An Act To Improve Home and Community-based Services for Adults with Intellectual Disabilities, Autism, Brain Injury and Other Related Conditions
Maine Legislature, Session 130, LD 1490
Committee: Health and Human Services
Sponsors: MILLETT, CLAXTON, CRAVEN, WHITE, BALDACCI
Amends: 34-B MRSA §5003-A, 34-B MRSA §5610

Legislative Document
No. 1490
H.P. 1104
House of Representatives, April 14, 2021
An Act To Improve Home and Community-based Services for 
Adults with Intellectual Disabilities, Autism, Brain Injury and 
Other Related Conditions
Received by the Clerk of the House on April 12, 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 MILLETT of Cape Elizabeth.
Cosponsored by Senator CLAXTON of Androscoggin and
Representatives: CRAVEN of Lewiston, WHITE of Waterville, Senator: BALDACCI of 
Penobscot.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  34-B MRSA §5003-A, sub-§1, as amended by PL 2011, c. 542, Pt. A, §83, 
is further amended to read:
1.  System of care services and support.  The Legislature declares that the system of 
care services and support through which the State provides services to and programs for 
persons with intellectual disabilities or autism must be designed to protect the integrity of 
the legal and human rights of these persons and to meet their needs consistent with the 
principles guiding delivery of services as set forth in section 5610.
Sec. 2.  34-B MRSA §5003-A, sub-§2, ¶E, as amended by PL 2011, c. 542, Pt. A, 
§83, is further amended to read:
E.  Eliminate the department's own duplicative and unnecessary administrative 
procedures and practices in the system of care services and support for persons with 
intellectual disabilities or autism, encourage other departments to do the same and 
clearly define areas of responsibility in order to use present resources economically;
Sec. 3.  34-B MRSA §5003-A, sub-§2, ¶F, as amended by PL 2011, c. 542, Pt. A, 
§83, is further amended to read:
F.  Strive toward having a sufficient number of personnel who are qualified and 
experienced to provide treatment that is beneficial to persons with intellectual 
disabilities or autism; and
Sec. 4.  34-B MRSA §5003-A, sub-§2, ¶G, as amended by PL 2011, c. 542, Pt. A, 
§83, is further amended by amending subparagraph (3) to read:
(3)  The commissioner shall inform the joint standing committee of the Legislature 
having jurisdiction over human resources matters about areas where increased 
cooperation by other departments is necessary in order to improve the delivery of 
services to persons with intellectual disabilities or autism.;
Sec. 5.  34-B MRSA §5003-A, sub-§2, ¶H is enacted to read:
H.  Post at least monthly on the department's publicly accessible website, for each home 
and community-based services waiver from the United States Department of Health 
and Human Services, Centers for Medicare and Medicaid Services in which the State 
participates, data on how many persons were on a waiting list for services on the first 
day of that month, including, for prioritized waiting lists, how many persons were in 
each prioritization category; and
Sec. 6.  34-B MRSA §5003-A, sub-§2, ¶I is enacted to read:
I.  Post at least quarterly on the department's publicly accessible website, for each home 
and community-based services waiver from the United States Department of Health 
and Human Services, Centers for Medicare and Medicaid Services in which the State 
participates, data on the median time from application for waiver services to approval 
by the department of the waiver application, using a statistically valid methodology.
Sec. 7.  34-B MRSA §5003-A, sub-§3, ¶F, as amended by PL 2011, c. 542, Pt. A, 
§83, is further amended to read:
F.  The plan must include an assessment of the roles and responsibilities of intellectual 
disability and autism agencies, human service agencies, health agencies and involved 
state departments and suggest ways in which these departments and agencies can better 
cooperate to improve the service systems.  The assessment must include quality metrics 
and data collection developed with input from stakeholder groups as described in 
paragraphs G and H.
Sec. 8.  34-B MRSA §5003-A, sub-§3, ¶H, as amended by PL 2011, c. 542, Pt. A, 
§83, is further amended to read:
H.  The commissioner must shall ensure that the development of the plan includes the 
participation of persons with intellectual disabilities, autism, brain injury and other 
related conditions; community intellectual disability and autism service providers,; 
consumer and family groups; direct care workers; and other interested persons or 
groups in annual statewide hearings, as well as informal meetings and work sessions.  
The commissioner shall ensure the participation of persons from immigrant and 
indigenous populations.  The plan must describe how the commissioner achieved this 
inclusion and what feedback the department received from participants in each of these 
groups.
Sec. 9.  34-B MRSA §5003-A, sub-§3, ¶J is enacted to read:
J.  The plan must project whether, given current budget projections and anticipated 
demographic changes, there will be any waiting lists for adult developmental services 
over the next 4 years and how many persons are projected to be on those waiting lists 
over that period of time.  For prioritized waiting lists, the plan must indicate how many 
persons are projected to be in each prioritization category and how many persons would 
be in a different prioritization category except for their living with a parent.
Sec. 10.  34-B MRSA §5003-A, sub-§3, ¶K is enacted to read:
K.  The plan must indicate the additional budgeted resources required to eliminate any 
waiting lists, if such waiting lists exist or are projected to exist over the next 4 years.  
The budget projections must detail any anticipated savings realized from a less 
expensive adult developmental service when a person relinquishes that less expensive 
adult developmental service in order to receive more comprehensive support from 
another adult developmental service.
Sec. 11.  34-B MRSA §5003-A, sub-§3, ¶L is enacted to read:
L.  The plan may consider how home and community-based services may be 
redesigned to promote self-determination by persons with intellectual disabilities or 
autism, to promote less restrictive placements over more restrictive placements and to 
promote competitive integrated employment by persons with intellectual disabilities or 
autism.
