An Act to Assist Nursing Homes in the Management of Facility Beds
Maine Legislature, Session 131, LD 0938
Committee: Health and Human Services
Sponsors: PERRY, BALDACCI, FAY, MADIGAN, ROEDER, STOVER
Amends: 22 MRSA §333, 22 MRSA §1720

Legislative Document
No. 938
H.P. 585
House of Representatives, March 2, 2023
An Act to Assist Nursing Homes in the Management of Facility Beds
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative PERRY of Calais.
Cosponsored by Senator BALDACCI of Penobscot and
Representatives: FAY of Raymond, MADIGAN of Waterville, ROEDER of Bangor, STOVER 
of Boothbay.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §333, sub-§1, as amended by PL 2011, c. 648, §2, is further 
amended to read:
1.  Procedures.  A nursing facility that voluntarily reduces the number of its licensed 
beds at any time prior to July 1, 2007, for any reason except to create private rooms may 
convert the beds back and thereby increase the number of nursing facility beds to no more 
than the previously licensed number of nursing facility beds, after obtaining a certificate of 
need in accordance with this section, as long as the nursing facility has been in continuous 
operation without material change of ownership.  For purposes of this section and sections 
333-A and 334-A, beds voluntarily removed from service prior to July 1, 2007 and 
available to be reinstated under this section are referred to as "reserved beds."  Reserved 
beds remain facility property until they lapse as provided for in this section or are 
transferred.  To reinstate reserved beds under this subsection, the nursing facility must 
shall:
A.  Give notice of the number of beds it is reserving no later than 30 days after the 
effective date of the license reduction;
A-1.  Annually provide notice to the department no later than July 1st of each year of 
the nursing facility's intent to retain these reserved beds, subject to the limitations set 
forth in subsection 2, paragraph B. Notice provided under this paragraph preserves the 
reserved beds through June 30th of the following year. The annual notice on reserved 
beds may be filed by an individual nursing facility or by multiple nursing facilities 
through a membership organization approved by the department by a single filing; and
B.  Obtain a certificate of need to convert beds back under section 335, except that, if 
no construction is required for the conversion of beds back, the application must be 
processed in accordance with subsection 2.  The department in its review shall evaluate 
the impact that the nursing facility beds to be converted back would have on those 
existing nursing facility beds and facilities within 30 miles of the applicant's facility 
and shall determine whether to approve the request based on current certificate of need 
criteria and methodology.
Sec. 2.  22 MRSA §333, sub-§2, ¶A, as enacted by PL 2001, c. 664, §2, is amended 
to read:
A.  Review of applications that meet the requirements of this section must be based on 
the requirements of section 335, subsection 7, except that the determinations required 
by section 335, subsection 7, paragraph B must be based on the historical costs of 
operating the beds and must consider whether the projected costs are consistent with 
the costs of the beds prior to closure, adjusted for inflation applications that seek to 
reopen reserved beds must be approved if the projected incremental costs of reopening 
and operating the reserved beds are consistent with the facility's costs of operating its 
other beds.  Applicants are not required to demonstrate that any increases in MaineCare 
costs are offset by other MaineCare savings.  The costs of ongoing operation of both 
the reopened beds and the complement of facility beds at the time the reserved beds 
are reopened must be recognized as allowable costs and incorporated into the facility's 
MaineCare payment rates; and
Sec. 3.  22 MRSA §1720, as enacted by PL 2005, c. 242, §1, is amended to read:
§1720.  Nursing facility medical director reimbursement
The department shall include in its calculation of reimbursement for services provided 
by a nursing facility an allowance for the cost of incurred by the facility for a medical 
director in a base year amount not to exceed $10,000, with that amount being subject to an 
annual cost-of-living adjustment.
Sec. 4.  Cost of computer and cloud-based software systems a fixed cost.  
Beginning October 1, 2023, the cost incurred by a nursing facility for the acquisition, 
including set-up costs, use and maintenance, of computer or cloud-based software systems 
must be included as a fixed cost by the Department of Health and Human Services in its 
rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 67, Principles of 
Reimbursement for Nursing Facilities.  Costs included pursuant to this section must include 
without limitation the costs of hardware, if any, software and software support.
SUMMARY
This bill restores the ability of nursing facilities to voluntarily reduce the number of 
their licensed beds and then later increase the number of their licensed beds to the prior 
level after obtaining a certificate of need and meeting certain conditions.
The bill modifies the process to obtain certificate of need approval to reopen reserved 
beds.  Applications that seek to reopen reserved beds must be approved if the projected 
incremental costs of reopening and operating the reopened beds are consistent with the 
facility's costs of operating its other beds.  Applicants are not required to demonstrate that 
any increases in MaineCare costs are offset by other MaineCare savings.  The costs of 
ongoing operation of both the restored beds and the complement of facility beds at the time 
the reserved beds are reopened must be recognized as allowable costs and incorporated into 
the facility's MaineCare payment rates.
The bill requires the Department of Health and Human Services to include in its 
calculation of reimbursement for services provided by a nursing facility the cost incurred 
by the facility for a medical director.
The bill requires the cost incurred by a nursing facility for the acquisition, use and 
maintenance of computer or cloud-based software systems to be included as a fixed cost.