An Act To Implement the Recommendations of the Blue Ribbon Commission To Study Long-term Home;'based and Community-based Care
Maine Legislature, Session 124, LD 0400
Sponsors: CRAVEN, MILLETT, BARTLETT, RA YE, CAMPBELL, MILLER, PINGREE

MAINE STATE LEGISLATURE 
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124th MAl ELEGISLATU 
Legislative Document 
No. 400 
S.P.142 
In Senate, February 5, 
An Act To Implement the Recommendations of the Blue Ribbon 
Commission To Study Long-term Home;'based and Community-
based Care 
(EMERGENCy) 
Reference to the Committee on Health and H:uman Services suggested and ordered printed. 
Presented by Senator CRAVEN of Androscoggin. 
Cosponsored by Representative MILLETT of Waterford and 
9tf)CJ~ 
JOY J. O'BRIEN 
Secretary of the Senate 
Senators: BARTLETT of Cumberland, MARRACHEQfKennebec, RA YE of Washington, 
Representatives: CAMPBELL of Newfield, JONES ofM~unt Vernon, MILLER of Somerville, 
Speaker PINGREE of North Haven. 
Printed 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 or who are adults with physical 
disabilities are in need of services, as evidenced by the waiting lists in November 2008 
containing 870 persons for homemaker services and 375 persons for home-based care 
services; and 
Whereas, the Federal Government has discontinued funding for the Aging and 
Disability Resource Centers that have been providing information to the elderly and 
adults with disabilities and their families; and 
Whereas, the agencies and programs that provide the needed services lack the 
resources to serve the persons waiting fOF services and require immediate appropriations 
of funding to meet those needs; and . 
. 
Whereas, in the judgment of the Legislature" these facts create an emergency within 
the meaning of the Constitution of Marne and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore, 
JBe it enacted by the People ofthe State of Maine as follows: 
Sec. 1. 22MRSA §7301, sub-§2, as enacted by PL 1981, c. 511, §1, is amended 
to read: 
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 oommunity support servioes 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 
suj:morts 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, 5hal± must be the elderly and physically disabled adults who 
are at the greatest risk of being, or who already have been, placed inappropriately in 
an institutional setting; and 
. 
C. 
That a variety of agencies, facilities and individuals 5hal± 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 support 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 
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F. To establish the most efficient, innovative and cost-effective system for delivering 
a broad array of long-term care services. 
Sec. 2. 22 MRS A §7302, sub-§5, as enacted by PL 1981, c. 511, § 1, is amended 
to read: 
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, 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; hospice care; counseling services; 
transportation; small rent subsidies; various devices wfl:i.el::!: that lessen the effects of 
disabilities; and other appropriate and necessary social services. 
Sec. 3. 
Planning for unified long-term care budget for services and 
supports for the elderly and adults with physical disabilities. The Department 
of Health and Human Services shall undertake a planning process for the adoption of a 
unified budget for long-tenn care services and supports for the elderly and adults with 
physical disabilities that is complementary to the State's vision for a consumer-centered 
approach to long-tenn care. The Commissioner of Health and Human Services, the 
Commissioner of Administrative and Financial Services and the Office of Fiscal and 
Program Review shall work together to prepare a revised chart of accounts that 
concentrates all long-term care services and supports accounts for the elderly and adults 
with physical disabilities in the office that provides services to the elderly and adults with 
physical disabilities, including program and administrative costs in the office that 
provides services to the elderly and adults with physical disabilities and excluding 
accounts in the department's office of MaineCare services, and accounts related to mental 
health, mental retardation and developmental disabilities. 
By January 1, 2010, the 
Commissioner of Health and Human Services and the Commissioner of Administrative 
and Financial Services shall submit a report to the joint standing committees of the 
Legislature having jurisdiction over appropriations and [mancial affairs and health and 
human services matters. The report must contain a plan for a unified budget to be 
implemented by July 1, 2010. 
Sec. 4. 
Reduction of waiting lists. The Department of Health and Human 
Services shall adopt as a priority reduction of waiting lists through the provision of 
services for home-based and community-based care and homemaker services for the 
elderly and adults with disabilities during fiscal year 2008-09 and elimination of waiting 
lists through the provision of services during the fiscal years 2009-10 and 2010-11. 
