An Act To Improve and Modernize Home-based Care
Maine Legislature, Session 129, LD 1655
Committee: Health and Human Services
Sponsors: MEYER, MOORE, MADIGAN, PERRY, STOVER
Amends: 5 MRSA §12004-I, 22 MRSA §3173-H, 22 MRSA §3173-I, 22 MRSA §3173-J, 22 MRSA §3174-B

Legislative Document
No. 1655
H.P. 1191
House of Representatives, April 30, 2019
An Act To Improve and Modernize Home-based Care
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MEYER of Eliot.
Cosponsored by Senator MOORE of Washington and
Representatives: MADIGAN of Waterville, PERRY of Calais, STOVER of Boothbay.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA §12004-I, sub-§39-A is enacted to read:
39-A.  
Sec. 2.  22 MRSA §3173-H, sub-§5, ¶¶C and D, as enacted by PL 2017, c. 307, 
§2, are amended to read:
C.  Must provide that group therapy for behavioral health or addiction services 
covered by the MaineCare program may be delivered through telehealth; and
D.  Must include requirements for individual providers and the facility or 
organization in which the provider works for providing telehealth and telemonitoring 
services.; and
Sec. 3.  22 MRSA §3173-H, sub-§5, ¶E is enacted to read:
E.  Must require that the department provide reimbursement for telehealth or 
telemonitoring private duty nursing, home health services and personal care services 
for an adult MaineCare member with a physical disability or an adult who is elderly 
who is receiving MaineCare services under a waiver granted by the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid 
Services for home-based and community-based services or state-funded home-based 
and community-based support services.  The services to be reimbursed must include 
the following:
(1)  Services that support a member's ability to remain in the member's home, 
including, but not limited to, telehealth and telemonitoring services that support a 
member's safety, mobility or medication compliance, or that support virtual home 
visits and clinical consultation; and
(2)  Services of a pharmacist to provide medication evaluation or consultation to 
a member.
Sec. 4.  22 MRSA §3173-I, sub-§3, as enacted by PL 2017, c. 307, §3, is 
amended to read:
3.  Duties.  The advisory group shall:
A.  Evaluate technical difficulties related to telehealth and telemonitoring services; 
and
B.  Make recommendations to the department to improve telehealth and 
telemonitoring services statewide.; and
Human Services
Social Determinants 
of Health 
Stakeholder 
Advisory Group
Not Authorized
MRSA §3173-J
C.  Make recommendations to the department on the use of technologies that can be 
used in a home.
Sec. 5.  22 MRSA §3173-J is enacted to read:
§3173-J.  Social Determinants of Health Stakeholder Advisory Group
The Social Determinants of Health Stakeholder Advisory Group, as established by 
Title 5, section 12004-I, subsection 39-A and referred to in this section as "the advisory 
group," is created within the department.
1.  Membership.  The advisory group consists of the commissioner or the 
commissioner's designee and 5 other members appointed by the commissioner as follows:
A.  A representative of an organization that provides home health care services as 
defined in section 3172;
B.  A representative of an organization that works to reduce food insecurity;
C.  A representative of an organization that provides housing assistance;
D.  A representative of an organization that promotes public health; and
E.  A representative of an organization that supports the aging process.
2.  Terms; quorum.  The appointed members serve for 3-year terms and may be 
reappointed.  Four members constitute a quorum.
3.  Meetings.  The advisory group shall hold at least one regular meeting and no 
more than 4 meetings each year.
4.  Duties.  The advisory group shall:
A.  Collaborate with providers of home health care services and other services 
relating to the social determinants of health; and
B.  Make recommendations to the department to increase collaboration and sharing of 
resources among service providers to improve MaineCare members' health and 
reduce unnecessary use of health care services.
For the purposes of this section, "social determinants of health" means a person's 
social, economic and physical environments that affect the person's health.
Sec. 6.  22 MRSA §3174-BBB is enacted to read:
§3174-BBB.  Compensation for care provided to the elderly or persons with physical 
disabilities
1.  Reimbursement.  The department shall provide for the reimbursement under the 
MaineCare program for private duty nursing, home health services and personal care 
services provided to adult MaineCare members with physical disabilities or who are 
elderly and receiving services under a waiver granted by the federal Department of 
Health and Human Services, Centers for Medicare and Medicaid Services or state-funded 
home-based and community-based support services for home-based and community-
based care on the basis of rates and a methodology established by rule under subsection 3.  
The department shall, beginning in 2020 and at least every 2 years thereafter and 
whenever legislation is enacted that affects the costs of providing private duty nursing, 
home health services and personal care services, conduct a substantive review of the rates 
set under this section.  The review must provide for public comment.
2.  Minimum rate.  A review conducted pursuant to subsection 1 may not result in a 
reimbursement rate received by a provider that is lower than the rate in effect on 
December 31, 2018.
3.  Rulemaking.  The department shall adopt rules to establish reimbursement rates 
under this section that take into account the costs of providing care and services in 
conformity with applicable state and federal laws, rules and regulations; quality and 
safety standards; and local competitive wage markets.  Rules adopted pursuant to this 
subsection are major substantive rules as defined in Title 5, chapter 375, subchapter 2-A.
This section applies to all funds, including federal funds, paid by any agency of the 
State to a provider for care covered by the waiver under subsection 1.
Sec. 7.  Staggered terms.  Notwithstanding the Maine Revised Statutes, Title 22, 
section 3173-J, subsection 2, of the initial appointments of the Social Determinants of 
Health Stakeholder Advisory Group, the Commissioner of Health and Human Services 
shall designate the first appointment for a one-year term, the next 2 appointments for 2-
year terms and any other appointments for 3-year terms.  An initial term of one or 2 years 
may not be considered a full term for purposes of limiting the number of terms for which 
a member may serve.
