An Act to Clarify the Laws Relating to the Licensure of Certain
Maine Legislature, Session 132, LD 1961
Committee: Health and Human Services
Sponsors: INGWERSEN
Amends: 22 MRSA §1717, 22 MRSA §1813, 22 MRSA §7701, 22 MRSA §7802, 22 MRSA §7852, 26 MRSA §683, 34-B MRSA §1203-A, 34-B MRSA §1203-B, 22 MRSA §8752, 22 MRSA §8753, 22 MRSA §8754, 22 MRSA §8755, 22 MRSA §1812-G

Legislative Document
No. 1961
S.P. 768
In Senate, May 13, 2025
An Act to Clarify the Laws Relating to the Licensure of Certain 
Facilities by the Department of Health and Human Services
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:
PART A
Sec. A-1.  22 MRSA §1717, sub-§2-C, ¶C, as enacted by PL 2023, c. 309, §7, is 
amended to read:
C.  A conditional license for a personal care agency with a provisional or a full license 
that fails to comply with applicable laws and rules when, in the judgment of the 
commissioner, issuing a conditional license is in the best interest of the public.  The 
conditional license must specify what corrections the personal care agency is required 
to make during the term of the conditional license and a timeline for those corrections. 
The conditional license may be issued for a period of time not more than 12 months or 
the remaining period of the personal care agency's full license, whichever the 
commissioner determines is appropriate considering the laws and rules violated.  A 
conditional license may be issued to an agency upon initial application if the agency 
has failed to comply with applicable laws and rules while operating under another 
license.
Sec. A-2.  22 MRSA §1813, 3rd ¶, as enacted by PL 1997, c. 488, §1, is amended 
to read:
For nursing facilities providing both nursing home facility and assisted living housing 
services, the department shall issue one license reflecting both levels of care.  The 
commissioner shall adopt rules to implement this paragraph.  Rules adopted pursuant to 
this paragraph are routine technical rules as defined by Title 5, chapter 375, subchapter 
II‑A 2-A.
Sec. A-3.  22 MRSA §7701, sub-§2, as amended by PL 2001, c. 645, §2, is further 
amended to read:
2.  Facility.  As used in this subtitle, the word "facility" means any of the places 
described in section 7801 or defined in section 8001, 8101, 8201 or 8301‑A, subsection 
1‑A, paragraph B.
Sec. A-4.  22 MRSA §7802, sub-§1, ¶C, as enacted by PL 1983, c. 386, §2, is 
amended to read:
C.  A conditional license or approval may be issued by the department when the 
individual or agency fails to comply with applicable law laws and rules and, in the 
judgment of the commissioner, the best interest of the public would be so served by 
issuing a conditional license or approval.  The conditional license or approval shall 
must specify when and what corrections must be made during the term of the 
conditional license or approval.  A conditional license or approval may be issued upon 
initial application to an individual or agency that has failed to comply with applicable 
laws and rules while operating under another license.
Sec. A-5.  22 MRSA §7852, sub-§6, as amended by PL 2023, c. 176, §14, is further 
amended to read:
6.  Independent housing with services program.  "Independent housing with services 
program" means a program of supportive services provided to residents in private 
apartments who receive that receives funds through a written agreement with the 
department's office of aging and disability services.
Sec. A-6.  26 MRSA §683, sub-§1, ¶B, as amended by PL 2011, c. 657, Pt. AA, 
§72, is repealed.
Sec. A-7.  34-B MRSA §1203-A, sub-§2, ¶A, as enacted by PL 1989, c. 227, §1, 
is amended to read:
A.  The commissioner may issue a conditional license to an agency or facility applying 
or reapplying for a provisional or full license, if:
(1)  The applicant fails to comply with applicable laws and rules; and
(2)  In the judgment of the commissioner, the best interests of the public would be 
served by issuance of a conditional license.