Sec. 5. Assistive technologies. The Department of Health and Human Services 
shall work with the Department of Labor to explore uses of and develop funding sources 
for assistive teclmologies to help accomplish the State's vision of long-term services and 
supports for the elderly and adults with physical disabilities. By January 1, 2010, the 
Department of Health and Human Services shall report to the joint standing conunittee of 
the Legislature having jurisdiction over health and human services matters on the results 
of the work on assistive technologies. 
Sec. 6. Alternative funding sources. The Department of Health and Human 
Services shall explore alternative non-MaineCare sources of funding for service packages 
provided to residents in the 7 tax-credit-assisted assisted living facilities that currently use 
MaineCare funding. 
The alternative funding must be used in the event MaineCare 
funding is no longer available to ensure continuation of service packages. By January 1, 
2010 the department shall report to the joint standing committee of the Legislature having 
jurisdiction over health and human services matters on the work on exploring alternative 
funding sources for service packages. 
Sec. 7. Direct care worker training, reimbursement and benefits. The 
Department of Health and Human Services shall work with interested parties to develop a 
comprehensive and systematic approach to training, reimbursement and benefits for 
direct care workers in home-based and community-based care, residential facilities and 
nursing facilities and by December 1, 2009 shall report to the joint standing committees 
of the Legislature having jurisdiction over appropriations and financial affairs and health 
and human services matters. 
Sec. 8. Reversal of spending trend. The Department of Health and Human 
Services shall undertake efforts to reverse the spending trend in long-term care to 
increase the number of people served and funds spent in home-based and community-
based care as compared to the spending on residential care and nursing facility care and 
shall report annually through 2015 on its progress by February 1 st beginning in 2010 to 
the joint standing committees of the Legislature having jurisdiction over appropriations 
and financial affairs and health and human services matters. 
Sec. 9. Improved discharge planning process. The Department of Health and 
Human Services shall undertake an effort in the assessment process for eligibility for 
long-term care services under the MaineCare program to improve the discharge planning 
process as it pertains to hospitals and residential care facilities, including improving the 
provision of information to the consumer about facility-based and home-based and 
community-based options, improving consumer choice in the discharge process, 
increasing consumer counseling for those choosing self-directed care and education on 
the availability of hospice services. The department shall report to the joint standing 
committees of the Legislature having jurisdiction over appropriations and financial affairs 
and health and human services matters on work done with regard to this effort by 
February 1, 2010 and February 1, 2011. 
Sec. 10. Aging and Disability Resource Centers. The Department of Health 
and Human Services shall work with the 5 area agencies on aging to provide services 
through Aging and Disability Resource Centers on a statewide basis. The department 
shall provide funding as appropriated in this Act. 
As a condition of receiving the 
funding, the area agencies on aging shall work with hospitals, nursing facilities and 
residential care facilities to improve the discharge planning process, including improving 
the provision of information to the consumer about facility-based and home-based and 
community-based options, improving consumer choice in the discharge process, 
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increasing consumer counseling for those choosing self-directed care and education on 
the availability of hospice services. The department shall report to the joint standing 
committees of the Legislature having jurisdiction over appropriations and financial affairs 
and health and human services matters on work done regarding the expenditures and the 
operations of the Aging and Disability Resource Centers by February 1, 2010 and 
February 1,2011. 
Sec. 11. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Long-term Care Services 
Initiative: Provides funding for Aging and Disability Resource Centers in the 5 area 
agencies on aging to provide information and referral services for the elderly and adults 
with physical disabilities and their families. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2009-10 
$300,000 
$300,000 
2010-11 
$300,000 
$300,000 
Sec. 12. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEAL TH AND HUMAN SERVICES, DEPARTMENT OF 
Long-term Care Services 
Initiative: Provides funding for the Priority Social Services Program for reimbursement of 
the costs of volunteers for the delivery of meals in the homes of consumers of long-term 
care services and medical rides. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Long-term Care Services 
2009-10 
$500,000 
$500,000 
2010-11 
$500,000 
$500,000 
Initiative: Provides funding for the family caregiver initiative that provides assistance to 
families of the elderly and adults with physical disabilities to enable the elderly and adults 
with disabilities to remain in their homes. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
H.EAL TH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
2009-10 
$200,000 
$200,000 
2009-10 
$700,000 
$700,000 
2010-11 
$200,000 
$200,000 
2010-11 
$700,000 
$700,000 
Emergency clause. 
ill view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
SUMMARY 
This bill contains legislation suggested by the Blue Ribbon Commission to Study 
Long-term Home-based and Community-based Care. 
