An Act To Establish Universal Home Care for Seniors and Persons with Disabilities Transmitted to the Clerk of the 128th Maine Legislature by the Secretary of State on March 12, 2018 and ordered printed.
Maine Legislature, Session 128, LD 1864
Amends: 5 MRSA §12004-G, 5 MRSA §12004-I, 22 MRSA §7284, 22 MRSA §7285

Legislative Document
No. 1864
I.B. 3
House of Representatives, March 13, 2018
An Act To Establish Universal Home Care for Seniors and Persons 
with Disabilities
Transmitted to the Clerk of the 128th Maine Legislature by the Secretary of State on
March 12, 2018 and ordered printed.
ROBERT B. HUNT
Clerk
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA §12004-G, sub-§14-I is enacted to read:
14-I.  
Sec. 2.  5 MRSA §12004-I, sub-§30-B is enacted to read:
30-B.  
Sec. 3.  22 MRSA sub-T. 4, Pt. 4 is enacted to read:
PART 4
HOME CARE SERVICES
CHAPTER 1611
UNIVERSAL HOME CARE
§7281.  Definitions
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1.  Advisory committee.  "Advisory committee" means the Universal Home Care 
Trust Fund Advisory Committee described in section 7285.
2.  Board.  "Board" means the Universal Home Care Trust Fund Board described in 
section 7284.
3.  Constituency.  "Constituency" means persons within one of the following 
categories: 
A.  Personal care agencies as defined in section 1717, subsection 1, paragraph C;
B.  Individual providers and direct care service providers employed by in-home and 
community support services agencies; and
C.  Persons receiving in-home and community support services through the program, 
or their family members.
4.  Covered program.  "Covered program" means any program funded entirely or in 
part by the board pursuant to this chapter.
Health Care
Universal Home 
Care Trust Fund 
Board
Expenses Only
MRSA §7284
Health Care
Universal Home 
Care Trust Fund 
Advisory Committee
Not Authorized
MRSA §7285
5.  Eligible person.  "Eligible person" means a person determined to be eligible 
pursuant to section 7286.
6.  Family caregiver.  "Family caregiver" means a person who provides care-related 
services to assist a family member who is permanently or temporarily incapable of fully 
caring for the family member's self.  Care-related services include but are not limited to 
coordinating care-related appointments and transportation, scheduling and coordinating 
additional care with other workers or agencies, providing financial or emotional support 
and supporting the physical needs of an individual necessary for day-to-day functioning 
such as bathing, dressing, cooking, feeding, medication management, wound care, 
transportation, shopping and domestic work.
7.  Family member.  "Family member" means an individual with any of the 
following relationships to the eligible person:
A.  Spouse or parent of the spouse;
B.  A child or spouse of the child;
C.  A parent or spouse of the parent;
D.  A sibling or spouse of the sibling;
E.  A grandparent or spouse of the grandparent;
F.  A grandchild or spouse of the grandchild;
G.  A domestic partner or parent of the domestic partner, including the domestic 
partner of any individual in paragraphs A to F; or
H.  Any other individual related to the eligible person by blood or whose close 
association with the eligible person is the equivalent of an acknowledged family 
relationship.
For purposes of this chapter, "child" includes a biological child, an adopted child, a 
stepchild, a foster child and a child to whom the eligible person stands in loco parentis.
For purposes of this chapter, "parent" includes a biological parent, foster parent, 
stepparent, adoptive parent or legal guardian of the eligible person, and an individual who 
stood in loco parentis when the eligible person was a minor.
8.  Fund.  "Fund" means the Universal Home Care Trust Fund established under 
section 7283.
9.  Individual provider.  "Individual provider" means any individual selected by and 
working under the direction of an eligible person in a covered program, or an eligible 
person's representative, to provide in-home and community support services to the 
eligible person.  "Individual provider" does not include a person providing care by virtue 
of that person's employment or contract with a provider agency.
10.  In-home and community support services.  "In-home and community support 
services" means health care 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; home repair, chore and homemaker services; respite 
care; hospice care; counseling services; transportation; small rent subsidies; various 
devices that lessen the effects of disabilities; and other appropriate and necessary social 
services.