Sec. A-8.  34-B MRSA §1203-A, sub-§5, as enacted by PL 1989, c. 227, §1, is 
amended to read:
5.  Monitoring for compliance.  Regardless of the term of the license, the 
commissioner shall monitor the licensee, at least once a year every 2 years, for continued 
compliance with applicable laws and rules.
Sec. A-9.  34-B MRSA §1203-B, sub-§4, ¶A, as enacted by PL 2023, c. 89, §7, is 
amended to read:
A.  The department may issue a conditional license to an agency applying for or 
renewing a provisional or full license if:
(1)  The applicant fails to comply with applicable laws and rules; and
(2)  In the judgment of the department, the best interests of the public would be 
served by issuance of a conditional license.   
PART B
Sec. B-1.  22 MRSA §8752, sub-§1, as amended by PL 2009, c. 358, §1, is further 
amended to read:
1.  Division.  "Division" means the Department of Health and Human Services, 
Division of Licensing and Regulatory Services department's division of licensing and 
certification.
Sec. B-2.  22 MRSA §8752, sub-§2, as amended by PL 2011, c. 542, Pt. A, §48, is 
repealed and the following enacted in its place:
2.  Health care facility.  "Health care facility" or "facility" means a general or specialty 
hospital including all facilities under the hospital's license, an ambulatory surgical facility, 
an end-stage renal disease facility and a state institution as defined under Title 34‑B, 
chapter 1, except that it does not include a facility licensed as a nursing facility or licensed 
under chapter 1664.
Sec. B-3.  22 MRSA §8752, sub-§3-A, as enacted by PL 2009, c. 358, §1, is 
repealed.
Sec. B-4.  22 MRSA §8752, sub-§4-A, as enacted by PL 2009, c. 358, §1, is 
amended to read:
4-A.  Sentinel event.  "Sentinel event" means:
A.  An unanticipated death, or patient transfer to another health care facility, unrelated 
to the natural course of the patient's illness or underlying condition or proper treatment 
of that illness or underlying condition in a health care facility;
B.  A major permanent loss of function unrelated to the natural course of the patient's 
illness or underlying condition or proper treatment of that illness or underlying 
condition in a health care facility that is present at the time of the discharge of the 
patient or that occurs within 48 hours of treatment.  If within 2 weeks of discharge from 
the facility, evidence is discovered that the major loss of function was not permanent, 
the health care facility is not required to submit a report pursuant to section 8753, 
subsection 2;
C.  An unanticipated perinatal death or major permanent loss of function in an infant 
with a birth weight over 2,500 grams that is unrelated to the natural course of the 
infant's or mother's illness or underlying condition or proper treatment of that illness 
or underlying condition in a health care facility; and
C-1.  The suicide of a patient within 48 hours of receiving health care services in a 
health care facility; and
D.  Other serious and preventable events as identified by using the most recent version 
of a nationally recognized quality forum and determined in rules adopted by the 
department pursuant to section 8756.
Sec. B-5.  22 MRSA §8753, sub-§1, as amended by PL 2009, c. 358, §2, is repealed 
and the following enacted in its place:
1.  Notification.  Using the sentinel event notification process under this chapter, a 
health care facility shall notify the division of a sentinel event within 3 business days after 
the facility discovers that the event occurred.
Sec. B-6.  22 MRSA §8753, sub-§2, as amended by PL 2009, c. 358, §2, is further 
amended to read:
2.  Reporting Written report.  The health care facility shall file a written report no 
later than 45 days following the notification of the occurrence of a sentinel event pursuant 
to subsection 1.  The written report must be signed by the chief executive officer of the 
facility and must contain the following information:
A.  Facility name and address;
B.  Name, title and phone number of the contact person for the facility;
C.  The date and time of the sentinel event and the sentinel event case number;
D.  The type of sentinel event and a brief description timeline of the sentinel event; and
H.  A thorough and credible root cause analysis.  A root cause analysis is thorough and 
credible only in accordance with the following.
