An Act to Address Unsafe Staff mg of Nurses and Im prov~ 'Patient Care
Maine Legislature, Session 131, LD 1639
Committee Amendment CA_A_S391 (Senate)

COMMITTEE Alv.lENDMENT "J "to SP 656, LD 1639, "An Act to Address 
Unsafe Staff mg of Nurses and Im prov~ 'Patient Care" 
Amend the bill m section 1 m c 404-A m § 1793 by illSertillg after subsect10n 2 the 
followillg 
'3. Cr1tical access hospital "Critical access hospital" has the same meanillg as m 
sect10n 7932, subsect10n 10' 
Amend the bill ill section 1 ill c 404-A ill § 1793 m subsection 5 ill the last lille (page 
2, lme 3 ill L D ) by illSertmg after the followmg "405 " the followmg "'Health care 
facility" does not illclude a state illstitution as defilled m Title 34-B, section 1001, 
subsection 8 ' 
Amend the bill ill section 1 m c 404-A m § 1793 by renumbermg the subsections to 
read consecutively 
Amend the bill m section 1 m c 404-A ill § 1794 ill the first illdented paragraph m the 
first lille (page 2, lille 13 illL D) by stnkillg out the followmg "section 1795" and illSertillg 
the followillg 'sections 1795 and 1796' 
Amend the bill ill section 1 ill c 404-A ill § 1794 ill subsection 1 m the first lme (page 
2, lme 17 ill L D ) by stnkillg out the followillg "A" and illSertillg the followmg 'Begmnmg 
July 1, 2025, a' 
Amend the bill m section l ill c 404-A by stnkillg out all of §1795 (page 5, Imes 29 to 
S ill L D ) and illSertillg the followillg 
'§1795. Exception to staffing regmrements 
1. Declared state of emergency. The drrect-care registered nurse staffillg assignments 
requrred pursuant to sections 1794 and 1796 do not apply when there is a declared state of 
emergency It is a defense to a complaillt allegillg a v10lat10n of section 1794 or 1796 filed 
agamst a health care facility under chapter 405 if the facility demonstrates that 1t undertook 
prompt and d1hgent efforts to mamtaill the staffillg assignments regurred pursuant to 
sections 1794 and 1796, despite the declared state of emergency 
COMMITTEE AMENDMENT 
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COMMIITEE AMENDMENT"~" to SP 656, L D 1639 
2. Local emergency event. The drrect-care registered nurse staffing assignments 
regurred pursuant to sections 1794 and 1796 do not apply to a health care facility when 
there 1s a local emergency event It is a defense to a complamt allegmg a v10lation of sect10n 
1794 or 1796 filed agamst a health care facility under chapter 405 if the facility 
demonstrates that 
A The violat10n resulted from an unpredictable and uncontrollable rapid mcrease m 
patient levels at the health care fac1hty due to a local emergency event, such as an 
accident, violence or a natural disaster, that caused multiple casualties and severe 
mmnes, and 
B 
The health care fac1hty undertook prompt and diligent efforts to mamtam the 
staffmg assignments regurred pursuant to sections 1794 and 1796, despite the local 
emergency event 
§1796 Mm1mum staffing regmrements of direct-care registered nurses m critical 
access hospitals 
A critical access hospital shall assign at least the number of drrect-care registered 
nurses at all t1mes durmg every shift consistent with the mm1mum reqmrements estabhshed 
m this section, and at no t1me may a critical access hospital assign fewer than 2 drrect-care 
registered nurses m a patient care unit A cntlcal access hospital shall assign at least the 
number of drrect-care registered nurses at all t1mes durmg every shift consistent with the 
mm1mum reqmrements established m this section 
Regmrements begmmng July 2025. Begmmng July 1, 2025, a critical access 
hospital shall assign a drrect-care registered nurse to no more than 
A Two patients when the patients are receivmg neonatal mtensive care, 
B Four patients when 
(1) The patients are receivmg step-down or mtermed1ate care, or 
(2) The drrect-care registered nurse is assigned to a patient care umt that receives 
patients requrrmg step-down or mtermed1ate care, mcludmg, but not l1m1ted to, a 
step-down or mtermed1ate care unit, 
C Four patients when 
(1) The patients are rece1vmg telemetry services, or 
(2) The nurse is assigned to a patient care unit that receives patients regurrmg 
telemetry services, 
D Five patients when 
