An Act To Strengthen Sustainable Long-term Supportive Services for Maine Citizens Rc:ference to the Committee on Health and Human Services suggested and ordered printed.
Maine Legislature, Session 124, LD 1078
Committee: Health and Human Services
Sponsors: PETERSON, MILLS, BERRY, CONNOR, LEWIN, PERRY, ROTUNDO, SANBORN, STRANG BURGESS
Amends: 22 MRSA §7301, 22 MRSA §7302

MAINE STATE LEGISLATURE 
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AUGUS1:4; MAINE 
124th MAl E LEGISLATURE 
Legislative Document 
No. 1078 
H.P.745 
House of Representatives, March 17,2009 
An Act To Strengthen Sustainable Long-term Supportive Services 
for Maine Citizens 
Rc:ference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representative PETERSON of Rumford. 
Cosponsored by Senator MILLS of Somerset and 
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MILLICENT M. MacFARLAND 
,Clerk 
Representatives: BERRY of Bowdoinham, CONNOR of Kennebunk, LEWIN of Eliot, 
PERRY of Calais, ROTUNDO of Lewiston, SANBORN of Gorham, STRANG BURGESS of 
Cumberland, Senator: RA YEof Washington. 
Printed 011 recycled pnpl!f 
Be it enacted by the People ofthe State of Maine as follows: 
Sec. 1. 22 MRSA §7301; as enacted by PL 1981, c. 511, § 1, is amended to read: 
§7301. Legislat;ve intent 
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1. Findings. The Legislature finds that: 
A. . In-home and community support services have not been sufficiently available to 
many adults with long-term care needs; 
B. 
Many adults with long-term care needs are at risk of being or already have been 
placed in institutional settings, because in-home and community support services or 
funds to pay for these services have not been available to them; 
C. 
In some instances placement of adults with long-term care needs in institutional 
settings can result in emotional and social problems for these adults and their 
families; aru:l 
D. 
For many adults with long-term care needs, it is less costly for the State to 
provide in-home and community support services than it is to provide care in 
ihstitutional settings":~ 
E. The majority of adults with long-term care needs have indicated a preference to 
remain in their own homes arid in community settings rather than having their needs 
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met in institutional settings; 
F. For many adults with long-term care needs and their families, the process to 
identify and secure appropriate services is confusing and difficult to navigate; and 
Go . A sustainable system of long-term care to meet the needs -of citizens must 
. emphasize in-home and community support services that capitalize upon personal 
and fawly responsibility. 
2. Policy. The Legislature declares that it is the policy of this State: 
A. 
To increase the availability of in-home and community support services for 
adults with long-term care needs; 
B., That the priority recipients. of in':home arid 'community support services, 
pursuant to this subtitle, shall be are the elderly and disabled adults who are at the 
greatest risk of being, or who already have been, placed inappropriately in an 
institutional setting; arui 
C. 
That a variety of agencies, facilities and individuals -shall must be encouraged to 
provide in-home and community support services.,.; and 
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D .. That the overall design of the long-term care system and the allocation of long-
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term care resources promote the goal of at least 50% of the elderly and disabled 
adults receiving in-home and corrimunity support services arid no more than 50% of 
those being served receiving such services in institutional settings. 
Sec. 2. 22 MRSA §7302, as amended by PL 2001, c. 596, Pt. B, § 1 0 and affected 
by §25 and amended by PL 2003, c.689, .Pt. B, §§6 and 7, is further amended to read: 
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§7302. Definitions 
As used in this subtitle, unless the context otherwise. indicates, the following tenns 
have the following meanings. 
1.' Adults with long-term care needs. "Adults with long-tenn care needs" means 
adults who have physical or mental limitations which restrict their ability to carry out 
activities of daily living and impede their ability to live independently, or who are at .risk 
of being, or who already have been, placed inappropriately in an institutional setting. 