(1)  A thorough root cause analysis must include:  a determination of the human 
and other factors most directly associated with the sentinel event and the processes 
and systems related to its occurrence; an analysis of the underlying systems and 
processes to determine where redesign might reduce risk; an inquiry into all areas 
appropriate to the specific type of event; an identification of risk points and their 
potential contributions to the event; a determination of potential improvement in 
processes or systems that would tend to decrease the likelihood of such an event in 
the future or a determination, after analysis, that no such improvement 
opportunities exist; an action plan that identifies changes that can be implemented 
to reduce risks or formulates a rationale for not undertaking such changes; and, 
where improvement actions are planned, an identification of who is responsible for 
implementation, when the action will be implemented and how the effectiveness 
of the action will be evaluated.
(2)  A credible root cause analysis must include participation by the leadership of 
the health care facility and by the individuals most closely involved in the 
processes and systems under review, is internally consistent without contradictions 
or unanswered questions, provides an explanation for all findings, including those 
identified as "not applicable" or "no problem," and includes the consideration of 
any relevant literature.
(3)  The root cause analysis submitted to the division may exclude protected 
professional competence review information pursuant to the Maine Health Security 
Act.
Sec. B-7.  22 MRSA §8753, sub-§4, as amended by PL 2009, c. 358, §2, is further 
amended to read:
4.  Immunity.  A person who in good faith reports a near miss, a suspected sentinel 
event or a sentinel event or provides a root cause analysis pursuant to this chapter is immune 
from any civil or criminal liability for the act of reporting or participating in the review by 
the division.  "Good faith" does not include instances when a false report is made and the 
person reporting knows the report is false.  This subsection may not be construed to bar 
civil or criminal action regarding perjury or regarding the sentinel event that led to the 
report.
Sec. B-8.  22 MRSA §8753, sub-§5, as enacted by PL 2009, c. 358, §2, is repealed.
Sec. B-9.  22 MRSA §8754, sub-§1, as amended by PL 2009, c. 358, §4, is further 
amended to read:
1.  Initial review; other action.  Upon receipt of a notification or report of a sentinel 
event, the division shall complete an initial review and may take such other action as the 
division determines to be appropriate under applicable rules and within the jurisdiction of 
the division.  Upon receipt of a notification or report of a suspected sentinel event the 
division shall determine whether the event constitutes a sentinel event and complete an 
initial review and may take such other action as the division determines to be appropriate 
under applicable rules and within the jurisdiction of the division.  The division may conduct 
on-site reviews of request medical records and may retain the services of consultants when 
necessary to the division.
A.  The division may conduct on-site visits to health care facilities to determine 
compliance with this chapter.
B.  Division personnel responsible for sentinel event oversight shall report to the 
division's licensing section only incidences of immediate jeopardy and each condition 
of participation in the federal Medicare program related to the immediate jeopardy for 
which the provider is out of compliance.
Sec. B-10.  22 MRSA §8754, sub-§4, as amended by PL 2009, c. 358, §6, is further 
amended to read:
4.  Report.  The division shall submit an annual report by February April 1st each year 
to the Legislature, health care facilities and the public that includes summary data of the 
number and types of sentinel events of the prior calendar year by type of health care facility, 
rates of change and other analyses and an outline of areas to be addressed for the upcoming 
year.
Sec. B-11.  22 MRSA §8755, sub-§1, as enacted by PL 2009, c. 358, §7, is amended 
to read:
1.  Oversight.  The division shall place primary emphasis on ensuring effective 
corrective action by the facility.  The division may conduct on-site visits to health care 
facilities to determine compliance with this chapter.