11.  Person with a disability.  "Person with a disability" means a person with a 
physical or mental disability as defined in Title 5, section 4553-A or with a disability as 
defined in 42 United States Code, Section 12102.
12.  Senior.  "Senior" means an individual 65 years of age or older.
13.  Universal Home Care Program.  "Universal Home Care Program" or 
"program" means the program established under section 7282.
§7282.  Program established
The Universal Home Care Program is established to provide in-home and community 
support services to individuals and families determined to be eligible under this chapter at 
no cost to those individuals and families.  The board oversees all funding for services 
provided pursuant to the program.
Due to the age of the population of this State and the growing utilization of in-home 
and community support services, the need for services may exceed the board’s ability to 
provide universal access to full benefits, in which case the board shall place limits on the 
amount of services available to each eligible person through the program.
§7283.  Universal Home Care Trust Fund established
The Universal Home Care Trust Fund is established as a nonlapsing fund managed by 
the board to support the program.  The fund may receive any revenue appropriated or 
allocated to the fund, including taxes collected under Title 36, sections 5002, 5204-C and 
5204-D, and receives all funds deposited in the fund from any other source.  Funds in the 
fund may be invested in the same manner as permitted for funds held in the State 
Treasury.
§7284.  Universal Home Care Trust Fund Board
The Universal Home Care Trust Fund Board, established in Title 5, section 12004-G, 
subsection 14-I, oversees and manages the fund and its use under the program in 
accordance with this chapter.  The board may provide services and incur other costs only 
to the extent that funding is available in the fund.  The board also collects and 
disseminates information to the Legislature, the Governor and the public about the needs 
of families in the State in order to encourage policy reform.
1.  Program design.  The board shall design and deliver the program to provide 
eligible persons with in-home and community support services. The board shall design 
the program to reduce the amount of unmet need and to supplement and not supplant 
existing programs.
The board shall maximize access to in-home and community support services using the 
funds available pursuant to this chapter. The program is not required to cover all possible 
in-home and community support services for all eligible persons. The board is prohibited 
from providing or offering services that would incur costs in excess of available funds.
If demand for services for eligible persons exceeds available funds, the board shall curtail 
services. When curtailing services, the board may provide varying levels of service to 
eligible persons depending on an assessment of their needs. The board may allocate an 
amount of funding for each assessment level and restrict the total amount of services 
provided to eligible persons in that assessment level to the funding amount allocated to 
that level. The assessment levels must be based on the extent of interference with 
activities of daily living, functional abilities and need for health and social services of the 
eligible persons.
2.  Powers and duties.  The board:
A.  Shall design and deliver to the extent that funds are available a home care 
program that funds both formal care and informal family care and shall use the fund 
to provide access to in-home and community support services for eligible persons by 
December 31, 2021;
B.  Shall ensure improvements in the wages, benefits and working conditions of 
persons providing in-home and community support services;
C.  Shall create within the program a system by which funds may be used to provide 
a stipend to a family caregiver providing care to an eligible family member;
D.  Shall set mandatory standards for quality and safety for in-home and community 
support services delivered with funding from the fund, without adversely affecting 
communities of color or low-wage earners;
E.  Shall determine how to use the fund to fulfill the requirements of this chapter, 
including by establishing a system for determining eligibility under section 7286, and 
how to manage the fund to ensure its long-term sustainability, including by creating a 
ramp-up period as described in section 7286 ending no later than December 31, 2021 
during which services are made available to eligible persons to the greatest extent 
possible without curtailing enrollment;
F.  Shall set reimbursement rates for services eligible for reimbursement under the 
program in a manner that maximizes access to those services, supports workforce 
development and ensures service quality;
G.  May manage the program's benefits to ensure the financial health of the fund, but 
may not restrict eligibility for the program as set forth in section 7286;
H.  May create advisory committees, in addition to the advisory committee under 
section 7285, to advise the board on the program and fund;
I.  Shall collect, analyze and disseminate information related to the program and the 
broader needs of families in the State, as applicable, including measuring and 