It amends existing law governing the legislative findings and policy for home-based 
and community-based long-term care services for the elderly and adults with physical 
disabilities. It adds statements of findings for in-home and community support services 
and long-term care services. 
It adds hospice care to the definition of "in-home and community support services." 
It directs the Department of Health and Human Services to undertake a planning 
process for the adoption of a unified budget for long-term care serVices and supports for 
the elderly and adults with physical disabilities. It directs the Commissioner of Health 
and Human Services, the Commissioner of Administrative and Financial Services and the 
Office of Fiscal and Program Review to work together to prepare a revised chart of 
accounts. The commissioners are required to report by January 1, 2010 to the joint 
standing committees of the Legislature having jurisdiction over appropriations and 
financial affairs and health and human services matters. The report must contain a plan 
for a unified budget to be implemented by July 1,2010. 
It directs the Department of Health and Human Services to adopt as a priority 
reduction of the waiting lists for home-based and community-based care and homemaker 
services for the elderly and adults with disabilities during fiscal year 2008-09 and 
elimination of the waiting lists during the fiscal years 2009-10 and 2010-11. 
It directs the Department of Health and Human Services to work with the Department 
of Labor to explore uses of and develop funding sources for assistive tec1mologies. It 
requires the Department of Health and Human Services to report by January 1, 2010 to 
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the joint standing committee of the Legislature having jurisdiction over health and human 
services matters. 
It directs the Department of Health and Human Services to explore alternative non-
MaineCare sources of funding for service packages provided to residents in the 7 tax-
credit-assisted assisted living facilities that currently use MaineCare funding. 
The 
alternative funding must be used in the event MaineCare funding is no longer available to 
ensure continuation of service packages. The department is required to report by January 
1, 2010 to the joint standing committee of the Legislature having jurisdiction over health 
and human services matters. 
It directs the Department of Health and Human Services to work with interested 
parliies to, develop a comprehensive and systematic approach to training, reimbursement 
and benefits for direct care workers in home-based and community-based care, residential 
facilities and nursing facilities and to report by December 1, 2009 to the joint standing 
committees of the Legislature having jurisdiction over appropriations and financial affairs 
and health and human services matters. 
It directs the Department of Health and Human Services to undertake efforts to 
reverse the spending trend in long-term care to increase the number of people served and 
funds spent in home-based and community-based care as compared to the spending on 
residential care and nursing facility care and to report annually by February 1 beginning 
in 2010 to the joint standing committees of the Legislature having jurisdiction over 
appropriations and financial affairs and health and human services matters. 
It directs the Department of Health and Human Services to undertake an effort in the 
assessment process for eligibility for long-term care services 'Under the MaineCare 
program to improve the discharge planning process as it pertains to hospitals and 
residential care facilities, including improving the provision of information to the 
consumer about facility-based and home-based and community-based options, improving 
consumer choice in the discharge process, increasing consumer counseling for those 
choosing self-directed care and education on the availability of hospice services, and to 
report to the joint standing committees of the Legislature having jurisdiction over 
appropriations and financial affairs and health and human services matters by February 1, 
2010 and February 1,2011. 
It directs the Department of Health and Human Services to work with the 5 area 
agencies on aging to provide services through Aging and Disability Resource Centers on 
a statewide basis, provides $300,000 per year for this purpose and conditions the funding 
on the area agencies on aging working with hospitals, nursing facilities and residential 
care facilities to improve the long-term care discharge planning process. It directs the 
department to report to the joint standing committees of the Legislature having 
jurisdiction over appropriations and financial affairs and health and human services 
matters on work done with regard to this initiative by February 1, 2010 and February 1, 
2011. 
It provides funding for long-term care services for the elderly and adults with 
physical disabilities in the amount of $500,000 per year for the Priority Social Services 
Program and $200,000 per year for the family caregiver initiative.