An Act To Implement the Recommendations of the Commission To Study Long-term Care Workforce Issues
Maine Legislature, Session 129, LD 2109
Committee: Health and Human Services
Amends: 5 MRSA §12004-I, 22 MRSA §5307

Legislative Document
No. 2109
H.P. 1504
House of Representatives, February 18, 2020
An Act To Implement the Recommendations of the Commission To 
Study Long-term Care Workforce Issues
Reported by Representative HYMANSON of York for the Joint Standing Committee on 
Health and Human Services pursuant to Public Law 2019, chapter 343, Part BBBBB, section 1.
Reference to the Committee on Health and Human Services suggested and ordered printed 
pursuant to Joint Rule 218.
ROBERT B. HUNT
Clerk
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1.  22 MRSA c. 1476 is enacted to read:
CHAPTER 1476
DIRECT CARE WORKER WAGES
§5319.  Definitions
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1.  Activities of daily living.  "Activities of daily living" means tasks routinely 
performed by a person to maintain bodily functions, including bed mobility, transfers, 
locomotion, dressing, eating, toileting, bathing and personal hygiene. 
2.  Direct access.  "Direct access" means, with respect to an individual who is 
receiving services from a direct care worker in an institutional setting or in a home or 
community setting, access to the individual's property, personally identifiable 
information, financial information or resources or physical access to the individual.
3.  Direct care worker.  "Direct care worker" means an individual who by virtue of 
employment generally provides to individuals direct contact assistance with activities of 
daily living or instrumental activities of daily living or has direct access to provide care 
and services to clients, patients or residents regardless of the setting.
4.  Home and community-based support services.  "Home and community-based 
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 or group homes.  
These services include, but are not limited to, self-directed care services; home health 
aide services; personal care assistance services; companion and attendant services; 
homemaker services; respite care; and other appropriate and necessary social services.
5.  Home or community setting.  "Home or community setting" means a place of 
residence or group home where adults with long-term care needs receive home and 
community-based support services.
6.  Institutional setting.  "Institutional setting" means residential care facilities 
licensed pursuant to chapter 1664, intermediate care and skilled nursing facilities and 
units and hospitals licensed pursuant to chapter 405 and state institutions for individuals 
who have intellectual disabilities or autism or other related conditions.
7.  Instrumental activities of daily living.  "Instrumental activities of daily living" 
includes, but is not limited to, preparing or receiving of a main meal, taking medication, 
using the telephone, handling finances, banking, shopping, routine housework, laundry 
and getting to appointments.
8.  Self-directed care services.  "Self-directed care services" means services 
procured and directed by the person receiving services or the person's surrogate that allow 
the person to reenter or remain in the community and to maximize independent living 
opportunities.  "Self-directed care services" includes the hiring, firing, training and 
supervision of direct care workers to assist with activities of daily living and instrumental 
activities of daily living.
§5320.  Direct care worker minimum wage
Starting January 1, 2021, the minimum hourly wage paid to a direct care worker must 
be no less than 125% of the minimum wage established in Title 26, section 664, 
subsection 1.  Increases to the minimum wage for direct care workers must begin on 
January 1st of each year at the same time as any increase in the minimum wage takes 
place.
§5320-A.  Rulemaking
The department shall adopt rules providing reimbursement rates under this chapter 
that take into account the costs of providing the direct care worker minimum wage 
required in section 5320.  Rules adopted pursuant to this section are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. A-2.  Department of Health and Human Services to adopt rules to 
provide reimbursement rates sufficient for structural costs.  The Department of 
Health and Human Services shall adopt rules to increase reimbursement rates under 
Chapter 101: MaineCare Benefits Manual and any state-funded programs to take into 
account costs of providing care and services in conformity with applicable state and 
federal laws, rules, regulations, training requirements and quality and safety standards, 
including, but not limited to:  costs of increases in wages for direct care workers pursuant 
to the Maine Revised Statutes, Title 22, chapter 1476; increases in minimum wages for 
any other workers pursuant to Title 26, section 664, subsection 1; earned paid leave 
pursuant to Title 26, section 637; background checks required pursuant to Title 22, 
chapter 1691; and electronic visit verification required under the federal 21st Century 
Cures Act, Public Law 114-255, Section 12006.  The department shall consult with 
providers and other stakeholders that the department determines appropriate to determine 
appropriate reimbursement levels for services.  Rules adopted pursuant to this section are 
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A except for rules 
that amend Chapter 101: MaineCare Benefits Manual, Chapter III, Section 97, which are 
major substantive rules.
