Resolve, To Establish a Responsive, Community-based, Cost-effective and Comprehensive Adult Mental Health System
Maine Legislature, Session 122, LD 1515
Committee: Health and Human Services
Sponsors: PINGREE, MAYO, CUMMINGS, CURLEY, DUDLEY, MILLER, WALCOTT, WEBSTER, BRENNAN, ROSEN

Legislative Document 
No. ISIS 
H.P.1060 
House of Representatives, March 30, 2005 
Resolve, To Establish a Responsive, Community-based, Cost-
effective and Comprehensive Adult Mental Health System 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representative PINGREE of North Haven. 
Cosponsored by Senator MAYO of Sagadahoc and 
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MILLICENT M. MacFARLAND 
Clerk 
Representatives: CUMMINGS of Portland, CURLEY of Scarborough, DUDLEY of Portland, 
MILLER of Somerville, WALCOTT of Lewiston, WEBSTER of Freeport, Senators: 
BRENNAN of Cumberland, ROSEN of Hancock. 
Printed on recycled paper 
Sec. 1. Development of regional system for management of mental 
health system. Resolved: That the Department of Health and Human 
Services, referred to in this resolve as "the department," in 
consul tation 
wi th 
provider, 
consumer 
and 
advocacy 
representatives, 
shall 
develop 
a 
capitated 
regional 
system, 
referred to in this resolve as "the regional system," for the 
financing, management and oversight of the state mental health 
system; and be it further 
Sec. 2. Duties of department. Resolved: That, in implementing 
the requirements of this resolve, the department shall: 
1. 
Develop plan. 
regional system; 
Develop and implement 
a plan for the 
2. 
Maintain existing system. 
Maintain the existing mental 
health system of services during the transition to the regional 
system; 
3. 
Develop 
statewide mental health policy. 
statewide mental health policy; 
Develop 
a 
4. 
Coordination of services. 
Coordinate services 
among 
other state agencies; 
5. 
Coordination of meetings. 
Coordinate and hold quarterly 
stakeholder oversight committee meetings; 
6. Regional entities. 
with regional entities and 
services and the quality of 
Develop standards for and contract 
monitor and evaluate the delivery of 
these services; and 
7. 
Medicaid waivers. 
Ensure that all applicable federal 
Medicaid waivers are filed in a timely manner; and be it further 
Sec. 3. Plan for system redesign. Resolved: That the department 
shall develop a plan for system redesign that includes plans for 
implementing the regional system, financing the regional system 
and transitioning from the current system. 
The department shall 
disseminate the plan and review it with stakeholders prior to 
filing for 
a 
Medicaid waiver under section I 
or issuing the 
request for 
proposal pursuant to 
section 
5. 
The 
plan must 
include a process for evaluating the pilot project under section 
before the regional system is implemented statewide. 
1. 
System readiness. 
Prior to submitting a 
issuing a request for proposal, the department shall 
the following are completed: 
Page I-LR1402 (l) 
waiver 
and 
ensure that 
A. 
An actuarial analysis. 
In accordance with 42 Code of 
Federal Regulations, 
Section 438.6(c), 
any 
system design 
that includes capitation, risk-sharing or other significant 
changes in the reimbursement methodology to providers of 
mental 
health 
services 
must 
be 
developed 
with 
the 
involvement 
of 
independent actuarial expertise. 
A 
joint 
committee that includes providers and representatives from 
the appropriate offices of State Government, as determined 
by 
the 
Governor, 
shall 
oversee 
the 
development 
of 
the 
rate-setting 
methodology. 
Capitation 
reimbursement 
methodologies must give due consideration to the issues of 
appropriate 
levels 
of 
care 
and 
the 
needs 
of high-cost 
recipients of services who may need residential treatment 
services: 
B. 
A 
human 
resources 
analysis. 
The 
department 
shall 
undertake an independent human resource needs analysis that 
describes 
what 
managerial 
and 
administrative skills 
and 
services will need to be purchased in order to carry out the 
design, pricing, implementation and management of any new 
systems 
design. 
This 
analysis 
must 
also 
describe 
what 
services 
will 
be 
eliminated 
from 
direct 
departmental 
responsibility to allow for administrative savings: 
C. 
An 
administrative burdens 
review. 
Identification of 
savings and system efficiencies must begin with a review and 
reduction of administrative burdens and the cost of these 
burdens to direct service agencies. 
The reductions in both 
administrative burdens and cost must achieve a savings of at 
least 15% in the costs of the system in 2005; 
D. 
A data systems readiness review. 
The department shall 
identify the 
minimum data set necessary for 
appropriate 
oversight, management and outcome measurement of the system 
of care. 
As 
a part of its plan for system redesign, the 
department shall undertake a review of data requirements and 
the 
capabilities of existing data 
systems 
in order 
to 
determine, prior to implementation, what, if any, enhanced 
data capacity will need to be purchased from independent 
vendors; 
E. 
Development 
of 
an 
outcome 
measures 
assessment. 
In 
consultation 
with 
consumers, 
providers 
and 
other 
stakeholders, 
the department shall develop 
a 
manageable, 
measurable set of performance standards and contract outcome 
measures 
for 
the 
regional 
system. 
These 
performance 
standards and outcome measures must be based on existing 
mandates 
and 
developed 
with 
due 
regard 
to 
available 
resources 
and 
with 
reference 
to 
national 
standards 
for 
public mental health systems; and 
F. 
A regulatory framework. 
The department, in conjunction 
with appropriate consumer and provider stakeholders, shall 
adopt rules that establish a 
clear regulatory 
framework 
prior to the implementation date that describes the regional 
system and its core components, including scope of services 
and populations covered, cost effectiveness and assumptions 
used to calculate savings. 