(1) The patients are receivmg medical surgical care services, or 
(2) The nurse 1s assigned to a patient care umt that receives patients regurrmg 
medical surgical care services, and 
E Five patients when 
(1) The patients are rece1vmg specialty care services, or 
(2) The nurse 1s assigned to a patient care unit receivmg patients regurrmg 
specialty care services, mcludmg, but not hmited to, a specialty care umt, 
COMMITTEE AMENDMENT 
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COMMITIEE AMENDMENT "A "to S P 656, L D 1639 
neurological care umt, gastromtestmal umt, orthopedic umt or any other umt that 
is orgamzed, operated and mamtamed to provide care for a specific medical 
condition or a specific patient populat10n 
This subsection is repealed July 1, 2026 
2. Regmrements begmnmg July 2026. Begmmng July 1, 2026, a critical access 
hospital shall assign a direct-care registered nurse to no more than 
A One patient when the patient is receivmg neonatal mtensive care, 
B Three patients when 
(1) The patients are receivmg step-down or mtermediate care, or 
(2) The direct-care registered nurse is assigned to a patient care umt that receives 
patients reguirmg step-down or mtermediate care, mcludmg, but not limited to, a 
step-down or mtermediate care umt, 
C Three patients when 
(1) The patients are receivmg telemetry services, or 
(2) The nurse is assigned to a patient care umt that receives patients requirmg 
telemetry services, 
D Four patients when 
(1) The patients are receivmg medical surgical care services, or 
(2) The nurse is assigned to a patient care umt that receives patients requmng 
medical surgical care services, and 
E Four patients when 
(1) The patients are receivmg specialty care services, or 
(2) The nurse is assigned to a patient care umt receivmg patients reqmrmg 
specialty care services, mcludmg, but not lnmted to, a specialty care umt, 
neurological care umt, gastromtestmal umt, orthopedic umt or any other umt that 
is orgamzed, operated and mamtamed to provide care for a specific medical 
condition or a specific patient population 
§1797. Department to establish critical access hospital fleub1hty 
1. Department to establish crit1cal access hospital fleub1hty. The department shall 
establish a process for critical access hospitals to request flexibility regardmg the direct-
care registered nurse staffmg requirements set forth m section 1796 In estabhshmg the 
process, the department must mclude the followmg cntena 
A The department may approve flexibility requests related to the direct-care registered 
nurse staffmg requirements on an mdividual-hospital basis, 
B The flexibility allowances must cover a penod of t1me not to exceed 6 months, 
C Only flexibility requests that do not 1eopardize the health, safety or well-bemg of 
patients affected may be considered, 
D 
A critical access hospital seekmg flexibility shall submit a written request with 
supportmg evidence to the department, 
COMMITTEE AMENDMENT 
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COMMITIEE AMENDMENT" A" to SP 656, L D 1639 
E A cntical access hospital that has laid off any chmcal staff w1thm the previous 6 
months 1s not ehg1ble for a flex1b1hty allowance, and 
F 
Where applicable, the department shall sohc1t comments from the collective 
bargammg agent that represents the registered nurses m a cnt1cal access hospital that 
1s seekmg flex1b1hty ' 
Amend the bill m section 1 m c 404-A m § 1796 m the first mdented paragraph m the 
last lme (page 5, lme 3 8 m L D ) by stnkmg out the followmg "sect10n 1794" and msertmg 
the followmg 'sections 1794 and 1796' 
Amend the b1ll m section 1 m c 404-A m § 1796 m subsect10n 1 m the last lme (page 
5, lme 41 m L D) by stnkmg out the followmg "1797" and msertmg the followmg '1799' 
Amend the bill m section 1 m c 404-A m § 1796 m subsection 3 m the 7th hne (page 
6, hne 10 m L D ) by stnkmg out the followmg "sect10n 1794" and msertmg the followmg 
'sect10ns 1794 and 1796' 
Amend the bill m section 1 m c 404-A m § 1796 m subsection 7 m the last lme (page 
6, hne 35 mL D) by stnkmg out the followmg "sect10n 1794" and msertmgthe followmg 
'sections 1794 and 1796' 
Amend the bill m section 1 m c 404-A m § 1796 m subsection 9 m the last lme (page 
