(3)__A report of any criminal conviction of a nursing assistant for resident abuse, mistreatment or neglect or misappropriation of resident property, with the date of the conviction.

C.__The department shall ensure that sufficient staff is assigned to the registry and that appropriate systems are in place in order that the information provided in response to any telephone inquiry contains all information currently available to the registry about the individual named in the request and that the information provided by telephone is a complete and accurate summary of all written records available with respect to the individual.__The department shall maintain systems with respect to the operation of the registry that ensure that any inquiry regarding an individual is answered, with current and complete information, no more than 30 minutes following the initial telephone inquiry.

Sec. 2. Treatment of costs and inflation in the principles of reimbursement for residential care facilities rules. By September 1, 2001, the Department of Human Services shall amend its rules regarding principles of reimbursement for residential care facilities to ensure that reimbursement reflects the current cost of providing services in an efficient manner. The revised principles of reimbursement must:

1. Provide for base reimbursement rates on percentages from the most recent audited year; and

2. Contain an annual inflation adjustment that reflects the actual increases in operating costs incurred by state residential care facilities and recognizes regional variations in labor costs.

Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.

Rules amended pursuant to this section must take effect no later than September 1, 2001.

Sec. 3. Treatment of cost components and inflation in the principles of reimbursement for nursing facilities rules. By September 1, 2001, the Department of Human Services shall amend its rules regarding principles of reimbursement for nursing facilities to ensure that reimbursement reflects the current cost of providing services in an efficient manner. The revised principles of reimbursement must:

1. Provide for base reimbursement rates on percentages from the most recent audited year; and

2. Contain an annual inflation adjustment that reflects the actual increases in operating costs incurred by state nursing facilities and recognizes regional variations in labor costs; and

3. Allow each nursing facility to retain the entire amount, if any, by which the interim per diem payment rate for the "routine component" exceeds the actual allowable per diem costs classified within the "routine component" for any cost-reporting period.

The rules must be designed to ensure that aggregate Medicaid payments for nursing facility services are sufficient to cover the total allowable costs of providing the Medicaid covered portion of those services. Allowable costs must be determined without any constraint based on any preestablished budget or appropriation amount.

Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.

Sec. 4. Principles of reimbursement for home health care services rules. By September 1, 2001, the Department of Human Services shall amend its rules governing payment for home health care services to ensure that those payments reflect the current costs of providing services in an efficient manner. The revised rules must:

1. Provide for periodic recalculation of payment rates at least once every 3 years to reflect current operating costs;

2. Provide sufficient reimbursement for wage and salary costs to ensure the availability of an adequate number of skilled professional personnel to provide needed home health care services;

3. Contain an annual inflation adjustment that reflects the actual increases in operating costs experienced by the home

health care providers in the State and recognizes regional variations in labor costs; and

4. Provide for payment of the costs of social worker services on the basis of the average cost per social worker visit for state home health care agencies.

Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.

Sec. 5. Validation of quality measurements project to be used in connection with reimbursement. The Department of Human Services shall commission and fund, based on a fair and competitive process of requesting proposals, a project to develop statistically valid quality standards and processes for evaluating long-term care provider performance in relation to those standards. The objectives of the project must include measurement methods that are cost effective to use in nursing facilities throughout the State and that quantify consumer satisfaction and other variables that are demonstrated to have a significant impact on the quality of care. By July 1, 2001, the department shall convene a conference that includes representatives of the long-term care industry to further discuss the specific objectives of this project. The department may not implement incentive provisions in the principles of reimbursement pertaining to quality of care until statistically valid measurements are determined and specified by rule after the completion of the project. If quality-of-care incentive provisions are incorporated into the principles of reimbursement, those provisions must provide for the measurement of the variables that affect the quality of care on a fair and objective basis by a party that is neither controlled nor owned by either a provider or the department. The department may not implement incentive provisions pertaining to quality of care except to the extent that sufficient appropriations are available to fund reimbursement of the current cost of providing services without regard to such incentives.

Sec. 6. Transfer of assets and spousal impoverishment rules. By September 1, 2001, the Department of Human Services shall amend its rules governing eligibility for coverage for residential care services to require that:

1. Resources available from a resident's assets be used to cover the cost of care to the same extent that such assets must be used prior to coverage for nursing facility services;

2. The restrictions and presumptions with respect to transfers of assets applicable to eligibility and coverage for

nursing facility services be applied in the same manner to eligibility and coverage of residential care services; and

3. The provisions governing spousal impoverishment applicable to nursing facility coverage are also applied to Medicaid coverage of services provided in a residential care facility.

Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.

Sec. 7. Homebound requirement rules. By September 1, 2001, the Department of Human Services shall amend its rules governing eligibility and coverage of home health care services to remove the homebound requirement that properly applies solely to Medicare-covered home health care services so that Medicaid home health coverage, in accordance with applicable federal law, is not subject to a homebound requirement.

Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.

Sec. 8. Aging in place. The Joint Standing Committee on Health and Human Services shall conduct a study and propose changes to existing law to facilitate and properly compensate providers for the delivery of services that allow consumers to choose to remain in a facility while aging without compromising the quality of care, the safety of consumers or the financial, administrative, and resident care capabilities of the providers of long-term care services.

Specifically, the committee shall consider means of ensuring that providers have the discretion to discharge consumers who require services that are currently unavailable in the facility where the consumer would prefer to remain when delivery of those services at the facility preferred by the consumer would impose costs that will not be fully reimbursed or will disrupt the character or effectiveness of the residential environment and the plan for delivery of services in the facility. The committee also shall consider allowing nursing facilities to provide reduced levels of care when consumers residing in those facilities but no longer requiring a nursing facility level of care prefer to remain, if costs can be adjusted appropriately so as to be fully recovered at reimbursement rates applicable for a reduced level of care and the adjusted services can be delivered without disrupting the effective delivery of services to other residents of the facility.

The committee shall report its findings and recommendations, including necessary implementing legislation amending the laws governing nursing facility and residential care facility licensing and reimbursement, to the Second Regular Session of the 120th Legislature by January 15, 2002.

Sec. 9. Rule amendments to remove penalties for occupancy declines. By September 1, 2001, the Department of Human Services shall amend its rules regarding the principles of reimbursement for nursing facilities and the principles of reimbursement for residential care facilities to remove any provision of those principles that reduces the total reimbursement of fixed costs when the facility's occupancy percentage, number of residents served or other measures of utilization relative to capacity falls below a specified percentage or threshold.

Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.

Emergency clause. In view of the emergency cited in the preamble, this Act takes effect when approved.

SUMMARY

This bill amends the Maine Registry of Certified Nursing Assistants laws to ensure adequate staffing and coverage in order to allow long-term care providers to obtain timely and accurate information about the certification status of potential nursing assistant employees and any record of past abuse or neglect that would preclude hiring of those individuals.

This bill also requires the Department of Human Services to make several improvements in the system of payment for long-term care, including nursing facility services, residential care facility services and home health care services, in order to fairly reflect the current cost of providing those services efficiently. These improvements include an overall requirement that the payment system reflect the current costs of efficiently providing necessary long-term care services, base reimbursement rates on the most recently available audited cost figures at least once every 3 years, adjust for inflation using factors that reflect actual increases in operating costs incurred in the State and allow nursing facilities to retain, as an efficiency incentive, savings that they may produce in routine component costs.

This bill also requires that the principles of reimbursement provide payment rates that cover total Medicaid allowable costs,

without adjusting the definition of such costs to conform to a predetermined budget or appropriation amount.

This bill requires the Department of Human Services to develop and fund a project to develop statistically valid measurements of long-term care quality and requires that these statistically valid measurements be applied in a fair and independent manner in implementing any quality incentives as part of the payment system for long-term care. The bill precludes the department from implementing quality incentives at the expense of full reimbursement of the current costs of providing service.

The bill requires recipients of long-term care coverage to exhaust their own available assets before obtaining public support, unless there is a spouse continuing to live in the community, in which case that spouse is protected from the loss of assets to the point of improvishment.

The department is required to remove the homebound requirement that currently applies to Medicaid home health coverage in recognition of the fact that federal law imposes the homebound standard only with respect to Medicare coverage of home health services and does not provide for such a restriction on Medicaid coverage.

The bill requires the Joint Standing Committee on Health and Human Services to study the current statutory obstacles to allowing a consumer to chose to remain in a single, long-term care setting when changes occur in the level of services needed. The committee is required to identify changes in the existing statutory scheme that should be made in order to properly compensate providers and remove regulatory obstacles to the provision of a continuum of services without needless disruption of residents' lives.

Finally, the bill requires the Department of Human Services to amend its principles of reimbursement rules for both nursing facilities and residential care facilities to remove any provision that reduces the total reimbursement of fixed costs when a facility's occupancy percentage, number of residents served or other measurement of utilization relative to capacity falls below a specified percentage or threshold.