 67, Principles of Reimbursement for Nursing Facilities as follows:
1.  To increase the reimbursement rates to nursing facilities, other than rural nursing 
facilities as defined in subsection 2, to provide for a supplemental allowance per patient 
per day that is the difference between the amount reimbursed by the MaineCare program 
and the MaineCare allowable costs as reported in the as-filed MaineCare 2022 cost report, 
as long as the supplemental allowance is no more than $90 per patient per day.  Annual 
inflation adjustments provided pursuant to the Maine Revised Statutes, Title 22, section 
1708, subsection 3, paragraph E and any one-time funding provided to nursing facilities 
during the COVID-19 pandemic for additional costs may not be included in the 
supplemental allowance.  The supplemental allowance rate is cost settled against both 
routine and direct care components costs;
2.  To increase the reimbursement rates to rural nursing facilities to provide for a 
supplemental allowance per patient per day that is the difference between the amount 
reimbursed by the MaineCare program and the MaineCare allowable costs as reported in 
the as-filed MaineCare 2022 cost report.  The supplemental allowance rate is cost settled 
against both routine and direct care components costs.  “Rural nursing facility” means, for 
the purposes of this resolve, a nursing facility that is not located in a Core Based Statistical 
Area as defined by the United States Census Bureau or that is not located within 15 miles 
of a critical access hospital as designated by the United States Department of Health and 
Human Services, Centers for Medicare and Medicaid Services; and
3.  To allow for education and training costs for direct care staff to be included as a 
cost component under the MaineCare program for:
A.  Education and training for direct care staff for certification or recertification and 
for any continuing education that is considered necessary for carrying out duties as 
direct care staff in nursing facilities;  
B.  Reimbursement at the applicable rate pursuant to the Maine Revised Statues, Title 
22, section 7402 to direct care staff receiving the education and training under 
paragraph A for the hours spent receiving the education and training; and
C.  Reasonable costs for educators providing education and training to direct care staff 
under paragraph A.
Sec. 2.  Rate reform; nursing facilities not including rural nursing facilities.  
Resolved:  That the Department of Health and Human Services shall ensure that new 
nursing facility reimbursement rates for nursing facilities that are not rural nursing facilities 
that are developed pursuant to the Maine Revised Statutes, Title 22, section 3173-J are no 
less than reimbursement rates established under section 1 including an annual inflation 
adjustment for the most recent year provided pursuant to Title 22, section 1708, subsection 
3, paragraph E.
Sec. 3.  Rate reform; rural nursing facilities.  Resolved:  That the Department 
of Health and Human Services shall ensure that new rural nursing facility reimbursement 
rates that are developed pursuant to the Maine Revised Statutes, Title 22, section 3173-J 
are compared to the most recently as-filed MaineCare cost report for rural nursing facilities 
and reimburse at the higher rate.
Sec. 4.  Private nonmedical institutions; medical and remedial service 
facilities; assistance from unspent funds.  Resolved:  That the Department of Health 
and Human Services shall direct any funds appropriated for one-time supplements or 
extraordinary circumstance allowances for nursing facilities within the scope of rule 
Chapter 101: MaineCare Benefits Manual, Chapter III, Section 67, Principles of 
Reimbursement for Nursing Facilities or for private nonmedical institutions within the 
scope of rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 97, Appendix 
C, Medical and Remedial Service Facilities to be used for increased costs and lost revenue 
due to the COVID-19 pandemic that have remained unspent to be used to create additional 
financial assistance opportunities for private nonmedical institutions within the scope of 
rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 97, Appendix C, 
Medical and Remedial Service Facilities.
Sec. 5.  United States Centers for Medicare and Medicaid Services 
approval.  Resolved:  That the Department of Health and Human Services shall seek 
any approvals necessary to achieve the requirements of this resolve from the United States 
Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Emergency clause.  In view of the emergency cited in the preamble, this legislation 
takes effect when approved.
SUMMARY
This resolve requires the Department of Health and Human Services to amend its rule 
Chapter 101: MaineCare Benefits Manual, Chapter III, Section 67, Principles of 
Reimbursement for Nursing Facilities to:
1.  Provide for a supplemental allowance per patient per day that is the difference 
between the amount reimbursed by the MaineCare program and the MaineCare allowable 
costs as reported in the as-filed MaineCare 2022 cost report.  The amount may be no more 
than $90 per patient per day for nursing facilities not including rural nursing facilities;
2.  Allow for education and training costs for direct care staff to be included as a cost 
component under the MaineCare program, including paying direct care staff wages while 
attending the education or training and paying the trainers; and
3.  Establish the category of rural nursing facilities. 
The resolve requires any new nursing facility reimbursement rates developed pursuant 
to the Maine Revised Statutes, Title 22, section 3173-J to be no less than reimbursement 
rates that include supplemental allowances and annual inflation adjustments for nursing 
facilities.  For rural nursing facilities, the higher of the rate in the most recent as-filed cost 
report and the rate developed pursuant to rate reform is the reimbursement rate that must 
be paid.
The resolve requires the department to direct any funds appropriated for one-time 
supplements or extraordinary circumstance allowances for nursing facilities or private 
nonmedical institutions within the scope of the department's rules for increased costs and 
lost revenue due to the COVID-19 pandemic that have remained unspent to be used to 
create additional financial assistance opportunities for private nonmedical institutions 
within the scope of the department's rules.
The resolve requires the department to seek any approvals necessary from the United 
States Department of Health and Human Services, Centers for Medicare and Medicaid 
Services.