An Act To Implement the Recommendations of the Commission To Study Long-term Care Workforce Issues
Maine Legislature, Session 130, LD 1573
Committee: Health and Human Services
Sponsors: FAY
Amends: 22 MRSA §1708, 26 MRSA §664, 5 MRSA §12004-I, 22 MRSA §5307

Legislative Document
No. 1573
H.P. 1170
House of Representatives, April 27, 2021
An Act To Implement the Recommendations of the Commission To 
Study Long-term Care Workforce Issues
(EMERGENCY)
Received by the Clerk of the House on April 23, 2021.  Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative FAY of Raymond.
Emergency preamble.  Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, direct care workers provide a valuable societal service for the people of 
Maine and often are grossly underpaid, to the disadvantage of the workers themselves and 
the people who they serve; and
Whereas, provision for the relief of direct care workers was submitted through 
legislation in the Second Regular Session of the 129th Legislature, but the sudden 
adjournment of the session due to the COVID-19 pandemic resulted in the legislation not 
becoming law; and
Whereas, providing relief in wages for direct care workers is now even more pressing 
because of the delay; 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 enacted by the People of the State of Maine as follows:
PART A
Sec. A-1.  22 MRSA §1708, sub-§5 is enacted to read:
5.  Reimbursement rates for in-home and community support services.  The 
department shall establish rules concerning MaineCare reimbursement rates for in-home 
and community support services as defined in section 7302, subsection 5 that establish the 
base year for those services every 2 years and increase the rate of reimbursement beginning 
July 1, 2022 and every year thereafter until June 30, 2026. For the state fiscal year 
beginning July 1, 2026, the base year for each in-home and community support services 
provider is its fiscal year that ended in the calendar year 2024. For state fiscal years 
beginning on or after July 1, 2027, subsequent rebasing must be based on the most recent 
cost report filings available. The department may provide a mechanism for subsequent 
adjustments to base year costs to reflect any material difference between as-filed cost 
reports used in rebasing and subsequent determinations of audited, allowable costs for the 
same fiscal period. The department's rules must provide that, beginning in the state fiscal 
year beginning July 1, 2026, the MaineCare reimbursement rates set for each rebasing year 
must include an inflation adjustment for a cost-of-living percentage change in in-home and 
community support services reimbursement each year in accordance with the United States 
Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care 
services index.  Any rebasing done pursuant to this subsection may not result in an in-home 
and community support services provider receiving a MaineCare reimbursement rate that 
is lower than the rate in effect on June 30, 2026.
Sec. A-2.  22 MRSA c. 1627 is enacted to read:
CHAPTER 1627
DIRECT CARE WORKER WAGES
§7401. 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.  In-home and community support services.  "In-home and community 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 in-home and 
community 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. 
§7402.  Direct care worker minimum wage 
Starting January 1, 2022, 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. 
§7403.  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 7402. Rules adopted pursuant to this section are routine technical rules as defined 
in Title 5, chapter 375, subchapter 2-A.
Sec. A-3.  26 MRSA §664, sub-§1, as amended by IB 2015, c. 2, §1, is further 
amended to read:
1.  Minimum wage.  The minimum hourly wage is $7.50 per hour.  Starting January 
1, 2017, the minimum hourly wage is $9.00 per hour; starting January 1, 2018, the 
minimum hourly wage is $10.00 per hour; starting January 1, 2019, the minimum hourly 
wage is $11.00 per hour; and starting January 1, 2020, the minimum hourly wage is $12.00 
per hour.  On January 1, 2021 and each January 1st thereafter, the minimum hourly wage 
then in effect must be increased by the increase, if any, in the cost of living. The increase 
in the cost of living must be measured by the percentage increase, if any, as of August of 
the previous year over the level as of August of the year preceding that year in the 
Consumer Price Index for Urban Wage Earners and Clerical Workers, CPI-W, for the 
Northeast Region, or its successor index, as published by the United States Department of 
Labor, Bureau of Labor Statistics or its successor agency, with the amount of the minimum 
wage increase rounded to the nearest multiple of 5¢.   If the highest federal minimum wage 
is increased in excess of the minimum wage in effect under this section, the minimum wage 
under this section is increased to the same amount, effective on the same date as the 
increase in the federal minimum wage, and must be increased in accordance with this 
section thereafter.  This subsection does not apply to a direct care worker under Title 22, 
section 7402.
Sec. A-4.  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 rule 
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 1627; reimbursement rates for in-home and community 
support services pursuant to Title 22, section 1708, subsection 5; 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. Reimbursement rates under this section may not 
be lower than rates in effect on the effective date of this Act. 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 as defined in section 7302, subsection 1-A or 
instrumental activities of daily living as defined in section 7302, subsection 6-A 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 7401, 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 
7401, 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 the quarterly reports under subsection 5 from the department, the 
Department of Labor and the Department of Education on implementing 
recommendations provided to the departments 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. 
5.  Quarterly reports from departments.  Beginning January 1, 2022, the department, 
the Department of Labor and the Department of Education shall each submit a quarterly 
report to the oversight committee on the respective department’s efforts and progress in 
implementing recommendations of the oversight committee and the recommendations of 
the Commission To Study Long-term Care Workforce Issues established by Public Law 
2019, chapter 343, Part BBBBB, section 1.
This subsection is repealed January 1, 2027.
Emergency clause.  In view of the emergency cited in the preamble, this legislation 
takes effect when approved.
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 directs the Department of Health and Human Services to establish a 2-year 
rebasing requirement to set and increase reimbursement rates for in-home and community 
support services.
2.  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. 
3.  It requires the Department of Health and Human Services to adopt rules to increase 
reimbursement rates under rule 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 for 
workers other than direct care workers, earned paid leave, electronic visit verification, 
background checks and other costs that are not provided for in the current reimbursement 
rates and to not reduce a reimbursement rate below that on the effective date of this bill. 
4.  It establishes the 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 Department of Health and Human 
Services, the Department of Labor and the Department of Education are directed to provide 
to the oversight committee quarterly reports on the progress and efforts to implement the 
recommendations of the oversight committee and of the Commission To Study Long-term 
Care Workforce Issues. The oversight committee must submit an annual report to the joint 
standing committee of the Legislature having jurisdiction over health and human services 
matters.