6, lme 42 m L D ) by stnkmg out the followmg "sect10n 1794" and msertmg the followmg 
'sect10ns 1794 and 1796' 
Amend the bill m section 1 m c 404-A m § 1798 by msertmg after subsect10n 2 the 
followmg 
'3. Construction. This Act may not be construed to hm1t the use of technology by a 
direct-care registered nurse as part of the nurse's typical duties and scope of practice' 
Amend the bill m sect10n 1 m c 404-A m § 1799 m subsect10n 4 m paragraph B m the 
2nd lme (page 8, lme 22 m L D) by msertmg after the followmg "1794" the followmg 'or 
1796' 
Amend the bill m section 1 m c 404-A m §1802 m the first mdented paragraph m the 
first lme (page 10, lme 4 m L D ) by strikmg out the followmg "1804" and msertmg the 
followmg '1806' 
Amend the bill m sect10n 1 m c 404-A m § 1802 by stnkmg out all of subsection 3 
(page 10, Imes 15 to 23 m L D ) and msertmg the followmg 
'3 Sanctions. The department may impose the followmg admm1strat1ve penalties on 
a health care fac1hty 
A 
Begmnmg July 1, 2026, except as provided m paragraph C, for v10lat1ons of 
subsection 1 or sections 1794, 1796, 1798, 1799, 1800, 1801 and 1802 or a rule adopted 
to Implement this section or those sections, the department may assess a fme of not 
more than $5,000 per nursmg shift m v10lat1on Each day a health care facility violates 
subsection 1 or section 1794, 1796, 1798, 1799, 1800, 1801 or 1802 is a separate 
offense 
This paragraph 1s repealed July 1, 2027 
B 
Begmnmg July 1, 2027, except as provided m paragraph D, for v10lations of 
subsection 1 or sections 1794, 1796, 1798, 1799, 1800, 1801 and 1802 or a rule adopted 
COMMITTEE AMENDMENT 
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COMMITIEE AMENDMENT "A-" to SP 656, L D 1639 
to llllplement this sect10n or those sections, the department may assess a fine of not 
more $10,000 per nursmg shift m violation Each day a health care facility violates 
subsection 1 or sect10n 1794, 1796, 1798, 1799, 1800, 1801 or 1802 is a separate 
offense 
C 
Begmnmg July 1, 2026, for violations of section 1801, subsection 5 or a rule 
adopted to llllplement that subsection, the department may assess a fine of not more 
than $12,500 per nursmg shift 
This paragraph is repealed July 1, 202 7 
D 
Begmmng July 1, 202 7, for violations of section 1801, subsect10n 5 or a rule 
adopted to llllplement that subsection, the department may assess a fine of not more 
$25,000 per nursmg shift' 
Amend the btll m sect10n 1 m c 404-A by stnkmg out all of § 1803 (page 10, Imes 24 
to 41 and page 11, Imes 1 and 2 m L D ) and msertmg the followmg 
'§1803. C1vd v1olat1ons 
This section governs v10lat10ns under this chapter 
1. V1olation of health care fac1hty staffing regmrements. This subsection applies 
to violations of sect10ns 1794, 1796, 1798, 1799, 1800 and 1802 and sect10n 1804, 
subsection 1 
A A health care facility may not violate section 1794, 1796, 1798, 1799, 1800 or 1802 
or section 1804, subsection 1 or a rule adopted to implement those sections 
B A health care facility that v10lates paragraph A commits a civil v10lat10n for which 
a fme may be admdged as follows 
(1) Begmnmg July 1, 2026, not more than $5,000 per nursmg shift m v10lation 
This subparagraph is repealed July 1, 2027, and 
(2) Begmnmg July 1, 2027, not more than $10,000 per nursmg shift m violation 
Each day a health care facility v10lates paragraph A is a separate offense 
2. V1olat10n for mterfermg or retahatmg for a nurse's ob1ect1on or refusal; 
v10lat10n. This subsection applies to v10lat10ns of sect10n 1801, subsect10n 5 
A 
A health care facility, an employee of a health care facility who is pnmanly 
responsible for managmg the health care facility or an employee of a health care facility 
who is prllllanly responsible for providmg patient care services may not v10late sect10n 
1801, subsection 5 or a rule adopted to nnplement that subsect10n 
B 
A health care facility, an employee of a health care facility who is prllllanly 
responsible for managmg the health care facility or an employee of a health care facility 
who is prllllanly responsible for providmg patient care services who v10lates paragraph 
A commits a civil v10lation for which a fme may be ad1udged as follows 