1-A. Activities of daily living. "Activities of daily living" means activities essential 
to a person's daily living including: eating and drinldng; .bathing and hygiene; dressing, 
including putting on and removing prostheses and clothing; toileting, including toilet or 
bedpan use, ostomy or catheter care, clothing changes and cleaning related to toileting; 
locomotion or moving between locations within a room or other areas, including with the 
use of a walker or wheelchair; transfers or moving to and from a bed, chair, couch, 
wheelchair or standing position; and bed mobility or positioning a person's body while in 
bed, including turning from side to side. 
2. Agreement." Agreement" means a contract, grant or other method of payment. 
2-A. Assessment. "Assessment" means an evaluation ofthe functional capacity of 1m 
individual to live independently given appropriate supports with activities of daily living 
and instrumental activities of daily living. 
3. Commissioner .. "Commissioner" means the Commissioner of Health and Human 
Services. 
3-A. Consumer. "Consumer" means a person eligible for services under this subtitle. 
4. 
Department. "DepaItment" means the Department of Health and Human 
Services. 
5. In-home and community support services. "In-home and community support 
services" means health and social services and other assistance required to enable adults 
with long-tenn care needs to remain in their places of residence. These services include, 
but are not limited to, self-directed care services; medical and diagnostic services; 
professional nursing; physical, occupational and speech therapy; dietary and nutrition 
services; home health aide services; personal care assistance ser:vices; companion and 
attendant services; handyman, chore and homemaker services; respite care; counseling 
services; transportation; small rent subsidies; various devices wf:ii.efl that lessen the effects 
of disabilities; and other appropriate and necessary social services. 
6. Institutional settings. "Institutional settings" means residential care facilities, 
licensed pursuant to chapter 1664; intennediate care and skilled nursing facilities and 
units and hospitals, licensed pursuant to chapter 405; and state institutions for individuals 
who are mentally ill or mentally retarded or who have related conditions. 
6-A. Instrumental activities of daily living. "Instrumental activities of daily living" 
means the essential, nonmedical tasks that enable the consumer to live independently in 
the community, including . light housework, preparing meals, taking medications, 
shopping for groceries or clothes, using the telephone, managing money and other similar 
activities. 
7. Personal care assistance services. "Personal care assistance services" means 
services .\vhich are required by an adult with long-term care needs to. achieve greater 
physical independence, which may be consumer directed self~directed and whieh include, 
but are not limited to: 
A. 
Routine bodily functions, such as bowel or bladder care; 
B. 
Dressing; 
C. 
Preparation and consumption of food; 
D. 
Moving in and out of bed; 
E. 
Routine bathing; 
F. 
Ambulation; and 
G. 
Any other similar activity Activities of daily living and instrumental activities of 
daily living. 
~ 8. Personal care assistant. "Personal care assistant" means an individual who has 
completed a training course of at least 40 hours, which includes, but is not limited to, 
instruction in basic personal care procedures, such as those listed in subsection 7, first aid 
and handling of emergencies; or an individual who meets competency requirements, as 
determined by the department or its desigilee; or, if providing service to a consumer 
receiving self-directed attendant services under chapter 1622, a person approved by the 
consumer or the consumer's surrogate as being able to competently assist in the 
fulfillment of the personal care assistance services outlined in the consumer's authorized 
plan of care. Nothing in Title 32, chapter 31, may be interpreted to require that a personal, 
care assistant be licensed under that chapter or supervised by a person licensed under that 
chapter. 
9. Provider. "Provider" means any entity, agency, facility or individual who offers 
or plans to offer any in-home or community support services or institutionally based 
long-term care services. 
9-A. Qualified provider agency. "Qualified provider agency" means a comrnunity-
based agency with the organizational and administrative capacity to administer and 
monitor a complete range of in-home and community support services including: serving 
as a resource for consumers and their surrogates to identify available service .options; 
coordinating and implementing the services in the consumer's authorized plan of care; 
insuring that authorized services an! delivered according to the authorized plan of care; 
providing' skills training; answering questions; assisting with problem resolution; 
administrative functions, including maintaining consumer records and processing payroll, 
reimbursement or ciaims; overseeing and assuring compliance with policy requirements; 
and conducting required utilization review activities. 
