Public Laws

124th Legislature

First Regular Session


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Chapter 213

H.P. 274 - L.D. 353

PART CC

Sec. CC-1. 22 MRSA §1714-B,  as amended by PL 2005, c. 519, Pt. PP, §1, is further amended to read:

§ 1714-B.  Critical access hospital reimbursement

For state fiscal years beginning on or after July 1, 2005 through June 30, 2009, the department shall reimburse licensed critical access hospitals that are licensed at 117% of MaineCare allowable costs for both inpatient and outpatient services provided to patients covered by the MaineCare program. For state fiscal years beginning on or after July 1, 2009, for each critical access hospital fiscal year up to but not including the hospital fiscal year beginning on or after April 1, 2011, the department shall reimburse licensed critical access hospitals at 109% of MaineCare allowable costs for both inpatient and outpatient services provided to patients covered by the MaineCare program. Of the total allocated from hospital tax revenues under Title 36, chapter 375, $1,000,000 in state and federal funds must be distributed annually among critical access hospitals for staff enhancement payments. This section is repealed April 1, 2012.

Sec. CC-2. 22 MRSA §1714-C  is enacted to read:

§ 1714-C.   Critical access hospital staff enhancement reimbursement

Beginning April 1, 2011, the department shall reimburse critical access hospitals from the total allocated from hospital tax revenues under Title 36, chapter 375 at least $1,000,000 in state and federal funds to be distributed annually among critical access hospitals for staff enhancement payments.

Sec. CC-3. 22 MRSA §3174-LL  is enacted to read:

§ 3174-LL.   Inpatient services reimbursement based on diagnosis-related groups

Beginning April 1, 2010, the Department of Health and Human Services shall begin to phase in a system to reimburse noncritical access hospitals for inpatient services under the MaineCare program an amount per discharge that is based on diagnosis-related groups modeled on the system used by the federal Medicare program. The new diagnosis-related groups payment system must be budget neutral, based on MaineCare hospital payments for the year prior to the year of implementation. The new payment system must be implemented for each noncritical access hospital at the beginning of the hospital's first fiscal year that commences on or after April 1, 2010. The Department of Health and Human Services shall adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter 2-A.

Sec. CC-4. 22 MRSA §3174-MM  is enacted to read:

§ 3174-MM.   Outpatient services reimbursement under the MaineCare program based on ambulatory payment classifications

Beginning April 1, 2010, the Department of Health and Human Services shall begin to phase in a system to reimburse noncritical access hospitals for outpatient services under the MaineCare program an amount per patient service based on ambulatory payment classifications modeled on the system used by the federal Medicare program. The new ambulatory payment classifications must be budget neutral based on MaineCare payments for the same services in the year prior to the year of implementation. The new payment system must be implemented for each hospital at the beginning of the hospital's first fiscal year that commences on or after April 1, 2010. The Department of Health and Human Services shall adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter 2-A.

Sec. CC-5. 22 MRSA §3174-NN  is enacted to read:

§ 3174-NN.   Inpatient services reimbursement for critical access hospitals based on diagnosis-related groups

Beginning April 1, 2011, the Department of Health and Human Services shall begin to phase in a system to reimburse critical access hospitals for inpatient services under the MaineCare program an amount per discharge that is based on diagnosis-related groups modeled on the system used by the federal Medicare program. The new diagnosis-related groups payment system must be budget neutral, based on MaineCare hospital payments for the year prior to the year of implementation. The new payment system must be implemented for each critical access hospital at the beginning of the hospital’s first fiscal year that commences on or after April 1, 2011. The Department of Health and Human Services shall adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter 2-A.

Sec. CC-6. 22 MRSA §3174-OO  is enacted to read:

§ 3174-OO.   Outpatient services reimbursement for critical access hospitals under the MaineCare program based on ambulatory payment classifications

Beginning April 1, 2011, the Department of Health and Human Services shall begin to phase in a system to reimburse critical access hospitals for outpatient services under the MaineCare program an amount per patient service based on ambulatory payment classifications modeled on the system used by the federal Medicare program. The new ambulatory payment classifications must be budget neutral based on MaineCare payments for the same services in the year prior to the year of implementation. The new payment system must be implemented for each critical access hospital at the beginning of the hospital's first fiscal year that commences on or after April 1, 2011. The Department of Health and Human Services shall adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter 2-A.