PART C
Sec. C-1.  22 MRSA §1812-G, sub-§2-C, as amended by PL 2023, c. 241, §7 and 
c. 309, §24, is repealed and the following enacted in its place:
2-C.  Registry notations.  The registry must include for a certified nursing assistant, a 
direct care worker and an immediate supervisor listed on the registry a notation of:
A.  Disqualifying criminal convictions; 
B.  Nondisqualifying criminal convictions, except that a notation is not required on the 
registry for Class D and Class E criminal convictions over 10 years old that did not 
involve as a victim of the act a patient, client or resident; and
C.  Substantiated findings, including but not limited to the following information:  
(1)  Documentation of an investigation of the certified nursing assistant, direct care 
worker or immediate supervisor, including the nature of the allegation and 
evidence supporting a determination that substantiates the allegation of abuse, 
neglect or misappropriation of property of a client, patient or resident; 
(2)  Documentation of substantiated findings of abuse, neglect or misappropriation 
of property of a client, patient or resident;  
(3)  If the certified nursing assistant, direct care worker or immediate supervisor 
appealed the substantiated finding, the date of the hearing; and  
(4)  The statement of the certified nursing assistant, direct care worker or 
immediate 
supervisor 
disputing 
the 
allegation 
of 
abuse, 
neglect 
or 
misappropriation of property of a client, patient or resident if the certified nursing 
assistant, direct care worker or immediate supervisor submitted such a statement.
Sec. C-2.  22 MRSA §1812-G, sub-§4, as amended by PL 2023, c. 241, §10 and 
c. 309, §25, is repealed and the following enacted in its place:
4.  Department verification of credentials and training.  The department may verify 
the credentials and training of certified nursing assistants listed on the registry.
Sec. C-3.  22 MRSA §1812-G, sub-§4-A, as amended by PL 2023, c. 241, §11 and 
c. 309, §26, is repealed and the following enacted in its place:
4-A.  Provider verification fee.  The department may establish a provider verification 
fee not to exceed $25 annually per provider for verification of a certified nursing assistant's 
credentials and training. Providers may not pass the cost on to the individual certified 
nursing assistant. Provider verification fees collected by the department must be placed in 
a special revenue account to be used by the department to operate the registry, including 
but not limited to the cost of criminal history record checks. The department may adopt 
rules necessary to implement this subsection. Rules adopted pursuant to this subsection are 
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. C-4.  22 MRSA §1812-G, sub-§6, as amended by PL 2023, c. 241, §13 and 
c. 309, §27, is repealed and the following enacted in its place:
6.  Prohibited employment based on disqualifying offenses.  An individual with a 
disqualifying offense, including a substantiated complaint or a disqualifying criminal 
conviction, may not work as a certified nursing assistant, a direct care worker or an 
immediate supervisor, and an employer is subject to penalties for employing a disqualified 
or otherwise ineligible person in accordance with applicable federal or state laws.
Sec. C-5.  22 MRSA §1812-G, sub-§6-A, as amended by PL 2023, c. 241, §14 and 
c. 309, §28, is repealed and the following enacted in its place:
6-A.  Background check.  Certified nursing assistants, direct care workers and 
immediate supervisors are subject to a background check as defined by rules adopted by 
the department and according to the following:
A.  A training program for certified nursing assistants or direct care workers must 
secure or pay for a background check on each individual who applies for enrollment. 
The individual's current name and all previous names are subject to the background 
check. A copy of the background check is given to the individual who, upon successful 
completion of the training, submits it with an application to be listed on the registry as 
a certified nursing assistant or a registered direct care worker.  
(1)  Prior to enrolling an individual, a training program for certified nursing 
assistants or direct care workers must notify individuals that a background check 
will be conducted and that certain disqualifying offenses, including criminal 
convictions, may prohibit an individual from working as a certified nursing 
assistant or a direct care worker.
B. Pursuant to sections 1717, 1724, 2137, 2149‑A, 7706, 8606 and 9005 and Title 34‑B, 
section 1225, licensed, certified or registered providers shall secure and pay for a 
background check prior to hiring an individual who will work in direct contact with 
clients, patients or residents, including a certified nursing assistant, a direct care worker 
or an immediate supervisor. 
C.  The department may secure a background check on certified nursing assistants, 
registered direct care workers and immediate supervisors on the registry every 2 years.
