An Act To Enhance Long-term Care Services for Maine Citizens
Maine Legislature, Session 125, LD 0683
Committee: Health and Human Services
Sponsors: PETERSON, McCORMICK, EVES, FOSSEL, O'CONNOR, SANBORN, STRANG BURGESS, STUCKEY

Legislative Document 
No. 683 
H.P. 510 
House of Representatives, February 18, 2011 
An Act To Enhance Long-term Care Services for Maine Citizens 
Received by the Clerk of the House on February 17, 2011.  Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401. 
HEATHER J.R. PRIEST 
Clerk 
Presented by Representative PETERSON of Rumford. 
Cosponsored by Senator McCORMICK of Kennebec and 
Representatives: EVES of North Berwick, FOSSEL of Alna, O'CONNOR of Berwick, 
SANBORN of Gorham, STRANG BURGESS of Cumberland, STUCKEY of Portland. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  22 MRSA c. 1622-A is enacted to read: 
CHAPTER 1622-A 
CONSOLIDATION OF LONG-TERM CARE SERVICES 
§7316.  Consolidation of long-term care services 
Beginning January 1, 2012, all long-term care services provided directly or indirectly 
under the MaineCare program or other state-funded programs by the department under 
this Title must be combined into one program, referred to in this chapter as "the 
program," with a single set of rules, coordinated criteria for assessment and qualifications 
and a single budget. 
§7317.  In-home and community support services; nursing facility services 
In-home and community support services and nursing facility services must be 
provided under the program, giving priority to expenditures that serve first those 
consumers with the greatest needs and the lowest service costs in accordance with the 
provisions of this section. 
1.  Intake and eligibility assessment.  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 age or other demographic factors, using the 
multidisciplinary teams designated by the commissioner pursuant to section 7323.  The 
intake process, application and forms must be standardized despite differences in the 
criteria for eligibility for services under different provisions of the MaineCare program 
state plan or federally approved waiver under Medicaid or under state-funded services. 
2.  Needs assessment.  The department shall assess a consumer for benefits 
determination periodically, as appropriate to the consumer, based on assessments of 
functional, health care and financial needs performed by an agency that is available to the 
consumer for case management services but that does not directly or indirectly provide 
in-home and community support services or nursing facility services.  The assessment of 
the consumer’s functional, health care and financial needs for in-home and community 
support services and nursing facility services must include a medical evaluation 
conducted by the consumer’s primary care provider or health care specialist, as 
appropriate, and an evaluation by the department of the requirements for personal care 
assistant services and the hours of service necessary to maintain the consumer in a 
home-based or community-based setting. 
3.  Benefits determination; service delivery model selection.  Once the needs 
assessment under subsection 2 has been completed for a consumer, the department shall 
determine the benefits that are available for the consumer and the consumer may choose 
which services to purchase.  The consumer may select service delivery through the 
following models:  the model in which the consumer directs the consumer's care and 
employs the persons who provide care, with or without a surrogate or unpaid 
representative to assist the consumer; the agency model in which an agency directs the 
consumer's care and employs the persons who provide care; and the residential care 
model or nursing facility care model.  If a consumer does not indicate a preference of 
service delivery model, the department shall assign the consumer to a self-directed model 
of in-home and community support services unless self-direction is determined to be 
inappropriate for the consumer. 
4.  Plan of care.  The department shall develop and authorize a plan of care for each 
consumer determined to be eligible under this chapter or Title 34-B, chapter 5, subchapter 
3, article 2.  The plan of care must be based on the needs assessment under subsection 2 
and must be designed to meet the needs of the consumer identified in the assessment, 
giving consideration to the consumer’s living arrangement and informal supports and, to 
avoid duplication of services, services provided by other private and public funding 
sources. 
5.  Transitional facilities and services.  The program must provide a consumer with 
transitional facilities and services to assist with changing functional needs and health care 
status. 
6.  Nursing facility diversion.  The program must include a nursing facility diversion 
component to encourage the use of facilities and services consistent with the consumer’s 
needs assessment under subsection 2 and as chosen by the consumer under subsection 3. 
7.  Reimbursement.  The program must provide reimbursement for skilled nursing 
care and in-home and community support services based on a uniform rate-setting 
process that is consistent across types of care and services, that reduces administrative 
costs and that is realistic regarding access to care and services.  The process must set 
aside a fixed percentage of the rate for wages and benefits of the direct-care workers. 
8.  Implementation.  In implementing the program the department shall: 
A.  Establish best practices training standards in a common module-based format 
with standard designations for direct-care workers; 
B.  Create structures for service delivery that apply to all types of payors; 
C.  Promote the use of assistive technology; 
D.  Integrate the delivery of skilled nursing care and personal care and services; 
E.  Establish a system to designate qualified providers who must: 
(1)  Provide the full range of services in the self-directed and agency models 
under subsection 3; 
(2)  Have the organizational and administrative capacity to administer and 
monitor a complete range of in-home and community support services, including, 
but not limited to, serving as a resource regarding service options, coordinating 
and implementing consumer services, ensuring the services are delivered, 
providing skills training, responding to questions and problems, performing 
administrative services, ensuring compliance with policies and performing 
utilization review functions; and 
(3)  Submit proposals for coordinated in-home and community support services 
in response to a solicitation for proposals to qualified provider agencies from the 
department, in the form and manner required by the department as specified in 
rules.  Rules adopted pursuant to this subparagraph are routine technical rules as 
defined by Title 5, chapter 375, subchapter 2-A; 
F.  Promote consumer choice by investing in needed care and services that consumers 
choose; and 
G.  Develop expanded financing options to encourage private investment in 
residential care and nursing facilities. 
Sec. 2.  Integrate accounts.  The Department of Health and Human Services shall 
combine long-term care accounts to implement the consolidation of long-term care 
services under the Maine Revised Statutes, Title 22, chapter 1622-A for fiscal years 
2011-12 and 2012-13.  The accounts that must be integrated into a single budget include 
the Office of Elder Services - Central Office account, the Long-term Care - Human 
Services account, the Nursing Facilities account and the Independent Housing with 
Services account. 
Sec. 3.  Report on progress.  By November 1, 2012, the Department of Health 
and Human Services shall report to the joint standing committee of the Legislature having 
jurisdiction over health and human services matters regarding the progress in 
implementing consolidation of long-term care services under the Maine Revised Statutes, 
Title 22, chapter 1622-A. 
Sec. 4.  Report regarding inclusion of services for persons with mental 
health needs and intellectual disabilities needs.  By January 1, 2012, the 
Department of Health and Human Services shall report to the Joint Standing Committee 
on Health and Human Services regarding the inclusion of services for persons with 
mental health needs and intellectual disabilities needs in the consolidation of long-term 
care services under the Maine Revised Statutes, Title 22, chapter 1622-A in fiscal years 
2013-14 and 2014-15. 
SUMMARY 
This bill reorganizes the provision of long-term care services for Maine citizens.  It 
consolidates long-term care services and provides a framework for consolidated in-home 
and community support services and nursing facility services with combined funding and 
integrated service delivery.  It requires the Department of Health and Human Services to 
administer long-term care accounts as one account with one budget.  By November 1, 
2012, the Department of Health and Human Services is required to report to the joint 
standing committee of the Legislature having jurisdiction over health and human services 
matters regarding the progress in implementing consolidation of long-term care services.  
The bill requires a report by January 1, 2012 from the Department of Health and Human 
Services to the same joint standing committee regarding the inclusion of services for 
persons with mental health needs and intellectual disabilities needs in the consolidation of 
long-term care services in fiscal years 2013-14 and 2014-15.