studying disparities in access to relevant services by race, income, disability and 
gender;
J.  Shall, in the event the board identifies disparities in access to relevant services by 
race, income or gender, manage the program so that those disparities are reduced or 
eliminated;
K.  Shall create a process for assessing the needs for in-home and community support 
services for individuals who need those services who are residing in their own homes 
or in other private homes in the community and a process for determining the extent 
of services eligible persons may receive;
L.  May partner with the department to provide supplementary funding to existing 
state programs, including long-term care programs other than in-home and 
community support services, to expand eligibility, increase payments to providers or 
raise quality standards consistent with other responsibilities, and to maintain a stable, 
high-quality care workforce;
M.  Shall create and adopt its own governance rules and develop and approve its own 
budget for the program and its administration and may expend no more than 5% of 
the fund on administrative costs;
N.  May fund initiatives that contribute to the effective use of the fund including 
workforce development, training and quality improvement programs and 
certifications for direct care workers;
O.  Shall conduct outreach activities to ensure public understanding of the program 
and promote awareness of application procedures;
P.  Shall report to the Legislature no later than February 15th annually on the status of 
the fund, including revenues, expenditures on in-home and community support 
services, administrative costs, provider reimbursement rates and any other 
information relating to the fund, and advise the Legislature on appropriate policies 
related to in-home and community support services;
Q.  Shall, if funds available are not sufficient to cover program costs, implement cost-
saving measures that curtail benefits as necessary while maintaining eligibility 
standards; and
R.  Shall take any other action necessary to implement the program and enable the 
board to exercise its powers and carry out its duties under this chapter.
3.  Membership.  The board consists of the following members:
A.  Three members who represent personal care agencies as defined in section 1717, 
subsection 1, paragraph C;
B.  Three members who are individual providers or direct care service providers 
employed by in-home and community support services agencies; and
C.  Three members receiving in-home and community support services, or family 
members or guardians of individuals receiving in-home and community support 
services.
4.  First board.  By February 1, 2019, the Speaker of the House of Representatives 
shall appoint 3 members to the first board who satisfy the requirements of subsection 3, 
paragraphs A to C, respectively; the President of the Senate shall appoint 3 members to 
the first board who satisfy the requirements of subsection 3, paragraphs A to C, 
respectively; and the Governor shall appoint 3 members to the first board who satisfy the 
requirements of subsection 3, paragraphs A to C, respectively.  A member of the first 
board serves for a one-year term or until the election of that member's successor under 
subsection 5.  A vacancy on the first board is filled in the same manner as the original 
appointment by the appointing authority.  The replacement member serves for the 
unexpired portion of the term.
5.  Election.  The board shall establish procedures to provide for elections of board 
members after the terms of the first board members expire.  The board shall establish and 
administer a system of nomination and secret ballot voting by mail or using a secure 
online voting system by which each member is elected by vote of that member's 
constituency.
The following persons are eligible to vote for the board members representing their 
respective constituencies:
A.  All personal care agencies as defined in section 1717, subsection 1, paragraph C, 
acting through their owners, directors and managers as they may choose;
B.  All individual providers and direct care service providers employed by in-home 
and community support services agencies; and
C.  All persons receiving in-home and community support services through the 
program, or their family members.
No later than August 1, 2019, the department shall provide to the board lists of all persons 
eligible to vote within the constituency categories, including names, addresses and e-mail 
addresses.  The board shall ensure that these lists are used solely for the purpose of 
providing information relating to the board election and for mailing or e-mailing ballots.  
The lists must be made available to the constituency associations set forth in section 7290 
for purposes of communicating about the election, candidates and issues relating to the 
program.  Persons on the list must be given the opportunity to opt out of receiving 
communications relating to the program.
The lists described in this subsection are not public records as described in Title 1, section 
402, subsection 3.  The board may adopt rules to implement this subsection, including 
rules for the confidentiality of lists and rules detailing the elections process.  Rules 
adopted pursuant to this subsection are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2-A.
