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131st MAINE LEGISLATURE
SECOND REGULAR SESSION-2024
Legislative Document No. 2287S.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. Page 1 - 131LR3135(01)1 acts and resolves of the Legislature do not
2 become effective until 90 days after adjournment unless enacted as emergencies; and
3 a workforce shortage and funding shortfalls have led to the closure of
4 nursing homes and limited access to long-term care, particularly in rural areas of the State;
5 and
6 MaineCare reimbursement rates have not been adequate to cover the costs
7 of long-term care; and
8 adequate funding is needed to prevent closures of nursing homes and
9 preserve access to long-term care for the State’s oldest and most vulnerable adults; and
10 in the judgment of the Legislature, these facts create an emergency within
11 the meaning of the Constitution of Maine and require the following legislation as
12 immediately necessary for the preservation of the public peace, health and safety; now,
13 therefore, be it
14
15 That, no later than July 1, 2024, the Department of Health and Human
16 Services shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter III,
17 Section 67, Principles of Reimbursement for Nursing Facilities as follows:
18 1. To increase the reimbursement rates to nursing facilities, other than rural nursing
19 facilities as defined in subsection 2, to provide for a supplemental allowance per patient
20 per day that is the difference between the amount reimbursed by the MaineCare program
21 and the MaineCare allowable costs as reported in the as-filed MaineCare 2022 cost report,
22 as long as the supplemental allowance is no more than $90 per patient per day. Annual
23 inflation adjustments provided pursuant to the Maine Revised Statutes, Title 22, section
24 1708, subsection 3, paragraph E and any one-time funding provided to nursing facilities
25 during the COVID-19 pandemic for additional costs may not be included in the
26 supplemental allowance. The supplemental allowance rate is cost settled against both
27 routine and direct care components costs;
28 2. To increase the reimbursement rates to rural nursing facilities to provide for a
29 supplemental allowance per patient per day that is the difference between the amount
30 reimbursed by the MaineCare program and the MaineCare allowable costs as reported in
31 the as-filed MaineCare 2022 cost report. The supplemental allowance rate is cost settled
32 against both routine and direct care components costs. “Rural nursing facility” means, for
33 the purposes of this resolve, a nursing facility that is not located in a Core Based Statistical
34 Area as defined by the United States Census Bureau or that is not located within 15 miles
35 of a critical access hospital as designated by the United States Department of Health and
36 Human Services, Centers for Medicare and Medicaid Services; and
37 3. To allow for education and training costs for direct care staff to be included as a
38 cost component under the MaineCare program for:
39 A. Education and training for direct care staff for certification or recertification and
40 for any continuing education that is considered necessary for carrying out duties as
41 direct care staff in nursing facilities; Page 2 - 131LR3135(01)
1 B. Reimbursement at the applicable rate pursuant to the Maine Revised Statues, Title
2 22, section 7402 to direct care staff receiving the education and training under
3 paragraph A for the hours spent receiving the education and training; and
4 C. Reasonable costs for educators providing education and training to direct care staff
5 under paragraph A.
6
7 That the Department of Health and Human Services shall ensure that new
8 nursing facility reimbursement rates for nursing facilities that are not rural nursing facilities
9 that are developed pursuant to the Maine Revised Statutes, Title 22, section 3173-J are no
10 less than reimbursement rates established under section 1 including an annual inflation
11 adjustment for the most recent year provided pursuant to Title 22, section 1708, subsection
12 3, paragraph E.
13 That the Department
14 of Health and Human Services shall ensure that new rural nursing facility reimbursement
15 rates that are developed pursuant to the Maine Revised Statutes, Title 22, section 3173-J
16 are compared to the most recently as-filed MaineCare cost report for rural nursing facilities
17 and reimburse at the higher rate.
18
19 That the Department of Health
20 and Human Services shall direct any funds appropriated for one-time supplements or
21 extraordinary circumstance allowances for nursing facilities within the scope of rule
22 Chapter 101: MaineCare Benefits Manual, Chapter III, Section 67, Principles of
23 Reimbursement for Nursing Facilities or for private nonmedical institutions within the
24 scope of rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 97, Appendix
25 C, Medical and Remedial Service Facilities to be used for increased costs and lost revenue
26 due to the COVID-19 pandemic that have remained unspent to be used to create additional
27 financial assistance opportunities for private nonmedical institutions within the scope of
28 rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 97, Appendix C,
29 Medical and Remedial Service Facilities.
30
31 That the Department of Health and Human Services shall seek
32 any approvals necessary to achieve the requirements of this resolve from the United States
33 Department of Health and Human Services, Centers for Medicare and Medicaid Services.
34
35 takes effect when approved.
36
37 This resolve requires the Department of Health and Human Services to amend its rule
38 Chapter 101: MaineCare Benefits Manual, Chapter III, Section 67, Principles of
39 Reimbursement for Nursing Facilities to:
40 1. Provide for a supplemental allowance per patient per day that is the difference
41 between the amount reimbursed by the MaineCare program and the MaineCare allowable
42 costs as reported in the as-filed MaineCare 2022 cost report. The amount may be no more
43 than $90 per patient per day for nursing facilities not including rural nursing facilities;
37
38
39 Page 3 - 131LR3135(01)
1 2. Allow for education and training costs for direct care staff to be included as a cost
2 component under the MaineCare program, including paying direct care staff wages while
3 attending the education or training and paying the trainers; and
4 3. Establish the category of rural nursing facilities.
5 The resolve requires any new nursing facility reimbursement rates developed pursuant
6 to the Maine Revised Statutes, Title 22, section 3173-J to be no less than reimbursement
7 rates that include supplemental allowances and annual inflation adjustments for nursing
8 facilities. For rural nursing facilities, the higher of the rate in the most recent as-filed cost
9 report and the rate developed pursuant to rate reform is the reimbursement rate that must
10 be paid.
11 The resolve requires the department to direct any funds appropriated for one-time
12 supplements or extraordinary circumstance allowances for nursing facilities or private
13 nonmedical institutions within the scope of the department's rules for increased costs and
14 lost revenue due to the COVID-19 pandemic that have remained unspent to be used to
15 create additional financial assistance opportunities for private nonmedical institutions
16 within the scope of the department's rules.
17 The resolve requires the department to seek any approvals necessary from the United
18 States Department of Health and Human Services, Centers for Medicare and Medicaid
19 Services.