An Act To Strengthen Sustainable Long-term Supportive Services for Maine Citizens
Maine Legislature, Session 124, LD 1078
Committee Amendment CA_A_H351 (House)
Amends: 22 MRSA §50, 22 MRSA §7301, 22 MRSA §7302

COMMITTEE AMENDMENT "A " 
to H.P. 745, L.D. 1078, Bill, "An Act To 
Strengthen Sustainable Long-term Supportive Services for Maine Citizens" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRSA §50 is enacted to read: 
§50. Planning for long-term care services 
By January 15, 2012 and every 4 years thereafter the department, after input from 
interested parties, shall report to the joint standing committee of the Legislature having 
jurisdiction over health and human services matters on the current allocation of resources 
for long-term care and the goals for allocation of those resources during the next 4 years. 
The report must be based on current and projected demographic data, current and 
projected consumer needs and recent or anticipated changes in methods of delivery of 
long-term care services and must include any action taken by the department to further 
these goals and any recommendations for action by the Legislature. 
Sec. 2. 22 MRSA §7301, as enacted by PL 1981, c. 511, §1, is amended to read: 
§7301. Legislative intent 
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; flfffi 
COMMITTEE AMENDMENT 
COMMITIEE AMENDMENT" ~" to H.P. 745, L.D. 1078 
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 
institutional settings~~ 
E. The majority of adults with long-term care needs have indicated a preference to 
remain in their own homes and in community settings rather than having their needs 
met in institutional settings; 
F. 
For many adults with long-term care needs and their families, the process ,to 
identify and secure appropriate services may be confusing and difficult to navigate; 
and 
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G. 
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 family responsibility. 
2. Policy. The Legislature declares that it is the policy of this State, with regard to in-
home and community support services: 
A. 
To increase the availability of in home and community support seFvices long-
term care services that are consumer-driven, optimize individual choice and 
autonomy and, maximize physical health, mental health, functional well-being and 
independence for adults with long-term care needs through high-quality services and 
supports in settings that reflect the needs and choices of consumers and that are 
delivered in the most flexible, innovative and cost-effective manner; 
B. 
That the priority recipients of in-home and community support services, 
pursuant to this subtitle, sflaU must be the elderly and disabled adults with long-term 
care needs who are at the greatest risk of being, or v.'ho already have been, placed 
inappropriately in an institutional setting without needed in-home and community 
support services; and 
C. 
That a variety of agencies, facilities and individuals sHall must be encouraged to 
provide in-home and community support services and to increase the percentages of 
adults with long-term care needs receiving in-home and community supp0l1 services~~ 
D. To promote and encourage public and private partnerships among a variety of 
agencies, facilities and individuals; 
E. To support the roles of family caregivers and a qualified workforce in the effort to 
streamline and facilitate access to high-quality services in the least restrictive and 
most integrated settings; and 
F. To establish the most efficient and cost-effective system for delivering a broad 
array.oflong-term care services. 
Sec. 3. 22 MRSA §7302, as amended by PL 2001, c. 596, Part B, § 1 0 and affected 
by §25 and amended by PL 2003, c. 689, Pat1 B, §§6 and 7, is further amended to read: 
§7302. Definitions 
As used in this subtitle, unless the context otherwise indicates, the following terms 
have the following meanings. 
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COMMIITEE AMENDMENT" A" to H.P. 745, L.D. 1078 
1. Adults with long-term care needs. "Adults with long-term 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. 
I-A. 
Activities of daily living. 
"Activities of daily living" means activities as 
defined in federal and state rules including those essential to a person's daily living 
including: eating and drinking; 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. 
3. Commissioner. "Commissioner" means the Commissioner of Health and Human 
Services. 
3-A. 
Consumer. 
"Consumer" means a person eligible for services under this 
subtitle. 
3-B. Consumer assessment. "Consumer assessment" means an evaluation of the 
functional capacity of an individual to live independently given appropriate supports with 
activities of daily living and instrumental activities of daily living or through the 
provision of information about service options that are available to meet the individual's 
needs. 
4. 
Department. "Department" 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-term 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 services; companion and 
attendant services; handyman, chore and homemaker services; respite care; counseling 
services; transportation; small rent subsidies; various devices wJ:Hefl 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; intermediate 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 activities· as defined in federal and state rules including those 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. 
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COMMITfEE AMENDMENT "A" to H.P. 745, L.D. 1078 
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 wIti€ft include, 
but are not limited to: 
A. 
Routine bodily functions, such as bowel or bladder care; 
B. 
Dressing; 
C. 
Preparation and consumption offood; 
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 designee; 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 ofthe personal care assistance services outlined in the consumer's plan of care. 
Nothing in Title 32, chapter 3 I, 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 institutioni:t1ly based 
long-term care services. 
9-A. Qualified providers. "Qualified providers" means community-based agencies 
or a network of agencies with the organizational and administrative capacity to administer 
and monitor an array of in-home and community support services that will promote 
choice and portability with an emphasis on coordinating and implementing the services in 
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the consumer's plan of care. 
