An Act to Update the Laws Governing the Licensing of Intermediate
Maine Legislature, Session 132, LD 0768
Committee: Health and Human Services
Sponsors: INGWERSEN
Amends: 22 MRSA §42, 22 MRSA §1812-B, 22 MRSA §1812-K, 22 MRSA §1812-M, 22 MRSA §8752

Legislative Document
No. 768
S.P. 326
In Senate, February 25, 2025
An Act to Update the Laws Governing the Licensing of Intermediate 
Care Facilities for Persons with Intellectual Disabilities
Submitted by the Department of Health and Human Services pursuant to Joint Rule 204.
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator INGWERSEN of York.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §42, sub-§1-A, as amended by PL 2011, c. 542, Pt. A, §24, is 
further amended to read:
1-A.  Administration of medication.  The administration of medication in boarding 
assisted housing programs, residential care facilities, drug treatment centers, day care 
facilities, children's homes and nursery schools and group home intermediate care facilities 
for persons with intellectual disabilities must be in accordance with rules established by the 
department.  In other facilities licensed or approved by the department, excluding those 
facilities licensed under section 1811, other than group home intermediate care facilities 
for persons with intellectual disabilities, the department may establish rules for the 
administration of medication as it considers necessary.  In establishing rules for each type 
of facility, the department shall consider, among other factors, the general health of the 
persons likely to receive medication, the number of persons served by the facility and the 
number of persons employed at the facility who might be involved in the administration of 
medication.  Any rules for the administration of medication must be established in 
accordance with Title 5, chapter 375.
Sec. 2.  22 MRSA §1812-B, as amended by PL 2011, c. 542, Pt. A, §28, is further 
amended to read:
§1812-B.  Hospitals and nursing homes Delegating the administration of medication
The administration of medication in facilities licensed under section 1811, except 
group home intermediate care facilities for persons with intellectual disabilities, may be 
delegated to unlicensed personnel when such personnel have received appropriate training 
and instruction and the programs of training and instruction have been approved by the 
State Board of Nursing. The administration of medication in group home intermediate care 
facilities for persons with intellectual disabilities may be performed by unlicensed 
personnel when these personnel have received appropriate training and instruction and the 
programs of training and instruction have been approved by the department.  Delegation of 
the administration of medication does not require the personal presence of the delegating 
professional nurse at the place where this service is performed, unless that personal 
presence is necessary to assure ensure that medications are safely administered. The board 
shall issue such rules concerning delegation as it considers necessary to insure ensure the 
highest quality of health care to the patient. The department shall issue such rules as it 
considers necessary to insure ensure the highest quality of health care to residents of group 
home intermediate care facilities for persons with intellectual disabilities.
Sec. 3.  22 MRSA §1812-K, as amended by PL 2013, c. 588, Pt. A, §24, is repealed.
Sec. 4.  22 MRSA §1812-M is enacted to read:
§1812-M.  Intermediate care facility for persons with intellectual disabilities
Notwithstanding any provision of section 1817 to the contrary, the following 
provisions apply to the licensing of intermediate care facilities for persons with intellectual 
disabilities.
1.  Definitions. For the purposes of this section, the following terms having the 
following meanings.
A.  "ICF/IID group facility" means a facility that provides services for clients with a 
diagnosis of intellectual disability, or related conditions, who require less than 8 hours 
of licensed nurse supervision per day. 
B.  "ICF/IID nursing facility" means a facility that provides services for clients with a 
diagnosis of intellectual disability whose medical and nursing needs require the 
presence of a licensed nurse at least 8 hours per day and 7 days per week and provides 
nursing coverage to its clients 24 hours per day.  
C.  "Intellectual disability" means significantly subaverage intellectual functioning 
resulting in or associated with concurrent impairments in adaptive behavior and 
manifested during the developmental period.
D.  "Intermediate care facility for individuals with intellectual disabilities" or 
"ICF/IID" means a facility that furnishes services to individuals with intellectual 
disabilities that conform with the conditions described in 42 Code of Federal 
Regulations, Section 440.150 (2024).
2.  License required.  The operation of an intermediate care facility for individuals 
with intellectual disabilities requires a license issued by the department in accordance with 
this section. 
