An Act to Update the Alternative Base Year Payment Method for Fedeially Qualified Health Centers
Maine Legislature, Session 131, LD 1768
Committee Amendment CA_A_H406 (House)
Amends: 22 MRSA §3173-J

COMMITTEE AMENDMENT "A "to HP 1132, L D 1768, "An Act to Update the 
Alternative Base Year Payment Method for Fedeially Qualified Health Centers" 
Amend the bill by st11kmg out the title and substitutmg the followmg 
'An Act to Clarify the MaineCare Rate Determination Requirements' 
Amend the bill by st11king out all of the emergency preamble 
Amend the bill by stnkmg out everythmg after the enactmg clause and msertmg the 
followmg 
'Sec. 1. 22 MRSA §3173-J, sub-§2, 1C, as enacted by PL 2021, c 639, §2, 1s 
amended to read 
C Coaduet No less frequently than once every 5 years, conduct a iate determmat10n 
process fo1 any eontemplated ehaage lfl 1e1meursemeBt amount m model f01 a each 
MameCare section of pohcy or for a specific covered service, m accordance with the 
followmg procedures 
(1) Provide pubhc notice of imtiation of the rate determmatlon for a MameCare 
section of pohcy or for a specific covered service, 
(2) Consider and, when app1opnate, adopt alternative payment models that use 
financial mcent1ves to promote or leveiage gi eate1 value for the MameCare 
program This consideration must mclude a 1 ev1ew of research on any avatlable 
nat10nal models or best practices regarding payment models for the set vice, 
(3) Determine whethei a Med1ca1 e rate 1s available fm the set vice and whethe1 the 
Medicare rate rept esents the most appropriate benchmark and payment model, 
(4) In the absence of a Medicare rate, determme whether a rate from a non-
Medicare payer source, mcludmg, but not hm1ted to, comme1 cial health care 1 ates 
m the State or other states' Med1ca1d rates, 1s available for the service and whethe1 
this alternate payer rate represents the most appropnate benchmark and payment 
model The department shall dete1mme an appropriate pe1centage of the 
COMMITTEE AMENDMENT 
ROS 
COMMITIEEAMENDMENT" A•toHP 1132, LD 1768 
benchmark rate for the service, takmg mto consideration the findmgs of the 
benchmarkmg report conducted m accordance with paiagraph B, 
(5) Conduct a rate study for every service for which a benchmark rate or payment 
model m accordance with subparagiaph (3) or (4) either 1s unavailable or is 
mconsistent with the goals of efficiency, economy and quahty of care to support 
member access Each rate study must mclude the followmg 
(a) A review of data, which must include 
(1) An assessment as to whether the delivery of service and associated 
reqmrements have changed smce the previous rate study, 1f available, to 
determme if the rate methodology needs to be revised, 
(u) The collect10n of data on provider costs and cost-1elated aspects of the 
dehvery of sei vice and associated i equu ements through ex1stmg cost 
reports, provider surveys and other available data sources, and 
(111) Research on any available national models or best practices regardmg 
cost-related aspects of the dehvery of service and associated reqmrements, 
and 
(b) Developmg or updatmg rates by considermg the followmg 
(1) 
The appropriateness of adoption of a change m payment model 
consistent with the purposes of this section, 
( 11) The current i ate assumptions and th err appropriateness given current 
provider costs, best practices or changes m the delivery of service and 
associated reqmrements, 
(m) The findmgs for related services of any comprehensive benchmarkmg 
report under paragraph B, and 
( 1v) 
The degree to which services ate dependent on MameCare 
reimbursement, mcludmg, but not hmited to, cost fact01s, such as aveiage 
wage, that may be reflective of 1 estramts of MameCare i e1mbursement 
versus costs of the broade1 marketplace, and 
(6) Upon completion of the rate determmat10n piocess, present the department's 
iat10nale and iecommendat1ons fot rate methodology, resultmg base iate amount 
and payment model for pubhc comment pr10r to the 1 ule~makmg process, convene 
a meetmg of mteiested providers and other mterested members of the pubhc to 
discuss the recommendations and hea1 comments, and respond m wntmg to 
comments with an explanat10n of whether and how feedback was mcorporated mto 
the final rate deternunat1on, and' 
Amend the bill by relettermg or renumbermg any nonconsecutive Part letter or section 
number to read consecutively 
SUMMARY 
This amendment replaces the btll and estabhshes that MameCa1e rate determmattons 
ate to take place no less frequently than once every 5 yeat s 
COMMITTEE AMENDMENT