6.  Terms; compensation; vacancy.  A member of the board elected under 
subsection 5 serves a 3-year term and may serve no more than 4 terms.  Members receive 
no compensation for service but are entitled to payment of any necessary expenses, 
including travel expenses, incurred in the discharge of their duties.  A vacancy during the 
term of a member elected under subsection 5 may be filled by appointment by the 
commissioner for the remainder of the member's term.  A member representing 
individuals receiving in-home and community support services under subsection 3, 
paragraph C who received such services upon election but who no longer receives those 
services may serve the remainder of the member's term.  A member appointed or elected 
under subsection 3, paragraph A or B is no longer eligible to serve if that member no 
longer meets the requirements of the respective paragraph unless that member is moving 
to a new position that will permit the member to meet the same requirements and the gap 
in qualifying lasts no longer than 8 weeks.
7.  Administrative support; executive director.  The board shall employ an 
executive director to take all actions appropriate and necessary to administer the program, 
provide administrative, managerial and technical support for the operations of the board 
and compile annual reports.  The executive director must have expertise relevant to 
managing the program.  The board shall set the salary of the executive director, who 
serves at the pleasure of the board.  The executive director may hire additional 
professional and administrative staff as necessary to administer the program.
§7285.  Universal Home Care Trust Fund Advisory Committee
The Universal Home Care Trust Fund Advisory Committee is established under Title 
5, section 12004-I, subsection 30-B.
1.  Members.  The advisory committee is composed of the following individuals or 
their designees:
A.  The commissioner;
B.  The Commissioner of Labor;
C.  The Commissioner of Education;
D.  The Treasurer of State;
E.  The President of the Senate; and
F.  The Speaker of the House of Representatives.
2.  Duties.  The advisory committee shall, on a quarterly basis, review the policies 
and financial management of the fund and provide guidance and advice to the board and 
the executive director.
§7286.  Eligibility
All seniors living in this State and all persons with a disability living in this State are 
eligible for services under this chapter if they need assistance with at least one activity of 
daily living as defined in section 7852, subsection 1.  Eligibility takes effect no later than 
September 1, 2019 but the board may implement a ramp-up period for services, to be 
completed no later than December 31, 2021, as it develops the full scope of the program.  
A person who resides in a hospital, nursing facility, intermediate care facility for persons 
with intellectual disabilities, adult family care home or residential care facility, as defined 
in section 7852, subsection 14, is not eligible for the program.  Income may not be a 
factor for eligibility for any services provided under the program.  If demand for the 
program exceeds the board’s ability to provide meaningful benefits to eligible persons, 
the board may create waiting lists of eligible persons and take such other measures as 
may be needed to create an orderly process providing eligible persons with benefits as 
soon as funding is available.
§7287.  Coordination
The board and the department shall create a simple, unified process for enrollment in 
coordination with the other services provided by the department intended to benefit an 
eligible person.
§7288.  Outreach
Beginning April 1, 2019, in accordance with rules adopted by the board, all 
employers in the State must display in workplaces posters notifying employees of the 
in-home and community support services available under the program.  The Department 
of Labor shall produce and distribute posters required under this section.  The board shall 
reimburse the Department of Labor for reasonable costs under this section.
§7289.  Direct service worker costs for in-home and community support services; 
report
1.  Direct service worker costs.  Providers of in-home and community support 
services participating in a covered program shall expend a minimum of 77% of the 
funding received from the Universal Home Care Program on direct service worker costs.  
When determining compliance, the board shall calculate this percentage on a statewide, 
annual basis for each provider.  A provider that fails to meet this direct service worker 
payment minimum may be suspended from the program or required to make additional 
payments to the respective direct service workers, or both; any additional payments must 
be for the year in which the provider failed to meet the minimum set forth in this section 
and must be sufficient to bring the provider into compliance.
2.  Report.  In order to prove compliance with subsection 1, a provider shall submit 
an annual cost report to the board based upon actual, documented expenditures for direct 
service worker costs, administrative costs and other costs of program support.
