An Act To Amend the Laws Governing MaineCare Eligibility Determination For Applicants To Nursing Homes
Maine Legislature, Session 128, LD 1424
Committee: Health and Human Services
Sponsors: GRATWICK, FAY, DESCHAMBAULT, SAVIELLO, CAMPBELL, DUCHESNE, HARLOW, PIERCE, ZEIGLER
Amends: 22 MRSA §3174-I

Legislative Document
No. 1424
S.P. 494
In Senate, April 13, 2017
An Act To Amend the Laws Governing MaineCare Eligibility 
Determination For Applicants To Nursing Homes
Reference to the Committee on Health and Human Services suggested and ordered printed.
HEATHER J.R. PRIEST
Secretary of the Senate
Presented by Senator GRATWICK of Penobscot.
Cosponsored by Representative FAY of Raymond and
Senators: DESCHAMBAULT of York, SAVIELLO of Franklin, Representatives: 
CAMPBELL of Orrington, DUCHESNE of Hudson, HARLOW of Portland, PIERCE of 
Dresden, ZEIGLER of Montville.
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  22 MRSA §3174-I, sub-§1-C is enacted to read: 
1-C.  Processing of initial applications for eligibility.  Initial applications for 
eligibility under this section must be processed in accordance with this subsection.  
A.  The department shall provide timely and adequate notice to the applicant, the 
applicant's guardian or conservator and the facility in which the applicant resides or 
seeks to reside in any circumstance if the department is not able to make a decision 
on eligibility due to inconclusive or conflicting information or other deficiencies in 
the application.  The notice must provide a period of not less than 20 business days 
for the recipient or recipients of the notice to respond.  The facility in which the 
applicant resides or seeks to reside shall provide the department with written 
authorization from the applicant or the applicant's guardian or conservator to receive 
such information. The department shall notify the applicant, the applicant's guardian 
or conservator and the facility in which the applicant resides or seeks to reside of the 
application questions that remain unanswered, the additional information that is 
required and any issues that need to be resolved in order to determine eligibility. The 
department shall, in a timely fashion, provide to the applicant, the applicant's 
guardian or conservator and the facility in which the applicant resides or seeks to 
reside copies of all communications required under this paragraph. 
B.  The department shall provide to the applicant and the applicant's guardian or 
conservator a period of not less than 20 business days in which to respond to 
questions and to provide any necessary information, and the facility in which the 
applicant resides or seeks to reside may assist the applicant and the applicant's 
guardian or conservator in providing responses and information. The department, 
when appropriate, shall extend the time frame for receipt of responses and 
information. 
C.  After contacting the applicant or the applicant's guardian or conservator and the 
facility in which the applicant resides or seeks to reside and after a period of not less 
than 30 days has elapsed following the department's request for information under 
paragraph B, if the department cannot determine that eligibility exists, the department 
may deny assistance.  If the necessary information and verifications are provided at a 
later date, the department shall use that information to update and supplement the 
previous application, and the applicant may not be required to submit a new 
application. 
1-D.  Notice of annual and other MaineCare reviews.  The department shall 
provide advance notice of not less than 20 days of reviews for annual determinations and 
other periodic redeterminations of MaineCare eligibility to a recipient of MaineCare, the 
recipient's guardian or conservator and the facility in which the recipient resides or seeks 
to reside. The department shall work cooperatively with the recipient, the recipient's 
guardian or conservator and the facility in which the recipient resides or seeks to reside to 
timely secure any information and documentation needed to properly carry out a fair, 
timely and proper review, which must be completed within 30 business days of receiving 
any requested information.  The department shall, in a timely fashion, provide to the 
recipient, the recipient's guardian or conservator and the facility in which the recipient 
resides or seeks to reside copies of all communications required under this subsection. 
SUMMARY 
This bill amends the laws governing MaineCare eligibility determinations for 
applicants to nursing homes.  It directs the Department of Health and Human Services to 
provide timely and adequate notice to both the applicant and the facility in which the 
individual resides or seeks to reside if the department is unable to make a decision of 
eligibility due to inconclusive or conflicting information or other deficiencies in the 
application and requires the department to notify the applicant and the affected facility of 
the additional information required. It requires that the provision of copies of all 
communications be timely provided to the facility as well as the applicant, and that the 
applicant be provided a reasonable amount of time to respond and provide information. It 
directs the department to extend the time frame for responses in appropriate 
circumstances. If an application is denied and if necessary information is later provided, 
the additional information must be used to update and supplement the prior application, 
and the applicant need not submit a new application. 
The bill also requires the department to provide timely advance notice of reviews for 
annual determinations and other periodic redeterminations of MaineCare eligibility to a 
MaineCare recipient and the facility in which the recipient resides or seeks to reside. The 
bill requires the department to provide to the recipient and the facility in which the 
recipient resides or seeks to reside copies of communications.