Rules adopted pursuant to this 
paragraph are major substantive rules as defined in the 
Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A. 
2. 
Leqislative review. 
reports to the joint standing 
jurisdiction over health and 
development, 
implementation 
regional system. 
The department shall make regular 
committee of the Legislature having 
human services matters regarding the 
and 
ongoing 
management 
of 
the 
3. 
Cost of system redesign. 
The plan for system redesign 
must describe the financing of the start-up and administration of 
the new regional system. 
Administrative costs may not reduce 
existing levels of direct services for adults. 
The plan must 
describe 
strategies 
to 
reduce 
state 
administrative 
costs 
to 
support the administrative requirements of regional entities; and 
be it further 
Sec. 4. System design components. Resolved: 
That the regional 
system design must contain the following components. 
1. 
Population served. 
The 
regional 
system design must 
encompass all adults with severe and persistent mental illness 
who were eligible as of July 1, 
2003 for services under the 
MaineCare Assistance Manual, Section 17. 
These include MaineCare 
recipients, 
people 
without 
insurance 
and 
people 
who 
are 
underinsured. 
2. 
Core services. 
Services provided under 
system must be explicitly delineated in rules and 
must include, at a minimum: 
the regional 
contract and 
A. 
All 
MaineCare 
services 
MaineCare Assistance Manual, 
currently provided under 
the 
Sections 17, 65 and 97 as well 
as authorization responsibilities for inpatient psychiatric 
care; 
B. 
Emerging, promising and best practices, including, but 
not limited to, those best practices currently identified by 
the United States Department of Health and Human Services, 
Substance Abuse and Mental Health Services Administration; 
C. 
Treatment services for concurrent disorders; 
D. 
Services that are provided to people with serious and 
not 
by 
persistent 
mental 
illness 
that 
are 
MaineCare-reimbursable services but that are paid for 
state grant funds, including services delivered in jails. 
3. 
Establishment of regional entities. 
establish the following regional entities: 
A. 
Stakeholder 
oversight 
committees. 
establish a stakeholder oversight committee 
of the State, to be defined in the plan. 
and role of each committee must be specified 
The 
plan 
must 
The 
plan 
must 
in each region 
The composition 
in the plan; and 
B. 
Regional 
entities. 
The 
plan 
must 
include 
the 
establishment of regional entities that are responsible for 
developing 
and 
contracting 
for 
a 
network 
of 
services, 
managing utilization of inpatient and high-cost services, 
ensuring that individualized service plans are developed for 
people with serious mental illness, 
paying claims 
under 
contracts, 
ensuring 
the 
implementation 
of 
a 
system 
of 
continuous quality improvement within the region, meeting 
all state and federal standards and reporting on utilization 
and service quality to the department; and be it further 
Sec. 5. Request for proposal components. Resolved: 
That the 
department shall issue an initial request for proposal for 
a 
regional pilot project to begin no earlier than July 1, 
2006; 
full implementation of the regional system must be completed by 
July 1, 2008. 
1. 
Components. 
The request for proposal must: 
A. 
Describe specific pilot project sites or regions; 
B. 
Contain 
specific 
outcome 
and 
performance 
standards 
developed 
in 
accordance 
with 
section 
3, 
subsection 
1, 
paragraph E. 
These standards must be phased in over time 
and be measurable and reasonable; 
C. 
Allow for a variety of responses according to regional 
needs. 
The successful bidder may be 
a 
single provider, 
multiple providers or a consortium of agencies; 
D. 
Establish standards for access to care and the provision 
of coordinated, flexible services; 
E. 
Require that the successful bidder: 
(1) 
Be community-based; and 
(2) 
Have 
a 
demonstrated ability 
and 
deliver, coordinate and manage community 
services within a specified region; 
expertise 
to 
mental heal th 
F. 
Include standards for the coordination of 
different disciplines, 
between physical health 
health and among the various state departments 
that provide support or assistance; 
care among 
and mental 
and bureaus 
G. 
Require that proposals ensure that individual needs and 
strengths will be recognized; 
H. 
Require that proposals ensure consumer choice. 
pilot 
project 
design 
must 
support 
services 
that 
consumer-centered and that meet consumer needs; 
The 
are 
I. 
Require that proposals address specific gaps in access, 
services and resources within the region; 
J. 
Require 
entities and 
and 
ensure 
design must 
relationship 
that proposals provide incentives to regional 
regional providers to deliver high-quality care 
clinical 
appropriateness. 
The 
pilot project 
recognize 
the 
importance 
of 
the 
therapeutic 
in continuity of care; 
K. 
Require 
that 
proposals 
address 
the 
coordination 
of 
treatment 
and 
support 
needs 
of 
the 
individual, 
such 
as 
social, vocational, housing and transportation necessities; 
L. 
Require that proposals support the individual's recovery 
through the delivery of recovery-oriented and rehabilitative 
services. 
Individual 
service 
plans 
must 
be 
based 
on 
clinical assessment and functionality; 
M. 
Require that proposals ensure flexible service delivery; 
N. 
Require that proposals require that clinical decisions 
that determine access to care be consumer-focused and occur 
at the community provider level; and 
o. 
Require that proposals incorporate the rules adopted by 
the 
former 
Department 
of 
Behavioral 
and 
Developmental 
Services regarding the rights of recipients of mental health 
services and effectively address the mandates of the Augusta 
Mental Health Institute consent decree compliance plans. 
SUMMARY 
This resolve requires the Department 
Services 
to 
develop 
a 
regional 
system 
management and oversight of the state mental 
of Health and Human 
for 
the 
financing, 
health system.