A.  The cost report must demonstrate that the provider has expended a minimum of 
77% of the funding received from the program for direct service worker costs.  The 
remaining funding received from the program may be spent by the provider on 
administrative or program support costs.
B.  An authorized representative of the provider shall attest to the accuracy of the cost 
report.
C.  The board may require the provider to engage an independent certified public 
accounting firm to verify the information and data submitted by the provider under 
this subsection if the board is in possession of evidence to suggest the information 
and data submitted is inaccurate, incomplete or fraudulent.  The provider is 
responsible for the cost of this audit.
D.  For a provider who does not submit a complete, accurate and timely report under 
this subsection, the board may impose a corrective action plan to reimburse service 
workers, temporarily suspend the provider from covering additional persons in the 
program or permanently terminate the provider from the program, in addition to other 
remedies that may be available.
3.  Rules.  The board may adopt rules to implement this section.  Rules adopted 
pursuant to this section are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A.  Rules adopted by the board pursuant to this section may include 
definitions of allowable and unallowable costs for purposes of the annual cost report 
requirement.
§7290.  Constituency associations
1.  Definition.  As used in this section, "constituency association" means a group of 
persons within a constituency that is recognized for the purpose of allowing consumers 
and workers to advocate for their interests before the board, elected officials and the 
general public.
2.  Access to contact information.  Upon a showing made to the board by a 
constituency association that at least 250 individuals of a particular constituency wish to 
have that association advocate for their interests, the board shall provide that association 
with the names and most recent contact information of the other constituents of the 
particular constituency eligible to vote in the next board election for the purpose of 
inviting those individuals to join their constituency association.  The board shall provide 
the names and contact information within 7 days of the request.  That association shall 
maintain the confidentiality of the list and may not share the list with the public or any 
other entity not authorized by the board.
3.  Dues.  If an employee of a provider of in-home and community support services 
chooses to join a constituency association, the provider must deduct and remit 
membership dues to the association if requested by the employee.
4.  Labor unions.  The board shall recognize as a constituency association any labor 
union that demonstrates that the union has at least 100 members in a constituency.
§7291.  State employees
For the purposes of the State Employees Labor Relations Act, Title 26, chapter 9-B, 
individual providers must be considered state employees.  This section does not require 
the treatment of individual providers as state employees for any other purpose.  Chapter 
9-B applies to individual providers except to the extent inconsistent with this section, in 
which case this section controls.
§7292.  Rules
The board shall adopt rules necessary to implement this chapter.  Rules adopted by 
the board pursuant to this section are routine technical rules as defined in Title 5, chapter 
375, subchapter 2-A.
Sec. 4.  36 MRSA c. 723 is enacted to read:
CHAPTER 723
EMPLOYER CONTRIBUTION TO UNIVERSAL HOME CARE THROUGH 
TAX ON HIGH EARNER WAGES
§5001.  Definitions
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1.  High earner.  "High earner" has the same meaning as in section 5204-C, 
subsection 1, paragraph A.
2.  Universal home care tax income threshold.  "Universal home care tax income 
threshold" has the same meaning as in section 5204-C, subsection 1, paragraph B.
3.  Wage income.  "Wage income" has the same meaning as in section 5204-C, 
subsection 1, paragraph C.
§5002.  Imposition on employer
In addition to other taxes, there is imposed on every employer maintaining an office 
or transacting business in this State an excise tax at the rate of 1.9% on that amount of 
wage income paid by that employer to any high earner employee in this State that in the 
tax year exceeds the universal home care tax income threshold.
§5003.  Tax collected deposited in Universal Home Care Trust Fund
One hundred percent of the tax collected pursuant to this chapter must be deposited 
each year into the Universal Home Care Trust Fund established in Title 22, section 7283.
§5004.  Application
This chapter applies to tax years beginning on or after January 1, 2019.
Sec. 5.  36 MRSA §§5204-C and 5204-D are enacted to read:
§5204-C.  Additional payroll tax on high earners' wages to support universal home 
care
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "High earner" means a taxpayer with Maine adjusted gross income exceeding the 
universal home care tax income threshold in a tax year. 