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9-B. 
Self-directed care services. "Self-directed care services" means 
services 
procured and directed by the consumer or the consumer's surrogate that allow the 
consumer to reenter or remain in the community and to maximize independent living 
opportunities. "Self-directed care services" includes the hiring, firing, training and 
superv.ision of personal care assistants to assist with activities of daily living and 
instrumental activities of daily living. 
10. Severe disability. "Severe disability" means a disability whlel:t that results in 
persons having severe, chronic physical, sensory or cognitive limitations whlel:t that 
restrict their ability to carry out the Hennal activ.ities of daily living and to live 
independently. 
11. Surrogate. "Surrogate" means an unpaid agent of a consumer designated to 
assist with the management of the tasks associated with in-home and community support 
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servIces. 
Sec. 3. 22 MRSA c. 1622 is enacted to read: 
CHAPTER 1622 
COORDINATED IN-HOME AND COMMUNITY SUPPORT SERVICES FOR 
THE ELDERLY AND DISABLED ADULTS 
§7311. Program established 
By July l, 2010, the department shall establish a coordinated program, referred to in 
this chapter as "the program," of in-home and community support services for adults with 
long-term care needs who are eligible for services pursuant to this subtitle and Title 34-B, 
chapter 5, subchapter 3, article 2. The program must have a unified system for intake and 
eligibility determination, consumer assessment and the development of authorized plans 
of care for consumers. The program must seek proposals from quallfied provider agencies 
and must provide standardized provider rates and wages. 
§7312. Program administration 
The department shall administer the program to ensure that services are delivered in 
the most comprehensive and equitable manner possible while minimizing administrative 
costs. 
1. 
Intal{e and eligibility determination. The department shall develop for the 
program a single system for' intake and eligibility determination for all consumers, 
regardless of diagnosis, type of disability or demographic factors, including age, using the 
multidisciplinary teams pursuant to section 7323. The intake process, application and 
forms must be standardized despite any differences in eligibility criteria for the regular 
Medicaid program, Medicaid disabilities waiver programs and the consumer-directed care 
program pursuant to Title 34-B. 
2. Assessment. The department shall complete an assessment of. the consumer's 
needs for in-home and community support services that includes a medical evaluation to 
be conducted by the consumer's primary care physician or specialist and an evaluation by 
the department of the requirements for the personal care assistant services and personal 
care assistant hours to maintain the consumer in a home or community-based setting. 
3. Authorized plan of care. The department shall develop an authorized plan of care 
for each consumer determined to be eligible for self-directed care services under this 
chapter or Title 34-B, chapter 5, subchapter 3, article 2. The authorized plan of care must 
be based upon the assessment under subsection 2 conducted by the department. The 
authorized plan of care must be designed to meet the needs identified by the assessment, 
giving consideration to the consumer's living arrangement, informal supports and services 
provided by other public or private funding sources to ensure nonduplication of services. 
4. 
Proposals· from qualified provider agencies. 
The department shall solicit" 
proposals from qualified provider agencies to provide coordinated in-home and 
community support services. Qualified provider agencies shall submit proposals in such 
form and manner as required. by the department. The department shall establish in rules 
adopted pursuant to section 7313. the criteria for selecting proposals. 
5. Standardized rates and wages. The department shall standardize provider rates, 
. qualified provider agency rates and personal. care assistant wages in rules adopted 
pursuant to section 7313. 
§7313. Rules 
The department shall adopt rules as necessary for the effective administration of the 
program pursuant to this chapter, in accordance with the Maine Administrative Procedure 
Act. In the development of such rules, the department shall consult with consumers, 
representatives of consumers and providers. Rules adopted pursuant to this section are 
major substantive rules as defined by Title 5, chapter 375, subchapter 2-A. 