PART B
Sec. B-1.  5 MRSA §12004-I, sub-§47-J is enacted to read:
47-J.  
Human Services
Long-term care 
workforce oversight 
advisory committee
Not Authorized
MRSA §5307
Sec. B-2.  22 MRSA §5307 is enacted to read:
§5307.  Long-term care workforce oversight advisory committee
The long-term care workforce oversight advisory committee, as established in Title 5, 
section 12004-I, subsection 47-J and referred to in this section as "the oversight 
committee," is established to provide advice and oversight to the department and the joint 
standing committee of the Legislature having jurisdiction over health and human services 
matters regarding long-term care workforce issues.
1.  Membership.  The oversight committee consists of 10 members as follows:
A.  Eight members, appointed by the commissioner, who are employers and providers 
of services in the long-term care industry and employ direct care workers who 
provide assistance with activities of daily living or instrumental activities of daily 
living to clients, patients or residents, in institutional and home or community 
settings;
B.  One member, appointed by the commissioner, who is a recipient of self-directed 
care services as defined in section 5319, subsection 8; and
C.  The long-term care ombudsman as described in section 5107-A.
For the purposes of this subsection, "direct care worker" has the same meaning as in 
section 5319, subsection 3.
2.  Terms; vacancy.  Members of the oversight committee are appointed to staggered 
2-year terms so that the terms of 4 members representing providers expire on July 1st of 
each year.  If the commissioner fails to make an appointment prior to the expiration of a 
member's term, that member continues to serve until the commissioner makes an 
appointment for the remainder of that term.  If a vacancy occurs prior to the expiration of 
a specified term, the commissioner shall appoint a person to serve the remainder of that 
term.
3.  Duties.  The oversight committee has the following duties:
A.  Collect data from the department relating to the number of hours of services 
provided by direct care workers, the number of approved hours for which staffing 
cannot be provided due to staffing shortages, vacancies for direct care worker 
positions and the number of unfilled beds in residential care facilities licensed under 
chapter 1664 and nursing facilities licensed under chapter 405;
B.  Compile data available from the Department of Labor relating to current and 
future needs for direct care workers;
C.  Review progress by the department in implementing recommendations provided 
to the department and the joint standing committee of the Legislature having 
jurisdiction over health and human services matters relating to long-term care 
workforce issues and address barriers to implementing those recommendations; and
D.  Make recommendations to the department and the joint standing committee of the 
Legislature having jurisdiction over health and human services matters on proposals 
to increase the long-term care workforce and address shortages in services.
4.  Meetings; report.  The oversight committee shall meet at least quarterly and 
submit an annual report no later than January 2nd to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters describing the 
oversight committee's activities and recommendations.
SUMMARY
This bill implements the recommendations of the Commission To Study Long-term 
Care Workforce Issues, which was established by Public Law 2019, chapter 343, Part 
BBBBB, section 1.  The bill does the following.
1.  It requires direct care workers across the long-term care spectrum to be paid no 
less than 125% of the minimum wage.  It requires the Department of Health and Human 
Services to adopt rules that take into account the cost of this increased wage in its 
reimbursement rates.
2.  It requires the Department of Health and Human Services to adopt rules to 
increase reimbursement rates under Chapter 101: MaineCare Benefits Manual and any 
state-funded programs to take into account costs of providing care and services in 
conformity with applicable state and federal laws, rules, regulations, training 
requirements and quality and safety standards, including, but not limited to, increases in 
the minimum wage, earned paid leave, electronic visit verification, background checks 
and other costs that are not provided for in the current reimbursement rates.
3.  It establishes a long-term care workforce oversight advisory committee to collect 
and compile data related to workforce shortages and services provided to clients, review 
progress by the Department of Health and Human Services regarding recommendations 
provided to the department and the joint standing committee of the Legislature having 
jurisdiction over health and human services matters, including the recommendations of 
the Commission To Study Long-term Care Workforce Issues, identify barriers to 
implementing recommendations and make recommendations on proposals to address 
long-term care workforce shortages.  The oversight committee must submit an annual 
report to the joint standing committee of the Legislature having jurisdiction over health 
and human services matters.