D.  A person or other legal entity that is not otherwise licensed by the department and 
that employs or places a certified nursing assistant or direct care worker to provide 
services allowing direct access shall secure and pay for a background check in 
accordance with state law and rules adopted by the department.
Sec. C-6.  22 MRSA §1812-G, sub-§6-B, as repealed by PL 2023, c. 241, §15 and 
amended by c. 309, §29, is repealed.
Sec. C-7.  22 MRSA §1812-G, sub-§6-C, ¶A, as amended by PL 2023, c. 241, 
§16 and c. 309, §30, is repealed and the following enacted in its place:
A.  A disqualifying criminal conviction prohibits employment as a certified nursing 
assistant or a direct access worker.  
(1)  An individual with a disqualifying criminal conviction is subject to an 
employment ban of 5, 10 or 30 years. The department shall adopt rules that specify 
disqualifying criminal convictions that prohibit employment for 5 years, 
disqualifying criminal convictions that prohibit employment for 10 years and 
disqualifying criminal convictions that prohibit employment for 30 years.
Sec. C-8.  22 MRSA §1812-G, sub-§6-C, ¶B, as amended by PL 2023, c. 241, 
§17 and c. 309, §30, is repealed and the following enacted in its place:
B.  Nondisqualifying criminal convictions do not prohibit employment as a certified 
nursing assistant, a direct care worker or an immediate supervisor.
Sec. C-9.  22 MRSA §1812-G, sub-§6-D, as repealed by PL 2023, c. 241, §18 and 
amended by c. 309, §31, is repealed.
Sec. C-10.  22 MRSA §1812-G, sub-§10, as amended by PL 2023, c. 241, §20 and 
c. 309, §32, is repealed and the following enacted in its place:
10.  Complaint investigation.  The department may investigate complaints and 
allegations against certified nursing assistants, direct care workers or immediate 
supervisors of abuse, neglect, exploitation or misappropriation of property of a client, 
patient or resident.
Sec. C-11.  22 MRSA §1812-G, sub-§13, as amended by PL 2023, c. 241, §22 and 
c. 309, §34, is repealed and the following enacted in its place:
13.  Substantiated finding; lifetime employment ban.  A certified nursing assistant, 
a registered direct care worker or an immediate supervisor with a notation of a substantiated 
finding on the registry is banned for life from employment as a certified nursing assistant, 
a direct care worker or an immediate supervisor.
SUMMARY
This bill amends several provisions related to the licensing and regulation of various 
medical and social service entities by the Department of Health and Human Services. 
Part A of the bill amends provisions related to the issuance of conditional licenses to 
applicants seeking licensure for a personal care agency; a facility for children and adults 
under the Maine Revised Statutes, Title 22, chapter 1663; the provision of mental health 
services; and an agency that provides services to adults with intellectual disabilities, autism 
spectrum disorder, a related condition or an acquired brain injury. Part A also amends the 
law governing licensure for the provision of mental health services to require the 
department to monitor for compliance every 2 years, rather than once a year, regardless of 
the license term. 
Part A of the bill also updates terms related to the licensing of health care facilities 
under Title 22, chapter 405; expands the definition of "facility" under Title 22, Subtitle 6, 
which concerns facilities for children and adults; clarifies the definition of "independent 
housing with services program" under the laws governing assisted housing facilities; and 
removes the requirement that the department must approve any employee assistance 
program for substance use.
Part B of the bill amends the law governing health care facility reporting of sentinel 
events by clarifying which health care facilities are required to comply with sentinel event 
reporting requirements; expanding the types of events that must be reported as sentinel 
events; removing the requirement to report a so-called near miss where a sentinel event 
almost occurred; and making other changes and clarifications with respect to the reporting 
and review process. 
Part C of the bill amends the provisions of law governing the Maine Registry of 
Certified Nursing Assistants and Direct Care Workers to resolve conflicts created by the 
concurrent passage of Public Law 2023, chapter 241 and Public Law 2023, chapter 309.