Sec. 4. Plan for consolidated services. The Department of Health and Human 
Services shall develop a plan, including any necessary legislation, for consolidating in-
home and community support services as described in the Maine Revised Statutes, Title 
22, chapter 1622. 
1. Self-directed models. The plan must evaluate a variety of self-directed program. 
models, including the use of those authorized in the federal Deficit Reduction Act of 
2005, Public Law 109-171, Sections 6086 and 6087 in combination with existing 
programs or as a replacement as long as the benefits consumers receive from current 
programs are not diminished . 
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2. Process. The plan must identify the process for consolidating the in-home and 
community support services including any reorganization or staffing needs for developing 
the consolidated intake, eligibility and assessment system. It must describe the 
assessment methodology and the components of the authorized plan of care. 
3. Setting rates and worker wages. The plan must include a description of the 
process and methodology for achieving standardized rates and worker wages. 
4. Submission of plan. The Commissioner of Health and Human Services shall 
submit the plan to the Joint Standing Committee on Health and Human Services no later 
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than January 15, ,2010. Following receipt and review of the plan,. the committee may 
report out to the Second Regular Session of the '124th Legislature legislation necessary to 
implement the plan. . 
Sec. 5. State plan amendment or. waivers. The Department of Health and 
Human Services shall submit to the federal Department of Health and Human Services, 
Centers for Medicare .and Medicaid Services any amendments or waivers needed to 
establish the consolidated program for consumer-directed care described in the Maine 
Revised Statutes, Title 22, chapter 1622. 
SUMMARY 
This bill requires the Department of Health and Human Services to develop a unified 
system of in-home and community support services, including self-directed care, for 
adults with long-term care needs who are eligible for services under the Maine Revised 
Statutes, Title 22, subtitle 5 and Title 34-B, chapter 5, subchapter 3, article 2. The bill 
does the following. 
1. 
It includes findings and policies related to legislative intent. 
2. 
It adds to Title 22, subtitle 5 definitions for "activities of daily living," 
"assessment," "consumer," "instrumental activities of daily living," "qualified provider 
agency," "self-directed care services" and "surrogate." 
3. 
It adds a new chapter for a program of coordinated in:-home and community 
support services for the elderly and disabled adults. The program must be established by 
July 1, 2010 and include: 
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A. A unified system for intake and eligibility determination, consumer assessment 
and the development of authorized plans of care for eligible consumers. The program 
must seek proposals from qualified provider agencies and must provide standardized 
provider rates and worker wages; 
B. A single system for the intake and eligibility determination functions of existing . 
programs for in~home and community support services; 
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C. . An assessment to be completed by the department with the consumer's physician 
determining medical eligibility and the department determining the requirements for 
support services as well as personal care assistant hours needed to maintain the 
consumer in a home or community-based setting; 
D. An authorized plan of care for each consumer to be developed by the department; 
and 
E. Proposals .from qualified provider agencies to provide or coordinate services for 
the authorized plan of care solicited by the department. 
4. It requires the department to adopt major substantive rules. 
5. By January 15, 2010, prior to the implementation of the new program, the bill 
requires the department to develop a plan, including any necessary legislation for 
consolidating in-home and community support services that includes: 
A. An evaluation of self-directed care models authorized in the federal Deficit 
Reduction Act to examine the possible use of these models in combination or instead 
of existing programs without diminishing the benefits consumers currently receive; 
B. A description of the process proposed for consolidating the in-home and 
community support services including any reorganization or staffing needs for 
developing the consolidated intake, eligibility and assessment system as well as the 
. assessment methodology and the components o,f the authorized plan of care; and 
C. The process and methodology for achieving standardized rates and worker 
wages. 
6. The bill authorizes the Joint Standing Committee on Health and Human Services to 
report out to the Second Regular Session of the 124th Legislature a bill to implement the 
plan, ifnecessary. . 
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