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Amend the bill in section 1 in paragraph QQ in the 2nd line (page 1, line 4 in L.D.) by inserting after the following: "income" the following: 'and not subtracted under paragraph FF'
Amend the bill by striking out all of sections 3 and 4 and inserting the following:
‘Sec. 3. Reimbursement for acute care critical access hospitals. The Department of Health and Human Services shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 45 regarding acute care critical access hospital physician services to require MaineCare reimbursement of 100% for all hospital-based physician costs.
Sec. 4. Reimbursement for rural health clinics. The Department of Health and Human Services shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 103 regarding the department's reimbursement methodology to provide an alternative payment methodology option that, effective January 1, 2020, is the same as the existing methodology except that rural health clinics may be reimbursed on the basis of 100% of the average of the reasonable costs of providing MaineCare-covered services during calendar years 2016 and 2017 as long as reimbursement is no less than reimbursement received under the prospective payment system described in Section 1902(bb) of the United States Social Security Act. Each rural health clinic must be given the option to be reimbursed under the methodology required by this section or under the existing prospective payment system methodology.
Sec. 5. State plan amendments; rulemaking. The Department of Health and Human Services shall submit any necessary state plan amendments to implement the requirements of this Act to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services no later than January 1, 2020. Upon approval, the department shall amend its rules within 180 days of approval. Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A.
Sec. 6. Appropriations and allocations. The following appropriations and allocations are made.
 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF
 
Revenue Services, Bureau of 0002
 
Initiative: Provides one-time funding for computer programming to update the individual income tax return.

GENERAL FUND	2019-20	2020-21	
All Other	$0	$11,000	
			
GENERAL FUND TOTAL	$0	$11,000	

ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF			
DEPARTMENT TOTALS	2019-20	2020-21	
			
GENERAL FUND	$0	$11,000	
			
DEPARTMENT TOTAL - ALL FUNDS	$0	$11,000	

HEALTH AND HUMAN SERVICES, DEPARTMENT OF
 
Medical Care - Payments to Providers 0147
 
Initiative: Provides appropriations and allocations to allow for MaineCare reimbursement of 100% for all hospital-based physician costs.

GENERAL FUND	2019-20	2020-21	
All Other	$371,768	$753,736	
			
GENERAL FUND TOTAL	$371,768	$753,736	

FEDERAL EXPENDITURES FUND	2019-20	2020-21	
All Other	$793,942	$1,577,684	
			
FEDERAL EXPENDITURES FUND TOTAL	$793,942	$1,577,684	

Medical Care - Payments to Providers 0147
 
Initiative: Provides appropriations and allocations to allow for MaineCare reimbursement for rural hospitals at 100% of inpatient hospital-based physician costs, outpatient emergency room hospital-based physician costs, outpatient nonemergency room hospital-based physician costs and graduate medical education costs and to allow for MaineCare reimbursement for nonrural hospitals at 93.3% of inpatient hospital-based physician costs, 93.4% of outpatient emergency room hospital-based physician costs and 83.8% of outpatient nonemergency room hospital-based physician costs.

GENERAL FUND	2019-20	2020-21	
All Other	$263,428	$534,084	
			
GENERAL FUND TOTAL	$263,428	$534,084	

FEDERAL EXPENDITURES FUND	2019-20	2020-21	
All Other	$562,573	$1,117,918	
			
FEDERAL EXPENDITURES FUND TOTAL	$562,573	$1,117,918	

Medical Care - Payments to Providers 0147
 
Initiative: Provides appropriations and allocations to allow for an alternative payment methodology option that, effective January 1, 2019, is the same as the existing methodology except that rural health clinics may be reimbursed on the basis of 100% of the average of the reasonable costs of providing MaineCare-covered services during calendar years 2016 and 2017 as long as reimbursement is no less than reimbursement received under the prospective payment system.

GENERAL FUND	2019-20	2020-21	
All Other	$739,449	$1,499,185	
			
GENERAL FUND TOTAL	$739,449	$1,499,185	

FEDERAL EXPENDITURES FUND	2019-20	2020-21	
All Other	$1,579,154	$3,138,020	
			
FEDERAL EXPENDITURES FUND TOTAL	$1,579,154	$3,138,020	

HEALTH AND HUMAN SERVICES, DEPARTMENT OF			
DEPARTMENT TOTALS	2019-20	2020-21	
			
GENERAL FUND	$1,374,645	$2,787,005	
FEDERAL EXPENDITURES FUND	$2,935,669	$5,833,622	
			
DEPARTMENT TOTAL - ALL FUNDS	$4,310,314	$8,620,627	

SECTION TOTALS	2019-20	2020-21	
			
GENERAL FUND	$1,374,645	$2,798,005	
FEDERAL EXPENDITURES FUND	$2,935,669	$5,833,622	
			
SECTION TOTAL - ALL FUNDS	$4,310,314	$8,631,627	
 
’
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section number to read consecutively.
 
SUMMARY
This amendment makes the following changes to the bill.
1. It changes the reimbursement for acute care critical access hospitals to 100% for all hospital-based physician costs rather than facility and physician costs.
2. It clarifies that rural health clinics are paid under an alternative payment methodology option that is the same as the current system except for rebasing costs to 2016 and 2017 costs as long as the rural health clinics are not paid less than the current reimbursement rate.
3. It requires the Department of Health and Human Services to submit any necessary state plan amendments to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services no later than January 1, 2020. Rulemaking must be completed by the department within 180 days of receiving federal approval.
4. It adds language to clarify that taxpayers cannot claim a double benefit for educational opportunity tax credits.
5. It adds an appropriations and allocations section.
FISCAL NOTE REQUIRED
(See attached)