Sec. 12.  34-B MRSA §5003-A, sub-§6, ¶A, as enacted by PL 2007, c. 356, §16 
and affected by §31, is amended by amending subparagraph (4) to read:
(4)  The system of care services and support under this section is efficient and 
effective.
Sec. 13.  34-B MRSA §5003-A, sub-§7 is enacted to read:
7.  Committee authorized to introduce legislation.  The joint standing committee of 
the Legislature having jurisdiction over health and human services matters is authorized to 
introduce a bill in each first regular session of the Legislature and a bill in each second 
regular session of the Legislature to address the system of services and support for persons 
with intellectual disabilities or autism.
Sec. 14.  34-B MRSA §5610, sub-§1, ¶D, as amended by PL 2011, c. 542, Pt. A, 
§131, is further amended to read:
D.  Service delivery to persons with intellectual disabilities and autism is based on the 
following fundamentals:
(1)  Maximizing the growth and development of the person and inclusion in the 
community;
(2)  Maximizing the person's control over that person's life;
(3)  Supporting the person in that person's own home;
(4)  Acknowledging and enhancing the role of the family, as appropriate, as the 
primary and most natural caregiver; and
(5)  Planning for the delivery of community services that:
(a)  Promotes a high quality of life;
(b)  Is based on ongoing individualized assessment of the strengths, needs and 
preferences of the person and the strengths of that person's family; and
(c)  Identifies and considers connections in other areas of the person's life, 
including but not limited to family, allies, friends, work, recreation and 
spirituality.; and
(6)  Acknowledging that inadequate reimbursement rates to community service 
providers, extended stays on waiting lists for home and community-based services, 
and service definitions that do not meet the needs of persons who have need for 
significant levels of support are incompatible with this section.
Sec. 15.  Department of Health and Human Services to amend rules.  By 
September 30, 2021, the Department of Health and Human Services shall submit an 
amendment or renewal to the federally approved Medicaid waiver implemented in 10-144 
CMR Chapter 101, MaineCare Benefits Manual, Chapters II and III, Section 21 that 
separates the community supports rate structure into 3 different tiers of service delivery 
consisting of Community Support-Individual, Community Support-Group and Community 
Support-Center Based, as described generally in draft waiver renewal ME.0467 for which 
the department accepted comments in the period August 14, 2020 through September 13, 
2020.
Sec. 16.  Behavioral add-on to community support service delivery 
structure.  By December 15, 2021, the Department of Health and Human Services shall 
submit amendments or renewals to the federally approved Medicaid home and community-
based services waivers implemented in 10-144 CMR Chapter 10l, MaineCare Benefits 
Manual, Chapters II and III, Sections 21 and 29, to add a so-called "behavioral add-on" to 
the community support service delivery structure in order to support people with significant 
behavioral challenges whose needs would not otherwise be met by the community support 
service delivery structure or who would not otherwise have access to community support 
because of their significant behavioral challenges.
SUMMARY
This bill amends the system of care for adults with intellectual disabilities, autism, 
brain injury and other related conditions in the following ways.
1.  It renames "system of care" the "system of services and support."
2.  It amends the principles guiding delivery of services by providers of services and 
the Department of Health and Human Services to add the principle that inadequate 
reimbursement rates, extended stays on waiting lists and service definitions that do not 
meet the needs of persons who have significant need for significant levels of support are 
incompatible with the other goals guiding delivery of services.
3.  It requires the department to post at least monthly on the department's website, for 
each home and community-based services waiver in which the State participates, data on 
how many persons were on a waiting list for services on the first day of that month, 
including, for prioritized waiting lists, how many persons were in each prioritization 
category.
4.  It requires the department to post at least quarterly on the department's website, for 
each home and community-based services waiver in which the State participates, data on 
median time from application for waiver services to approval by the department for receipt 
of the same waiver services, using a statistically valid methodology.
5.  It requires that the Commissioner of Health and Human Services' plan include 
quality metrics and data collection developed with input from across stakeholder groups.
6.  It requires that the commissioner's plan include participation of persons with 
intellectual disabilities, autism, brain injury and other related conditions; direct care 
workers; and persons from immigrant and indigenous populations.  It requires the plan to 
describe how the commissioner achieved the required inclusion and to describe the 
feedback received from participants in each required group.
7.  It requires that the commissioner's plan project whether there will be any waiting 
lists for home and community-based services waivers over the next 4 years, how many 
people are projected to be on those waiting lists, how many people are projected to be in 
each prioritization category of prioritized waiting lists and how many people would be in 
a different prioritization category if they were not currently living with a parent.
8.  It requires that the commissioner's plan project the budgetary impact of eliminating 
any waiting lists for home and community-based services if such waiting lists are projected 
to exist over the next 4 years, including detailing any anticipated savings from release of 
resources of a less expensive service when a person transfers to another service.
9.  It allows the commissioner's plan to consider how home and community-based 
services may be redesigned to promote self-determination by persons with intellectual 
disabilities or autism, to promote less restrictive placements over more restrictive 
placements and to promote competitive integrated employment by persons with intellectual 
disabilities or autism.
10.  It authorizes the joint standing committee of the Legislature having jurisdiction 
over health and human services matters to introduce legislation in each regular session of 
the Legislature.
11.  It requires the department to submit a waiver renewal or waiver amendment for 
home and community-based services that separates community support into tiered services 
as described in a draft waiver renewal for home and community-based services.
12.  It requires the department to submit a waiver renewal or waiver amendment for 
home and community-based services to add a so-called "behavioral add-on" for persons 
who otherwise would be denied access to community support or whose needs would not 
otherwise be met by the community support service structure.