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 hir"ing, firing, training and 
supervision of personal care assistants to assist with activities of daily living and 
instrumental activities of dai Iy living. 
10. Severe disability. "Severe disability" means a disability whieft that results in 
persons having severe, chronic physical, sensory or cognitive limitations whieft that 
restrict their ability to carry out the normal activities of daily living and to live 
independently. 
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COMMITTEE AMENDMENT "A" to H.P. 745, L.D. 1078 
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 
servIces. 
Sec. 4. 22 MRSA c. 1622 is enacted to read: 
CHAPTER 1622 
COORDINA tED IN-HOME AND COMMUNITY SUPPORT SERVICES FOR 
THE ELDERLY AND ADULTS WITH DISABILITIES 
§7311. Program established 
By July 1, 2010, the department shall establish a coordinated program, referred to in 
this chapter as "the program," of in-home and community support services that are 
available under state-funded and MaineCare-funded programs for adults with long-term 
care needs who are eligible for services from qualified providers pursuant to this subtitle. 
The program must have a unified system for intake and eligibility determination for all 
consumers, regardless of diagnosis, type of disability or demographic factors, including 
age, lising the multidisciplinary teams pursuant to section 7323, consumer assessment and 
the development of plans of care that take into consideration the consumer's living 
arrangement, informal supports and services provided by other public or private funding 
sources to ensure nonduplication of services for consumers. 
§7312. 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. 5. Phin for consolidated services. The Commissioner of Health and Human 
Services shall convene a work group of persons representing all of the significant parties, 
including consumers, interested in the issue of efficient and effective long-term care in 
the State. The purpose of the work group is to analyze the long-term care service system 
and to make recommendations that will assist the commissioner in designing the system 
that promotes consumer choice, transparency, portability and flexibility. The work group 
shall employ a disciplined improvement analysis and implementation approach and 
methodology in its work. In this process, personal care services will be reviewed to 
deterniine the extent to which the following principles are currently being met: 
1. Consumers know about and have access to a full range of personal care service 
options; 
2. Access to personal care services is expeditious; 
3. Personal care services are delivered efficiently and in a manner that promotes 
maximum consumer choice; 
4. Personal care services are transparent so that the services are easily understood by 
consumers and their families; 
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COMMITTEE AMENDMENT" A" to H.P. 745, L.D. 1078 
5. Personal care services are portable from one provider to another; 
6. 'Personal care services are flexible to meet the needs of the consumer; and 
7. Provider rates and worker wag~s are standardized to promote overall efficiency 
and ensure a sufficient number and quality of direct-care workers. 
The work group must meet at least 3 times and provide a report to the Joint Standing 
Committee on Health and Human Services by January 15,2010. The report must contain 
the work group's recommendations for improvements in the long-term care system in the 
State. 
These recommendations must address intake and eligibility determination, 
consumer assessment, development of plans of care, the definition of qualified providers 
and the means to standardize rates and wages within the system. 
Sec. 6. 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 any part of a consolidated program, including a program of consumer-directed 
care described in the Maine Revised Statutes, Title 22, chapter 1622.' 
SUMMARY 
This amendment replaces the bill. ,It directs the Department of Health and Human 
Services to undertake a planning process on long-term care, with stakeholder input, every 
years. 
It adds to policy statements and findings in the statutes on in-home and 
community support services for adults with long-term care needs. 
It adds to the 
definitions in that section of law, amending some definitions and providing new 
definitions for "activities of daily living," "consumer assessment," "instrumental activities 
of daily living," "qualified providers," "self-directed services" and "surrogate." It enacts a 
new chapter on coordinated in-home and community support services for the elderly and 
adults with disabilities. It establishes a coordinated program of in-home and community 
support services for adults with long-term care needs effective July 1, 2010 and directs 
the department to adopt major substantive rules for the administration of the program. It 
directs the departmentto convene a work group to make recommendations on the State's 
long-term care system and report to the Joint Standing Committee on Health and Human 
Services by January 15, 2010. 
It directs the department to submit to the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
any amendments or waivers needed to establish any part of a consolidated program, 
including a program of consumer-directed care. 
FISCAL ;\'OTE REQLIRED 
(See attached) 
COMMITTEE AMENDMENT 
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Approved: 05/20109 wac:.. 
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LD 1078 
LR 1030(02) 
An Act To Strengthen Sustainable Long-term Supportive Services for Maine Citizens 
Fiscal Note for Bill as Amended by Committee Amendment "A" 
Committee: Health and Human Services 
Fiscal Note Required: No 
Fiscal Note 
Minor cost increase - General Fund 
Fiscal Detail and Notes 
The additional costs to the Department of Health and Human Services to plan for, establish and report on a 
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coordinated program of in-home and community support services for adults with long-term care needs can be absorbed 
by the department utilizing existing budgeted resources. 
LRI 030(02) - Fiscal Note - Page 1 of 1