3.  Licenses generally.  The department is authorized to issue a license to an ICF/IID 
that, after inspection, is found to comply with this section and any rules adopted by the 
department. The following general terms apply to all types of licenses issued under this 
section: 
A.  A license is not assignable or transferable; 
B.  A license is immediately void if ownership of the ICF/IID changes; and
C.  A license may not be effective earlier than the date on which the department 
receives a completed application and payment of the required application fee.  
4.  Provisional license. A provisional license may be issued for a period of at least 3 
months and not more than 12 months if, in the department's judgment, the applicant:  
A.  Has not previously operated an ICF/IID;  
B.  Has complied with all applicable laws and rules, except those that can only be 
followed once clients are served by the applicant; and
C.  Has demonstrated the ability to comply with all applicable laws and rules once 
clients are in residence at the ICF/IID.
5.  Full license.  The department may issue a full license to, or renew a full license for, 
an ICF/IID that the department determines has complied with all applicable laws and rules. 
The term of a full license may not exceed 2 years.
6.  Conditional license.  The department may issue a conditional license to an ICF/IID 
applying for an initial license, or renewing a full license, if the applicant has failed to 
comply with applicable laws and rules or, in the judgment of the department, the best 
interests of the public would be served by issuance of a conditional license. Conditional 
licenses issued under this subsection are further governed by the following provisions:
A.  The term of a conditional license must be:   
(1)  A specified period of time of not more than one year for applicants applying 
for a new license; or
(2)  The remaining period of the applicant's full license if the applicant has a full 
license and has applied for renewal;
B.  The department shall determine the period of the conditional license based on the 
severity of the laws or rules violated by the conditional licensee. The department shall 
specify the conditions imposed by the department and specify when the conditional 
licensee must comply with those conditions;
C.  Failure of the ICF/IID to meet any of the department's conditions immediately voids 
the conditional license. Notification to the ICF/IID of the voiding of the conditional 
license must be made in writing by the department to the conditional licensee or, if the 
conditional licensee cannot be reached for personal service, by notice left at the 
licensed premises; and
D.  The department may consider a new application for a full license from the previous 
holder of a voided conditional license only after the conditions set forth by the 
department at the time of the issuance of the voided conditional license have been met 
and satisfactory evidence of this fact has been furnished to the department. 
7.  Licensing fees; application fees.  The department may charge a licensing fee that 
is no less than $200 per year and no more than $2,000 per year.  The department may 
establish an application fee for any license issued under this section.  An application fee 
established by the department must be nonrefundable and must be due upon submission of 
the application for licensure. 
8.  Right of entry and inspection of ICF/IID.  The department and any duly 
designated officer or employee of the department has the right to enter the premises of an 
ICF/IID licensed under this section at any reasonable time in order to determine whether 
the ICF/IID is complying with this section and any rules adopted pursuant to this section. 
An application for an ICF/IID license made pursuant to this section constitutes permission 
for and complete acquiescence in any entry or inspection of the premises for which the 
license is sought in order to facilitate verification of the information submitted on or in 
connection with the application.
The right of entry and inspection extends to any premises that the department has reason to 
believe is being operated or maintained as an ICF/IID without a license, except that the 
department may not enter or inspect any premises without the permission of the owner or 
person in charge of that premises unless a warrant is first obtained from the District Court 
authorizing that entry or inspection. 
9.  Inspections.  ICF/IIDs must be periodically inspected by the department for 
compliance with this section and the rules adopted by the department pursuant to this 
section. An inspection for purposes of maintaining state licensure may be done 
concurrently with a survey to ensure that the ICF/IID meets the requirements for 
certification as an ICF/IID in federal Medicare and state Medicaid programs. The 
department must also inspect ICF/IIDs in response to complaints of suspected violations of 
rules adopted under this section, or suspected violations of the United States Department 
of Health and Human Services, Centers for Medicare and Medicaid Services' conditions of 
participation. 
10.  Shared staffing.  The department shall permit staff in an ICF/IID nursing facility 
to be shared with an ICF/IID group facility as long as there is a clear, documented audit 
trail and the staffing in the ICF/IID nursing facility remains adequate to meet the needs of 
clients. Staffing to be shared may be based on the average number of hours of coverage 
used per week or per month within the ICF/IID group facility. The department may suspend 
the facilities' ability to share staffing under this subsection if the most recent survey for 
either classification of ICF/IID indicates deficiencies that are related to client care and that 
arise from the sharing of staff.   
