An Act To Improve Quality, Effectiveness and Efficiency in the Department of Health and Human Services
Maine Legislature, Session 122, LD 1555
Committee: Health and Human Services
Sponsors: LERMAN, NASS, CRA YEN, CROSTHWAITE, GROSE, PINGREE, WEBSTER, MAYO
Amends: 22 MRSA §42

Legislative Document 
No. 1555 
H.P.1096 
House of Representatives, April 6, 2005 
An Act To Improve Quality, Effectiveness and Efficiency in the 
Department of Health and Human Services 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representative LERMAN of Augusta. 
Cosponsored by Senator NASS of York and 
Il/~ 
frl·71I~ 
MILLICENT M. MacFARLAND 
Clerk 
Representati ves: BURNS of Berwick, CRA YEN of Lewiston, CROSTHWAITE of Ellsworth, 
GROSE of Woolwich, PINGREE of North Haven, WEBSTER of Freeport, Senator: MAYO of 
Sagadahoc. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-t. 22 MRSA §42, sub-§9 is enacted to read: 
9. 
ReimburSement. audit_r:md appeal prQ.cedures. 
Beginning 
January 
1, 
2006, 
the 
following 
requirements 
apply 
to 
reimbursement, audit and app..eJtis proce.d!.u'es for community-based 
Q%ganizations 
providing 
m~~ta~e~ax~ation and 
dey~opmeQ~al 
disabilities services to clients of the department through the 
MaineCare 
program or 
through contract or 
agreement with the 
department. 
These procedures ~ply in addition to the procedures 
otherwise required by law or rule. 
A. 
In the principles of reimbursement, the department shall 
adopt a 
standard defin~f "allowable 
cos~for all 
principles of reimbursement unless federal law or regulation 
specifically prohibits 
the 
use of 
the definition for 
a 
particular program. 
B. 
The principles of reimbursement for private nonmedical 
institutions 
must 
enable 
community-based 
org~nizations 
operating private nonmedical institutions to shift variable 
cost funds within certain designated accounts provided that 
the totals are met for the private nonmedical institution. 
C. 
The 
department 
sb.Q.ll 
pu~j,~on its 
pubHc-.ally 
accessible site on the Internet all interpretations of the 
application 
of 
the 
principles 
of 
reimbursement 
by 
the 
department's auditors. 
D. 
When 
a 
new interpretation of the application of the 
principles of reimbursement is made by the department and a 
previously allowed practice is disallowed by the department 
through an audit, 
a 
new practice replacing the previously 
allowed practice may not be required prior to the beginning 
of the next fiscal year after the audit is completed. 
E. 
Appeals 
by 
a 
community-based organization 
regarding 
programmatic and budg~!".Y-issues W-.St be conducted for the 
department by an independent decisiorunaker. 
F. 
If a community-based organization is successful in an 
appeal against the department, 
the_~~ionmaker shall award 
to the organization as an allowable cost the cost of legal 
fees and representation in the appeal. 
Sec. A-2. Pilot project. 
The Department of Heal th and Human 
Services shall conduct a pilot project to determine the efficacy 
of 
accepting 
audits 
by 
certified 
public 
accountants 
Page l-LRI64l(1) 
using only a sampling technique to close audits on a more timely 
schedule. 
The department shall report to the joint standing 
committee of the Legislature having jurisdiction over health and 
human services matters by January 1, 2007 on the results of the 
pilot project and anf recommendations pertaining to the project 
of the department and the providers of community-based mental 
retardation and developmental disabilities services. 
PARTB 
Sec. B-1. 22 MRS A §3187, as amended by PL 2003, c. 684, §1, 
is further 
amended by adding after the 
2nd paragraph a 
new 
paragraph to read: 
Beginning January 1, 2006, the principles of reimbursement 
must 
allow 
the 
retent~n of 
sayings 
by 
intermediate 
care 
facilities for persons with mental retardation up to a maximum 
amount QJ2Plicable to 
alLJ;.b~~_tilllities durin9-~Uscal yeaL 
that is egual to the amount retained by those facilities during 
~ate~iscal year 2003-04 a~~d 
by the Consumer Price Index 
for fiscal year 2005-06 and annually thereafter. 
Sec. B-2. Review of rules and regulations. 
The Department of 
Health and 
Human 
Services shall 
convene 
a 
working group of 
department staff, 
providers of services in intermediate care 
facilities for persons with mental retardation and developmental 
disabilities 
and 
consumers 
of 
mental 
retardation 
and 
developmental disabilities services and their families to review 
federal regulations and state rules regarding quality assurance, 
health and safety in all Medicaid waiver programs. 
The working 
group shall report its recommendations 
to the Joint Standing 
Committee on Health and Human Services by January 1, 2006 and 
shall include recommendations that focus on outcomes rather than 
process to reach goals of improved quality, health and safety. 
Sec. B-3. Review of administrative requirements. 
The Department 
of Health and Human Services shall convene a working group of 
department staff, 
providers of services in intermediate care 
facilities for persons with mental retardation and developmental 
disabilities 
and 
consumers 
of 
mental 
retardation 
and 
developmental disabilities services and their families to review 
federal 
regulations 
and 
state 
rules 
regarding 
administrative 
requirements and to conduct a cost-benefit analysis. 
The working 
group shall report its recommendations to the Joint Standing 
Committee on Health and Human Services by January 1, 
2006 and 
shall include recommendations that address the quality of service 
and quality of life of residents of intermediate care facilities 
along 
with 
the 
requirements 
for 
administrative 
process 
and 
accountability. 