Sec. 8.  Department of Health and Human Services to amend rules.  The 
Department of Health and Human Services shall amend its rules for services provided 
under rule Chapter 101: MaineCare Benefits Manual, Chapter II, Sections 19, 40 and 96 
and rule Chapter 5, Office of Elder Services Policy Manual, Section 63 so that:
1.  A certified nurse practitioner licensed under the Maine Revised Statutes, Title 32, 
chapter 31 and a physician assistant licensed under Title 32, chapter 36 or 48 may 
authorize or amend a plan of care; and
2.  Reimbursement is provided for activities performed outside of the home by a 
registered nurse licensed under Title 32, chapter 31 that are directly related to a member's 
care and are part of the member's plan of care.
Sec. 9.  Department of Health and Human Services to convene work 
group.  The Department of Health and Human Services shall convene a work group to 
review options for adjusting reimbursement rates, including, but not limited to, the 
feasibility and cost of adjusting rates, in order to provide health care coverage and paid 
sick leave to home-based and community-based care providers providing services under 
rule Chapter 101: MaineCare Benefits Manual, Chapter III, Sections 19, 40 and 96 and 
rule Chapter 5, Office of Elder Services Policy Manual, Section 63.  The work group 
must include home-based and community-based care providers, including personal 
support services workers and direct care workers; worker advocates; and stakeholders 
affected by rate changes.  By December 15, 2019, the Department of Health and Human 
Services shall submit a report to the Joint Standing Committee on Health and Human 
Services on the work group's review and recommendations regarding adjusting 
reimbursement rates to provide health care coverage and paid sick leave to home-based 
and community-based care providers.  The joint standing committee may report out a bill 
concerning the report to the Second Regular Session of the 129th Legislature.
Sec. 10.  Department of Health and Human Services to review and amend 
its supervisory requirements.  The Department of Health and Human Services shall 
review the current requirement for in-person supervision as required under rule Chapter 
101: MaineCare Benefits Manual, Chapter II, Sections 19, 40 and 96 and rule Chapter 5, 
Office of Elder Services Policy Manual, Section 63.  In its review, the department shall 
determine whether this requirement is clinically necessary or the best use of financial 
resources given the availability of technology for interactive, real-time communication 
and in light of the federal 21st Century Cures Act, Public Law 114-255, Section 
12006(a).  In its review, the department shall consider the use of technology in meeting 
compliance requirements and making supervisory requirements consistent for all 
providers.  By December 15, 2019, the department shall submit a report to the Joint 
Standing Committee on Health and Human Services on the department's review and 
recommendations regarding in-person supervision requirements under rule Chapter 101: 
MaineCare Benefits Manual, Chapter II, Sections 19, 40 and 96 and rule Chapter 5, 
Office of Elder Services Policy Manual, Section 63 for all providers and regarding 
meeting compliance requirements.  The joint standing committee may report out a bill 
concerning the report to the Second Regular Session of the 129th Legislature.
SUMMARY
This bill:
1.  Establishes the Social Determinants of Health Stakeholder Advisory Group to 
collaborate with providers of home health care services and other services relating to the 
social determinants of health and make recommendations to the Department of Health 
and Human Services;
2.  Provides for reimbursement for telehealth or telemonitoring private duty nursing, 
home health services and personal care services for an adult MaineCare member with a 
physical disability or an adult who is elderly who is receiving MaineCare services under a 
waiver granted by the federal Department of Health and Human Services, Centers for 
Medicare and Medicaid Services for home-based and community-based services or state-
funded home-based and community-based support services.  The services must include: 
A.  Services that support a member's ability to remain in the member's home, 
including, but not limited to, telehealth and telemonitoring services that support a 
member's safety, mobility or medication compliance, or that support virtual home 
visits and clinical consultation; and 
B.  Services of a pharmacist to provide medication evaluation or consultation to a 
member;
3.  Expands the duties of the Maine Telehealth and Telemonitoring Advisory Group 
to include making recommendations about home technology to the Department of Health 
and Human Services;
4.  Directs the Department of Health and Human Services, beginning in 2020 and at 
least every 2 years thereafter and whenever legislation is enacted that affects the costs of 
providing private duty nursing, home health services and personal care services, to review 
the rates for providers of services under a waiver granted by the federal Department of 
Health and Human Services, Centers for Medicare and Medicaid Services for home-based 
and community-based services or state-funded home-based and community-based support 
services;
5.  Directs the Department of Health and Human Services to amend its rules for 
services provided under rule Chapter 101: MaineCare Benefits Manual, Chapter II, 
Sections 19, 40 and 96 and rule Chapter 5, Office of Elder Services Policy Manual, 
Section 63 so that:
A.  A certified nurse practitioner licensed under the Maine Revised Statutes, Title 32, 
chapter 31 and a physician assistant licensed under Title 32, chapter 36 or 48 may 
authorize or amend a plan of care; and
B.  Reimbursement is provided for activities performed outside of the home by a 
registered nurse licensed under Title 32, chapter 31 that are directly related to a 
member's care and are part of the member's plan of care;
6.  Directs the Department of Health and Human Services to convene a work group to 
review options for adjusting rates in order to provide health care coverage and paid sick 
leave to home-based and community-based care providers and to report the 
recommendations of the work group to the Joint Standing Committee on Health and 
Human Services; and
7.  Directs the Department of Health and Human Services to review its in-person 
supervisory requirement for home-based and community-based care providers to 
determine whether the use of technology that provides interactive, real-time 
communication is feasible and practical and to report its recommendations to the Joint 
Standing Committee on Health and Human Services.