Resolve, To Establish the Commission To Continue the Study of Difficult-to-place Patients
Maine Legislature, Session 127, LD 1615
Committee: Health and Human Services

Legislative Document 
No. 1615 
S.P. 653 
In Senate, March 1, 2016 
Resolve, To Establish the Commission To Continue the Study of 
Difficult-to-place Patients 
(EMERGENCY) 
Reported by Senator BRAKEY of Androscoggin for the Joint Standing Committee on 
Health and Human Services pursuant to Joint Order 2016, S.P. 639. 
Reference to the Committee on Health and Human Services suggested and ordered printed 
pursuant to Joint Rule 218. 
HEATHER J.R. PRIEST 
Secretary of the Senate 
Emergency preamble.  Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, the Commission To Study Difficult-to-place Patients, established 
pursuant to Resolve 2015, chapter 44, reviewed and deliberated on numerous issues 
related to difficult-to-place patients with complex medical conditions and the feasibility 
of making policy changes to the long-term care system for those patients; and 
Whereas, this resolve establishes the Commission To Continue the Study of 
Difficult-to-place Patients to address various complex, important and unresolved issues 
identified by the Commission To Study Difficult-to-place Patients; and 
Whereas, immediate enactment of this resolve is necessary to provide the 
Commission To Continue the Study of Difficult-to-place Patients adequate time to 
complete its work; and 
Whereas, in the judgment of the Legislature, these facts create an emergency within 
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.  Commission established.  Resolved:  That, notwithstanding Joint Rule 
353, the Commission To Continue the Study of Difficult-to-place Patients, referred to in 
this resolve as "the commission," is established; and be it further 
Sec. 2.  Commission membership.  Resolved:  That the commission consists of 
members appointed as follows: 
1.  Two members of the Senate appointed by the President of the Senate, including 
members from each of the 2 parties holding the largest number of seats in the Legislature; 
2.  Three members of the House of Representatives appointed by the Speaker of the 
House of Representatives, including members from each of the 2 parties holding the 
largest number of seats in the Legislature; 
3.  The Commissioner of Health and Human Services or the commissioner's designee; 
4.  Four members, appointed by the President of the Senate, who possess expertise in 
the subject matter of the study, as follows: 
A.  The director of the long-term care ombudsman program described under the 
Maine Revised Statutes, Title 22, section 5106, subsection 11-C; 
B.  An individual representing a statewide association of hospitals; 
C.  An individual representing a statewide organization advocating for people with 
mental illness; and 
D.  An individual or a family member of an individual with a complex medical 
condition; and 
5.  Three members, appointed by the Speaker of the House of Representatives, who 
possess expertise in the subject matter of the study, as follows: 
A.  An individual representing a statewide association of long-term care facilities; 
B.  An individual representing the agency that serves as the protection and advocacy 
agency for persons with disabilities designated pursuant to the Maine Revised 
Statutes, Title 5, chapter 511; and 
C.  An individual representing an organization promoting independent living for 
persons with disabilities; and be it further 
Sec. 3.  Chairs; subcommittees.  Resolved:  That the first-named Senate 
member is the Senate chair and the first-named House of Representatives member is the 
House chair of the commission.  The chairs of the commission are authorized to establish 
subcommittees to work on the duties listed in section 5 and to assist the commission.  
