Resolve, To Improve the Continuity of Care for Individuals with . Behavioral Issues in Long-term Care
Maine Legislature, Session 124, LD 1245
Committee: Health and Human Services
Sponsors: WALSH INNES, BEAUDOIN, EVES

FIRST P~GULAR SESSION-2009 
Legislative Document 
No. 1245 
H.P.864 
House of Representatives, March 30, 2009 
Resolve, To Improve the Continuity of Care for Individuals with 
. Behavioral Issues in Long-term Care 
(EMERGENCY) 
Reference t6 the Committee on Health and Human Services suggested and ordered piinted. 
Presented by Representative WALSH INNES of Yarmouth. 
'77/~ 
/J1.17!t2C~{ 
MILLICENT M. MacFARLAND 
. Clerk 
Cosponsored by Representatives: BEAUDOIN of Biddeford, EVES of North Berwick, ' 
MARTIN of Eagle Lake. 
Printl!d on recycled'paper 
Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, citizens of the State who are elderly and who develop behavioral issues. 
due to dementia or other reasons are receiving inappropriate treatment, often at 
significant emotional costs to themselves and at significant financial cosito the State; and 
Whereas, the long-term care facilities that provide care to these individuals lack the 
resources to serve the persons they are caring for; and 
Whereas, there exist policies and best practices that could improve the treatment of 
these individuals and that can be made reasonably available within existing resources; 
and 
Whereas, in the judgment of the Legislature, these facts create an emergency within 
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the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore, be it 
. 
. 
Sec. 1. 
Implementation of recommendations.· 
Resolved: That the 
Department of Health and Human Services, referred to in this resolve as "the 
department," shall implement the recommendations contained in its report to the Joint 
Standing Committee on Health and Human Services pursuant to Resolve 2007, chapter 
61. In implementing these recommendations, the department shall: 
1. Redirect its services to adult MaineCare members to fbcus on earlier intervention 
so as to treat challenging behaviors at an earlier stage; 
2. 
Identify individuals for earliest possible intervention and provide support and 
training to nursing facility staff in regard to managing the challenging behaviors of these 
individuals; 
3. Provide support and training to in-state nursing facilities that accept individuals 
who have been placed outside the State and who are returning to the State; 
4. Convene an integrated team to develop a means to prevent placement outside the 
State and to assist in developing appropriate placements for individuals in in-state 
facilities; 
5. Review each out-of-state placement annually to assess the individual's functional 
and behavioral status to determine if the individual may be returned safely to an in-state 
facility; 
6. Educate nursing facilities regarding the obligations of the facilities under licensing 
rules governing transfer and discharge requirements; and 
. 
7. Review current contracts and practices regarding geropsychiatric units to 
determine if the geropsychiatric units are being properly used; and be it further 
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Sec. 2. Case mix reimbursement. Resolved: That the department shall work 
with interested pmiies to undertake a review of the current case mix reimbursement 
system used to establish payment for individuals in long-term care facilities to determine 
if current reimbursement is adequate and reasonable for the provision of high-quality care 
for individuals with behavioral issues. The department shall report its findings to the Joint 
Standing Committee on Health and Human Services by February 1, 2010; and be it 
fUliher 
Sec. 3. 
Standardized transfer protocol; improved discharge planning. 
Resolved: That the depm1ment, in conjunction with interested pmiies including but not 
limited to representatives of long-term care facilities and hospitals, shall develop and 
implement a standardized transfer protocol, including improving the support offered to a 
long-teml care facility when a hospital has determined that an individual is ready to be 
discharged back to the 
long~term care facility. The depmiment shall report on 
implementation of the protocol to the Joint Standing Committee on Health and Human 
Services by February 1, 20 I 0; and be it furth~r 
Sec. 4. Alternative funding sources. Resolved: That the depmiment shall 
undeliake a review of existing and potential payment sources for psychiatric assessments 
and psychiatric treatments that are currently unavailable to individuals with behavioral 
issues because the individuals do not have a diagnosis of severe and persistent mental 
illness. The department shall submit a report, together with any recommendations for 
legislative or rule changes, to the Joint Standing Committee on Health and Human 
. Services by February 1, 2010; and be it fUliher 
Sec. 5. Levels of care. Resolved: That the department shall work with interested 
parties to explore the need for a supplementary level of care to accommodate the needs of 
individilals with behavioral issues who, because of the severity of their behaviors, are not 
appropriate candidates for return to an existing long-term care facility but who no longer 
require an acute geropsychiatric hospital setting. The department shall submit its report, 
together with any recommendations for legislative or rule changes, to the Joint Standing 
Committee on Health and Human Services by February 1, 2010. 
Emergency clause. 
In view of the emergency cited in the' preamble, this 
legislation takes effect when approved. 
SUMMARY 
This resolve directs the Depalirrient of Health and Human Services: 
1. To implement the recommendations contained in the report to the Joint Standing 
Committee on Health and Human Services pursuant to Resolve 2007, chapter 61, which 
was enacted by the 123rd Legislature; 
. 
2. To work with interested paliies to review the current case mix reimbursement 
system used to establish payment for individuals in long-term care facilities to determine 
if current reimbursement is adequate and reasonable for the provision of high-quality care 
for individuals with behavioral issues. It requires the Department of Health and Human 
Services to report to the Joint Standing Committee on Health and Human Services by 
February 1,2010; 
3. In conjunction with interested parties, including but not limited to representatives 
from 'long-t~l1n care facilities and hospitals, to develop and implement a standardized 
transfer protocol, including improving the support_offered to long-term care facilities 
once a hospital has determined an individual is ready to be discharged bac~ to the facility. 
It requires the Department of Health and Human Services to. report by February 1, 2010 
to the Joint Standing Committee on Health and Human Services; 
4. To review existing and potential payment sources for psychiatric assessments and 
psychiatric treatments that are currently unavailable to individuals with behavioral issues 
. because the individuals do not have a diagnosis of severe and persistent mental illness. It 
requires the Department of Health and Human Services to repmt by February 1,2010 to 
the Joint Standing Committee on Health andHuman Services; and 
5'. To work with interested parties to explore the need for a supplementary level of 
care to accommodate the needs of individuals with behavioral issues who, because of the 
severity of their behaviors, ate not appropriate candidates for.return to an existing long-
term care facility but who no longer require an acute geropsychiatric hospital setting. It 
requires the Department of Health and Human Services to report by February 1, 2010 to 
the Joint Standing Committee on Heahh and Human Services. 
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