An Act To Improve MaineCare Nursing Home Reimbursement To Preserve Access and Promote Quality
Sec. 1. 22 MRSA §1708, sub-§3, as corrected by PL 2001, c. 2, Pt. A, §33 and amended by PL 2003, c. 689, Pt. B, §6, is further amended to read:
(1) Recognizes regional variations in labor costs and the rates of increase in labor costs determined pursuant to the principles of reimbursement and establishes at least 4 regions for purposes of annual inflation adjustments; and
(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 . ;
Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter II-A.
(1) Nursing homes whose MaineCare patient days exceed 70% of total patient days, determined on an annual basis, must receive this supplemental MaineCare payment; and
(2) For each one percent increment above 70%, eligible nursing homes must receive a supplemental MaineCare payment of $0.20 per MaineCare patient day; and
(1) Criteria for incentive payment must include both improvement in performance and high levels of performance in specified areas, including, but not limited to, resident and family satisfaction, resident choices available, clinical measures and staffing levels.
(2) Payments pursuant to this paragraph must be in addition to amounts otherwise provided in accordance with applicable principles of reimbursement, and the program must be implemented in a manner that does not result in any reduction of the amount that would be paid to any home in the absence of a pay-for-performance program.
(3) Payments pursuant to this paragraph may not be required to be returned to the State if they remain in the possession of a nursing home at the time of a state audit.
Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 2. Emergency rules. Notwithstanding the Maine Revised Statutes, Title 5, section 8054, the Department of Health and Human Services may adopt emergency rules to implement Title 22, section 1708, subsection 3, paragraph F without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health or safety or the general welfare, if notice is given through a MaineCare provider list and 5 days or more are allowed for comment prior to adoption of the rules. The emergency rules and subsequent permanent rules must be made effective retroactively to July 1, 2013.
Sec. 3. Appropriations and allocations. The following appropriations and allocations are made.
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Nursing Facilities 0148
Initiative: Appropriates state funds and allocates matching federal funds for cost-of-living increases for MaineCare reimbursement to nursing facilities in the 2014-2015 biennium.
| FEDERAL EXPENDITURES FUND | 2013-14 | 2014-15 |
|
All Other
|
$2,835,000 | $2,948,400 |
 |
|
|
| FEDERAL EXPENDITURES FUND TOTAL | $2,835,000 | $2,948,400 |
| GENERAL FUND | 2013-14 | 2014-15 |
|
All Other
|
$1,665,000 | $1,731,600 |
|
|
|
| GENERAL FUND TOTAL | $1,665,000 | $1,731,600 |
summary
This bill provides supplemental MaineCare payments to nursing homes that serve a high percentage of MaineCare residents and establishes a pay-for-performance program in nursing homes.
The Department of Health and Human Services is authorized to adopt emergency rules to take effect retroactively to July 1, 2013 for the establishment of the supplemental MaineCare payments to nursing homes that serve a high percentage of MaineCare residents.
The bill also appropriates state funds and allocates matching federal funds for cost-of-living increases for MaineCare reimbursement to nursing facilities in the 2014-2015 biennium.