Any subcommittees established by the chairs must be composed of members of the 
commission and interested persons who are not members of the commission and who 
volunteer to serve on the subcommittees without reimbursement.  Interested persons may 
include individuals with expertise in placing individuals with complex medical conditions 
in long-term care placements, individuals who provide long-term care to individuals with 
complex medical conditions, individuals affected by neurodegenerative diseases and 
individuals affected by mental illness; and be it further 
Sec. 4.  Appointments; convening of commission.  Resolved:  That all 
appointments must be made no later than 30 days following the effective date of this 
resolve.  The appointing authorities shall notify the Executive Director of the Legislative 
Council once all appointments have been completed.  After appointment of all members 
and after adjournment of the Second Regular Session of the 127th Legislature, the chairs 
shall call and convene the first meeting of the commission.  If 30 days or more after the 
effective date of this resolve a majority of but not all appointments have been made, the 
chairs may request authority and the Legislative Council may grant authority for the 
commission to meet and conduct its business; and be it further 
Sec. 5.  Duties.  Resolved:  That the commission shall study the following issues 
and the feasibility of making policy changes to the long-term care system for patients 
with complex medical conditions: 
1.  With input from the Department of Labor, identification of medical staffing needs 
in the State and the barriers to, and solutions for, increasing the availability of trained 
staff across the spectrum of care; 
2.  With input from the Department of Health and Human Services and the State 
Board of Nursing, as established in the Maine Revised Statutes, Title 5, section 12004-A, 
subsection 25, examination of the feasibility of implementing in-house staff certification 
programs by medical providers, such as a certified nursing assistant training program; 
3.  Determination of existing capacity and demand for additional capacity in private 
nonmedical institutions in the State governed by Department of Health and Human 
Services Rule Chapter 101: MaineCare Benefits Manual, Chapter III, Section 97, 
Appendix C and options to expand or reconfigure the State's Appendix C private 
nonmedical institution system to better meet identified demands; 
4.  Examination of the feasibility of implementing a presumptive eligibility option 
whereby a medical facility would be authorized to presume a patient's eligibility for the 
MaineCare program and receive reimbursement for the patient's eligible care costs prior 
to final approval of eligibility by the Department of Health and Human Services; 
5.  Identification of efficiencies that can be implemented to expedite the MaineCare 
application process for patients currently being cared for in a facility; 
6.  Review of options for amending the MaineCare application process to better 
address financial exploitation of an applicant by a family member or relative of the 
applicant; 
7.  Examination of methods of expediting the Department of Health and Human 
Services' placement process for open geropsychiatric beds, including a review of the 
application of the preadmission screening and resident review process within the 
placement process and the application of the geropsychiatric placement criterion that a 
patient have a long history of mental illness; 
8.  Determination of existing need for so-called step-down options for geropsychiatric 
and other patients who no longer require the level or type of care they are receiving at a 
specialized facility, as well as addressing issues relating to geropsychiatric patients that 
develop dementia, expansion of residential care options at facilities that offer 
geropsychiatric services and a discussion of applicable assessment criteria for admission 
and discharge at geropsychiatric facilities; 
9.  Evaluation of the feasibility of facilitating and funding long-term care contracts 
for behavioral health support at long-term care facilities for care plan consultations, 
treatment and staff education; 
10.  Review of the Department of Health and Human Services' adult protective 
services and public guardianship processes to identify efficiencies that can be 
implemented to facilitate more expedient resolutions and to evaluate, with input from 
representatives of the State's judiciary, the feasibility of implementing a temporary 
guardianship process to facilitate hospital discharge for patients awaiting guardianship; 
and 
11.  Any other issue identified by the commission; and be it further 
Sec. 6.  Staff assistance.  Resolved:  That the Legislative Council shall provide 
necessary staffing services to the commission; and be it further 
Sec. 7.  Information and assistance.  Resolved:  That the Commissioner of 
Health and Human Services shall provide information and assistance to the commission 
as required for its duties; and be it further 
Sec. 8.  Report.  Resolved:  That, no later than December 15, 2016, the 
commission shall submit a report that includes its findings and recommendations, 
including suggested legislation, for presentation to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters.  The joint 
standing committee of the Legislature having jurisdiction over health and human services 
matters may report out legislation regarding the subject matter of the report to the First 
Regular Session of the 128th Legislature. 
Emergency clause.  In view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
SUMMARY 
This resolve, which is a recommendation of the Commission To Study Difficult-to-
place Patients, establishes the Commission To Continue the Study of Difficult-to-place 
Patients.  The commission is charged with studying certain issues related to patients with 
complex medical conditions and the feasibility of making policy changes to the long-term 
care system for those patients.  The commission comprises 13 members reflecting a 
similar membership to that of the Commission To Study Difficult-to-place Patients.  The 
commission is required to submit a report containing its findings and recommendations to 
the joint standing committee of the Legislature having jurisdiction over health and human 
services matters no later than December 15, 2016.  The committee is authorized to report 
out legislation to the First Regular Session of the 128th Legislature.