An Act to Promote Quality and Innovation in Nursing and Residential Care Facilities
Maine Legislature, Session 131, LD 1575
Committee: Health and Human Services
Sponsors: MEYER
Amends: 22 MRSA §1708

Legislative Document
No. 1575
H.P. 1020
House of Representatives, April 11, 2023
An Act to Promote Quality and Innovation in Nursing and 
Residential Care Facilities
Submitted by the Department of Health and Human Services pursuant to Joint Rule 204.
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MEYER of Eliot.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §1708, sub-§3, ¶E, as amended by PL 2013, c. 594, §1, is further 
amended by amending subparagraph (2) to read:
(2)  Uses the applicable regional inflation factor as established by a national 
economic research organization selected by the department to adjust costs other 
than labor costs or fixed costs; and
Sec. 2.  22 MRSA §1708, sub-§3, ¶F, as amended by PL 2021, c. 29, Pt. R, §1, is 
further amended by enacting at the end a new last blocked paragraph to read:
This paragraph is repealed on June 30, 2024; and
Sec. 3.  22 MRSA §1708, sub-§3, ¶G is enacted to read:
G.  For the state fiscal year beginning on July 1, 2024, the department may implement 
updated rates to take effect on January 1, 2025. The rates may be updated in subsequent 
years in accordance with principles and processes articulated in section 3173-J, 
subsection 2. The reimbursement methodology applied in the rates that take effect on 
January 1, 2025 and in subsequent years must update or replace the use of resource 
utilization groups with an appropriate method that promotes efficiency and reimburses 
nursing facilities adequately.  The methodology may eliminate cost settlement and 
other practices that are administratively burdensome for nursing facilities and the 
department.  The methodology may incorporate alternative payment models as defined 
in section 3173-J, subsection 1, paragraph A.
Sec. 4. Nursing and residential care facility innovation and quality 
initiatives.  The Department of Health and Human Services may establish innovation and 
quality initiatives to advance a continuum of person-centered nursing and residential care 
facility services that promote access, health, quality of life, autonomy and safety.  The 
department may establish participation criteria for the initiatives that complement federal 
regulations and may seek waivers and Medicaid state plan amendments as needed from the 
federal Department of Health and Human Services, Centers for Medicare and Medicaid 
Services to implement the initiatives. Participation criteria may include geographic 
location, past performance of applicants and commitment to program features identified by 
the state Department of Health and Human Services with input from stakeholders, which 
may include but are not limited to the following: 
1. Enhanced care coordination and person-centered care planning that identifies the 
preferences of residents and their families or surrogate decision makers using structured, 
shared decision-making approaches to address health, safety, social needs, self-esteem and 
achievement of full potential;
2. Accessible written policies and procedures in plain language and detailed workflow 
plans that ensure resident safety standards to prevent infection, minimize medication errors, 
support appropriate use of antipsychotic medications, reduce risk of falls and recognize 
early the signs of exploitation and abuse;
3. Physical environments that promote resident safety, privacy, autonomy and quality 
of life;
4. Recruitment and retention of a well-trained, well-supported workforce;
5. Development of a quality improvement program that builds upon and strengthens 
quality assurance and performance improvement measures reported in the federal Centers 
for Medicare and Medicaid Services' Care Compare tool, with additional input and 
engagement from front-line providers, staff and administration, and that uses evidence-
based measures that are derived from administrative data and from data collected directly 
from residents and their families and surrogate decision makers;
6. Use of technology to facilitate improvements, efficiencies and desired outcomes in 
the care of nursing and residential care facility residents;
7. Promotion of sustainable options through or approval of nursing or residential care 
facility types and sizes that are consistent with a county's needs, as established by a service 
delivery needs assessment conducted by the department or its designee; and
8. Incentives for nursing and residential care facilities to participate, including but not 
limited to start-up grants, alternative payment methods, waiver of certificate of need and 
other requirements contained in the Maine Revised Statutes, Title 22, chapter 103-A and 
participation in a learning collaborative or other technical assistance provided by the 
department or its designees.
For purposes of this section, "residential care facility" means any adult residential care 
setting licensed by the department, including but not limited to an assisted living facility, 
residential care facility and adult family care home.
The Commissioner of Health and Human Services shall appoint stakeholders to a 
nursing and residential care facility innovation and quality advisory committee to provide 
feedback on the initiatives. The committee must include representatives of nursing and 
residential care facility residents and their families; a representative from the long-term 
care ombudsman program under the Maine Revised Statutes, Title 22, section 5107-A; 
nonprofit and for-profit facility providers; medical directors or geriatricians; and experts 
from universities or other settings.
SUMMARY
This bill authorizes the Department of Health and Human Services to implement new 
payment methods for nursing facilities, as well as implement nursing and residential care 
facility innovation and quality initiatives.