B.  "Universal home care tax income threshold" means the federal Old-Age, 
Survivors, and Disability Insurance contribution and benefit base set forth in 42 
United States Code, Section 430(b), as published in the Federal Register for the 
applicable tax year.
C.  "Wage income" means "wages, salaries, tips, and other employee compensation" 
as set forth in 26 United States Code, Section 32(c)(2)(A)(i).
2.  Tax imposed.  In addition to all other taxes contained in this Part, a tax to support 
universal home care is imposed on the wage income of high earners for the taxable year.  
The tax is imposed on that amount of the high earner's wage income that exceeds the 
universal home care tax income threshold.  This tax is in addition to the excise tax set 
forth in section 5002.
3.  Tax rate.  The rate of the tax imposed under this section is 1.9%.
4.  Collection.  The Bureau of Revenue Services shall instruct employers to report 
the tax imposed under this section on the federal form W-2 wage and tax statement in box 
in the category labeled "Other" with the designation "UHC."  This tax must be 
collected by the employer of the high earner by deducting the amount of the tax from the 
wages as and when paid.
5.  Tax collected deposited in Universal Home Care Trust Fund.  One hundred 
percent of the tax collected pursuant to this section must be deposited each year into the 
Universal Home Care Trust Fund established in Title 22, section 7283.
6.  Application.  This section applies to tax years beginning on or after January 1, 
2019.
§5204-D.  Additional tax on high earners' nonwage income to support universal 
home care
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "High earner" has the same meaning as in section 5204-C, subsection 1, 
paragraph A.
B.  "Universal home care tax income threshold" has the same meaning as in section 
5204-C, subsection 1, paragraph B.
C.  "Universal home care wage tax credit" means the sum of the taxes paid by an 
employee pursuant to section 5204-C, subsection 2 plus the taxes owed by the 
taxpayer's employer pursuant to section 5002.
2.  Tax imposed.  In addition to all other taxes contained in this Part, a tax to support 
universal home care is imposed on high earners.  The tax is imposed on that amount of 
the high earner's Maine adjusted gross income that exceeds the universal home care tax 
income threshold for the tax year.
3.  Tax rate; adjustment.  The rate of the tax imposed under this section is 3.8%.  
The tax owed under this section is reduced by an amount equal to the high earner's 
universal home care wage tax credit.
4.  Tax collected deposited in Universal Home Care Trust Fund.  One hundred 
percent of the tax collected pursuant to this section must be deposited each year into the 
Universal Home Care Trust Fund established in Title 22, section 7283.
5.  Application.  This section applies to tax years beginning on or after January 1, 
2019.
Sec. 6.  Program development and implementation.  The following provisions 
govern the development and implementation of the Universal Home Care Program 
established under the Maine Revised Statutes, Title 22, chapter 1611.
1.  Start up; appointment of first board.  No later than March 1, 2019, the first 
Universal Home Care Trust Fund Board appointed pursuant to Title 22, section 7284, 
subsection 2 shall meet to develop and oversee the implementation of the Universal 
Home Care Program and to engage in planning with the Department of Health and 
Human Services.  No later than March 1, 2019, the board shall also examine the need for 
and develop a plan for maintaining or eliminating existing advisory councils relating to 
in-home and community support services and shall submit a report of its 
recommendations to the joint standing committee of the Legislature having jurisdiction 
over health and human services matters relating to the appropriate roles for those 
councils.
2.  Waivers.  No later than December 31, 2019, the Department of Health and 
Human Services shall prepare and submit to the United States Department of Health and 
Human Services, Centers for Medicare and Medicaid Services applications to request any 
necessary waivers to implement the Universal Home Care Program under the Maine 
Revised Statutes, Title 22, chapter 1611.
SUMMARY
This initiated bill establishes the Universal Home Care Program to provide in-home 
and community support services for all people with disabilities living in Maine who 
require assistance with an activity of daily living and people 65 years of age or older who 
are living in Maine and who require assistance with an activity of daily living, without 
regard to income, to be funded by a new tax of 3.8% on income and wages that exceed 
the maximum wages subject to social security employment taxes.