128th MAINE LEGISLATURE
		LD 1134		LR 951(02)
	An Act To Amend the Laws Governing Nursing Facilities To Permit Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants To Perform Certain Physician Tasks
	Fiscal Note for Bill as Amended by Committee Amendment " "
	Committee: Health and Human Services
	Fiscal Note Required: Yes
Fiscal Note
Potential future biennium savings - General Fund Potential future biennium savings - Federal Expenditures Fund
Fiscal Detail and Notes
	This bill provides that, in accordance with federal regulations for certain nursing home level services, a physician assistant, nurse practitioner or clinical nurse specialist may provide medically necessary visits currently performed by a physician. For nursing facilities a prospective case mix payment system is utilized in which the payment rate for services is set in advance of the actual provision of those services. The rate is established in a two-step process: 1) facility's base-year cost report is reviewed to extract those costs that are allowable costs and 2) the costs which must be incurred by an efficiently and economically operated facility are identified. Since these rates are set ahead of service, any savings from using a lower clinical level to provide certain services would not be achieved until a future biennium. The efficiencies gained through this bill may not lead to immediate savings in the MaineCare system because skilled nursing facilities are not reimbursed for each direct service, but rather on a per diem basis. Long-term the per diem rates should be adjusted lower because of this bill and the MaineCare system should incur savings.