11.  Notice of voluntary closure.  Any person, including a county or local 
governmental unit, that is conducting, managing or operating an ICF/IID and that is 
properly licensed in accordance with this section shall give:
A.  At least 60 days' written notice of the voluntary closure date of the ICF/IID to the 
department; and 
B.  At least 30 days' written notice of the voluntary closure date of the ICF/IID to any 
governmental units or institutions that are primarily responsible for the welfare of the 
ICF/IID's clients and to:
(1)  The clients of the ICF/IID; and 
(2)  As applicable, the clients' guardians, family members and both medical and 
financial powers of attorney.
The purpose of the notice under this paragraph is to provide for adequate preparation 
for the orderly transfer of ICF/IID clients to another qualified facility.
12.  Intermediate sanctions. In addition to the actions authorized in subsections 13 
and 14, the department may impose intermediate sanctions to improve the quality of care 
in ICF/IIDs. 
13.  Amend, modify or refuse to renew license.  In respect to any license issued under 
this section, the department may amend, modify or refuse to renew a license by initiating 
proceedings consistent with the Maine Administrative Procedure Act or filing a complaint 
with the District Court requesting suspension or revocation of that license for the following 
conduct: 
A.  Violation of this section or any rules adopted pursuant to this section; 
B.  Permitting, aiding or abetting the commission of any illegal act in the ICF/IID to 
which the license applies; or 
C.  Engaging in practices that are detrimental to the welfare of a client of the ICF/IID. 
14.  Suspend or revoke license.  Whenever conditions are found in an ICF/IID that 
violate this section or department rules issued pursuant to this section that, in the opinion 
of the commissioner, immediately endanger the health or safety of the clients of the ICF/IID 
or create an emergency, the department by its duly authorized agents may request, under 
the emergency proceeding provisions of Title 4, section 184, subsection 6, that the District 
Court suspend or revoke the ICF/IID's license.  
15. Appeals. Any person that is aggrieved by the decision of the department to refuse 
to issue a license or renew a license may request a hearing as provided by the Maine 
Administrative Procedure Act.
16. Rules. The department shall adopt rules to administer this section.  Rules adopted 
pursuant to this section are routine technical rules within the meaning of Title 5, chapter 
375, subchapter 2-A. Rules must include, but are not limited to:  
A.  General licensing requirements;
B.  Application requirements; 
C.  Quality measures;  
D.  Personnel qualifications;   
E.  Mandatory and minimum training requirements; 
F.  Compliance with federal certification requirements;
G.  Staffing requirements;
H.  Services provided and coordination of services;   
I.  Supervision and organizational structure, including lines of authority;
J.  Physical plant and environmental requirements;
K.  Record-keeping and confidentiality practices;
L.  Business records requirements;
M.   Clients' rights;
N.  Medical services requirements;
O.  Infection control and biomedical waste requirements;
P.  Management of personal funds of clients;
Q.  Requirements of the ICF/IID before, during and after both voluntary and 
involuntary termination of services; and
R.  Other aspects of services provided by an ICF/IID that may be necessary to protect 
clients.
Sec. 5.  22 MRSA §8752, sub-§2, as amended by PL 2011, c. 542, Pt. A, §48, is 
further amended to read:
2.  Health care facility.  "Health care facility" or "facility" means a state institution as 
defined under Title 34‑B, chapter 1 or a health care facility licensed by the division, except 
that it does not include a facility licensed as a nursing facility or licensed under chapter 
1664. "Health care facility" includes a general and specialty hospital, an ambulatory 
surgical facility, and an end-stage renal disease facility and an intermediate care facility for 
persons with intellectual disabilities or other developmental disabilities.
SUMMARY
This bill updates the provision of law governing the licensing of intermediate care 
facilities for individuals with intellectual disabilities, or ICF/IIDs, to establish specific 
licensing requirements in statute. Under current law, there are no licensing standards for 
these facilities, only authority for the Department of Health and Human Services to adopt 
rules governing licensing standards. The bill both codifies existing department rules 
governing the licensing of ICF/IIDs and updates these licensing standards to align with 
similar licensing laws. The bill updates related statutory language and a headnote. 
The bill also amends the provision of law governing the reporting of sentinel events at 
health care facilities by removing ICF/IIDs from the list of health care facilities that are 
required to make reports to the department under this provision.