Sec. CC-7. PL 2009, c. 1, Pt. V  is repealed.

Sec. CC-8. Report on progress regarding inpatient services reimbursement under MaineCare. By January 15, 2011, the Department of Health and Human Services shall present a report to the joint standing committee of the Legislature having jurisdiction over health and human services matters on the progress in moving to reweighting the payments to acute care hospitals based on diagnosis-related groups and ambulatory payment classifications to provide incentives for the use of primary care.

Sec. CC-9. Report on progress regarding reducing the use of emergency departments in hospitals and reducing preventable admissions to the hospital from emergency departments. By January 15, 2010, the Governor's Office of Health Policy and Finance shall, after seeking input from interested parties, report to the Joint Standing Committee on Health and Human Services and the Joint Standing Committee on Appropriations and Financial Affairs regarding progress in reducing the use of emergency departments in hospitals and reducing preventable admissions to the hospitals. The Joint Standing Committee on Health and Human Services is authorized to report out legislation to the Second Regular Session of the 124th Legislature regarding reducing the use of hospital emergency departments and reducing preventable admissions to the hospitals from emergency departments.

Sec. CC-10. Report on the impact of increased physician MaineCare reimbursement. By October 1, 2010, the Department of Health and Human Services shall present a report to the Joint Standing Committee on Health and Human Services and the Joint Standing Committee on Appropriations and Financial Affairs on the impact of increased MaineCare physician reimbursement rates on access to and use of preventive and primary care services by MaineCare members.

Sec. CC-11. Rulemaking regarding MaineCare reimbursement. The Department of Health and Human Services shall adopt rules regarding reimbursement under the MaineCare program as provided in this section. Rules adopted pursuant to this section are routine technical rules as defined by the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A.

1. Rules for hospital-based providers of inpatient services. By July 1, 2009 the department shall adopt rules for reimbursement of hospital-based providers for inpatient services that establish the reimbursement rate at 93.3% of MaineCare allowable costs.

2. Rules for hospital-based providers of outpatient services. By July 1, 2009 the department shall adopt rules for reimbursement of hospital-based providers for outpatient services that establish the reimbursement rate at 83.8% of MaineCare allowable costs.

3. Rules for hospital emergency department providers of outpatient services. By July 1, 2009 the department shall adopt rules for reimbursement of hospital emergency department providers for outpatient services that establish the reimbursement rate at 93.4% of MaineCare allowable costs.

4. Rules for nonhospital-based physicians, nurse practitioners, physician assistants and nurse anesthetists. By February 1, 2010 the department shall adopt rules for reimbursement for services provided by nonhospital-based physicians, nurse practitioners, physician assistants and nurse anesthetists who are reimbursed at less than 70% of Medicare rates that establish the rates at 70% of Medicare rates.

5. Rules for hospital reimbursement. By July 1, 2009 the department shall adopt rules for hospital reimbursement as follows.

A. The rates must decrease reimbursement to noncritical access hospitals per discharge for inpatient hospital services by 6.7% and must provide a one-time increase in prospective interim payments to critical access and to noncritical access hospitals by 3%.
B. The rates must decrease reimbursement to critical access hospitals for inpatient and outpatient services from 117% of MaineCare allowable costs to 109% of MaineCare allowable costs.
C. The rates must decrease reimbursement to hospitals reclassified to a wage area outside of the State by the Medicare Geographic Classification Review Board from 117% of MaineCare allowable costs to 109% of MaineCare allowable costs.

Sec. CC-12. Report on feasibility and advisability of reimbursing critical access hospitals on a diagnosis-related group system for inpatient services and on an ambulatory payment classification for outpatient services under the MaineCare program. By January 15, 2010 the Department of Health and Human Services shall report to the Joint Standing Committee on Health and Human Services on the feasibility and advisability of reimbursing critical access hospitals on a diagnosis-related group system for inpatient MaineCare services and on ambulatory payment classifications for outpatient MaineCare services.

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State House, Room 108
Augusta, ME 04333