The working group must recommend a cost-benefit 
analysis 
that 
is 
based 
on 
objective 
criteria that will be required before the imposition of any new 
administrative procedures. 
Sec. B-4. Standardized data collection, contract formats and financial 
reports. 
By January 1, 2006, the Department of Health and Human 
Services 
shall 
adopt 
rules 
setting 
forth 
standardized 
requirements for data reporting and collection, contract formats 
and 
financial 
reports 
for all providers 
of 
residential 
and 
community-based 
services 
to persons 
with mental 
retardation, 
developmental disabilities and mental illness. 
The standardized 
requirements must apply across all funding sources and must allow 
for better comparison of costs 
and service outcomes. 
Rules 
adopted pursuant to this section are routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A. 
Sec. B-5. Medication course. 
The Department of Health and 
Human 
Services 
shall 
develop 
and 
maintain 
a 
medication 
administration 
course 
for 
employees 
of 
residential 
care 
facilities with fewer than 15 residents that are licensed under 
the Maine Revised Statutes, Title 22, chapter 1663. 
The course 
must consist of 24 hours of training. 
PARTC 
Sec. C-l. Deemed status. 
By January 1, 2006, the Department 
of Health and Human Services shall adopt rules to grant licenses 
under deemed status to all community mental health, developmental 
disability and mental retardation services agencies that have 
earned national 
accreditation through 
the 
Commission 
on 
the 
Accreditation 
of 
Rehabilitation 
Facilities, 
the 
Council 
on 
Accreditation, 
the 
Joint 
Commission 
on 
Accreditation 
of 
Healthcare 
Organizations, 
the 
National 
Association 
for 
the 
Education of 
Young 
Children or 
other 
national 
accreditation 
body. 
If the department determines that amendment to law is 
needed, 
the 
department 
shall 
report 
to 
the 
Joint 
Standing 
Committee on Health and Human Services recommendations for any 
necessary amendments to law. 
Rules adopted pursuant to this 
section are 
routine technical rules 
as defined in Title 
5, 
chapter 375, subchapter 2-A. 
Sec. C-2. Maintenance of Child Development Services System. 
The 
Department of Education shall maintain the Child Development 
Services System in substantially the same manner as the system 
exists on the effective date of this Act for a time period of at 
least 2 years. 
Sec. C-3. State Board of Nursing. 
By January 1, 2006, the State 
Board of Nursing shall adopt rules to allow registered nurse 
training for and supervision of the use of gastronomy tubes for 
the 
purpose 
of 
medication 
administration, 
nutrition 
and 
hydration. 
Sec. C-4. Rules review. 
The State Board of Nursing and the 
nursing 
association 
representing 
nurses 
in 
the 
field 
of 
developmental disabilities shall review the rules for residential 
options 
for 
persons 
with 
developmental 
disabilities, 
mental 
retardation and other medical issues to determine whether Maine 
law 
and 
rules 
could 
be 
changed 
to 
increase flexibility in 
residential options. 
By January 1, 
2006, 
the State Board of 
Nursing and the participating nursing association shall report to 
the 
Joint 
Standing 
Committee 
on 
Health 
and 
Human 
Services 
regarding recommendations and any proposed changes to rules or 
laws. 
Sec. C-5. Advocacy. 
The 
Department 
of Health 
and 
Human 
Services shall actively advocate for and shall work to support 
federal legislation on improved wages and benefits for direct 
support professionals working in the fields 
of developmental 
disabilities and mental retardation. 
The department shall report 
to the Joint Standing Committee on Health and Human Services 
by 
January 1, 2006 and every 6 months thereafter on the status of 
federal legislation on direct support professionals. 
Sec. C-6. Cost-of-living adjustment. 
The Department of Heal th 
and Human Services shall amend the rules of reimbursement for 
developmental 
disabilities 
and 
mental 
retardation 
services 
agencies 
to 
provide 
for 
rate 
increases 
as 
a 
result 
of 
cost-of-living increases. 
The rules must provide that if the 
department determines to adopt a rate increase of less than the 
amount of the cost of living increase, the department must issue 
a 
statement 
acknowledging 
the budget 
imbalance 
that will 
be 
created 
for 
the 
agencies 
and 
must 
provide 
guidance 
to 
the 
providers of services about cost savings that could be achieved 
to counterbalance the budget imbalance. 
Rules adopted pursuant 
to this section are routine technical rules as defined in Title 
5, chapter 375, subchapter 2-A. 
Sec. C-7. Dirigo Health coverage. 
By 
January 1, 
2006, 
the 
Board of Directors of Dirigo Health shall report to the Joint 
Standing 
Committee 
on 
Health 
and 
Human 
Services 
on 
the 
feasibility of extending Dirigo Health insurance under the Maine 
Revised 
Statutes, 
Title 
24-A, 
chapter 
to 
all 
nonprofit 
organizations by amending the definition of "eligible business" 
under Title 24-A, section 6903, subsection 5. 
SUMMARY 
This bill addresses the following issues in the field of 
community-based 
services 
for 
persons 
with 
developmental 
disabilities and mental retardation: 
reimbursement, 
audit and 
appeal 
procedures, 
rules, 
regulations 
and 
administrative 
requirements, standardized data, contract formats and financial 
reports, medication courses, deemed status licensure, maintenance 
of the Child Development Services System, gastronomy tubes, rules 
regarding 
residential 
options, 
advocacy 
regarding 
federal 
legislation, 
cost-of-living 
adjustments 
and 
Dirigo 
Health 
insurance.