(1) Begmnmg July 1, 2026, not more than $12,500 per nursmg shift This 
subparagraph is repealed July 1, 2027, and 
(2) Begmnmg July 1, 2027, not more than $25,000 per nursmg shift' 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT~ "to SP 656, L D 1639 
Amend the bill m section 1 m c 404-A m § 1805 m the first mdented paragraph m the 
2nd lme (page 11, lme 8 m L D) by stnkmg out the followmg "1799" and msertmg the 
followmg '1801' 
Amend the bill m sect10n 1 m c 404-A by msertmg after § 1806 the followmg 
'§1807. Apphcab1hty 
The regurrements m sect10n 1794 apply for patients or umts not mentioned m section 
1796 and for all other health care facilities except for critical access hospitals If a 
requrrement m section 1 794 and a separate requrrement m sect10n 1796 both apply to a 
patient, the health care facility shall assign a drrect-care registered nurse m accordance with 
the lowest numerical patient assignment applicable to the patient ' 
Amend the bill m section 1 m c 404-A by renumbermg the sections to read 
consecutively 
Amend the bill by relettermg or renumbermg any nonconsecutive Part letter or section 
number to read consecutively 
SUMMARY 
This amendment is the maJonty report of the committee The amendment exempts state 
mstitutions from the requrrements of the Mame Quality Care Act enacted m the bill It 
provides that a health care facility must comply with the drrect-care registered nurse 
staffmg requrrements begmnmg July 1, 2025 It establishes different drrect-care registered 
nurse staffing requrrements for critical access hospitals begmnmg July 1, 2025 and changes 
those requrrements agam on July 1, 2026 The amendment requrres the Department of 
Health and Human Services to establish a process for critical access hospitals to request 
flexibility regardmg drrect-care registered nurse staffing requrrements It also provides for 
a defense to a complamt regardmg a v10lation of the drrect-care registered nurse staffmg 
levels at health care facilities for local emergencies, mcludmg accidents, v10lence and 
natural disasters The amendment also phases m the monetary penalties at 5 0% of the 
penalty m the bill begmnmg July 1, 2026 and mcreasmg to 100% of the penalty m the bill 
on July 1, 2027 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved 06/18/23 t/Yae!-
LD 1639 
LR 765(02) 
An Act to Address Unsafe Staffing of Nurses and Improve Patient Care 
Fiscal Note for Bill as Amended by Comnuttee Amendment ;1!• ( ,:;,3 q J'. 
Committee: Labor and Housmg 
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Net Cost (SaVIngs) 
General Fund 
"~prop nations/ Allocat1ons 
General Fund 
Other Special Revenue Funds 
Revenue 
Other Special Revenue Funds 
Correctional and Jud1c1al Impact Statements 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2023-24 
$0 
$0 
$0 
$0 
FY 2024-25 
$0 
$0 
$0 
$0 
ProJectJ.ons 
FY 2025-26 
$180,247 
$180,247 
$288,729 
$22,753 
Establishes new civil v10lat10ns May mcrease the number of c1v1l suits filed m the court system 
Pro1ect1ons 
FY 2026-27 
$185,926 
$185,926 
$297,826 
$22,967 
The additional workload associated with the mmnnal number of new cases filed m the court system does not require 
add1t10nal fundmg at this time The collect10n of add1t10nal fines and filmg fees may mcrease General Fund or other 
dedicated revenue by mmor amounts 
Fiscal Detatl and Notes 
It 1s estnnated that the Department of Health and Human Services will requrre General Fund appropnat10ns of 
$180,247 m fiscal year 2025-26 and $185,926 m fiscal year 2026-27 to establish 2 Health Services Consultant II 
pos1t10ns, one Comprehensive Health Planner II pos1t10n and one Semor Health Care Fmancial Analyst pos1t10n to 
ensure profess10nal staff have completed any required tra1mngs, that the fac1ht1es have a process to ensure any 
statutonally required assessments are bemg completed while conductmg surveys, to handle the process for add1t10nal 
penalties and for other added respons1b1hties, begmnmg July 1, 2025 
, Add1t10nal costs to the Office of the Attorney General and to the Mame Human Rights Comm1ss10n associated with 
the prov1S1ons of the Mame Quality Care Act are expected to be mmor and can be absorbed w1thm ex1stmg budgeted 
resources