Sec. WW-1. 26 MRSA §1412-G, as amended by PL 2003, c. 2, Pt. W, §1 and c. 465, §5, is repealed.
Sec. WW-2. 26 MRSA §1412-H is enacted to read:
§1412-H. Program of state-funded consumer-directed personal care assistance services
1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Applicant" means a person who has applied or is applying for services through the program.
B. "Bureau" means the Bureau of Rehabilitation Services within the department, which is the lead agency for administering the program.
C. "Consumer" means a person who has been determined to be eligible under subsection 3.
D. "Program" means the program of state-funded consumer-directed personal care assistance services.
2. Program administration. The bureau shall administer the program under this section. Within available funds, the bureau shall ensure that services are delivered in the most comprehensive manner possible, shall strive to maximize the participation of adults with disabilities and shall coordinate with programs for persons with disabilities administered by the Department of Human Services.
3. Eligibility. An applicant is eligible for personal care assistance services under the program if the bureau or its designee determines that the person is an adult who:
A. Has a severe disability;
B. Needs personal care assistance services or an attendant at night or both to prevent or remove the adult from inappropriate placement in an institutional setting; and
C. Has no or insufficient personal income or other support from public services, family members or neighbors.
4. Consumer cost sharing. The bureau shall establish a sliding scale for consumer cost sharing for services provided under the program. The sliding scale must be based on the net income of the consumer, factoring in the expenses associated with the consumer's disability, and may take assets into consideration.
5. Evaluation teams. The commissioner shall designate evaluation teams to assist the department with evaluations of applicants and consumers.
A. Each evaluation team must include the applicant or consumer and at least one registered nurse or registered occupational therapist.
B. For each applicant or consumer evaluated by an evaluation team, the team shall assist the bureau to:
(1) Determine the eligibility of the applicant or consumer for services under the program;
(2) Determine the capability of the applicant or consumer, at the time of evaluation or after skills training provided pursuant to subsection 6, to hire and direct a personal care assistant; and
(3) Reevaluate the applicant or consumer periodically to determine continuing need for the services.
6. Skills training. When sufficient funds are available, the commissioner shall arrange for skills training for consumers in the following areas by the following individuals:
A. Personal health management skills to maximize personal well-being in relation to the consumer's disability, including all aspects of prevention, maintenance and treatment techniques, provided by a registered nurse or other qualified person experienced in the rehabilitation of the severely disabled;
B. Personal care assistant management skills, including training in recruiting, hiring and managing a personal care assistant, scheduling and potential problems, provided by a registered nurse or other qualified person experienced in the rehabilitation of the severely disabled; and
C. Functional skills required to maximize the consumer's abilities in activities of daily living, provided by a registered occupational therapist or other qualified person experienced in the rehabilitation of the severely disabled.
7. Relatives as providers. The department may not refuse to pay a relative of a consumer for the provision of services under the program if the relative is qualified to provide the services and payment is not prohibited by law or rule or federal regulation.
8. Review of reimbursement rates. By January 1, 2005 and every 2 years thereafter, the commissioner shall review the rates of reimbursement under the program. As part of the review, the following provisions apply.
A. The commissioner shall:
(1) Ensure the input of consumers, personal assistants and any organization that represents personal assistants regarding providing a livable wage for personal care assistance services. The commissioner may seek input through one or more public hearings or by other means determined reasonable by the commissioner; and
(2) Seek advice and input from the Long-term Care Oversight Committee established in Title 22, section 5107-J to determine whether the rates of reimbursement are sufficient for consumers to recruit, hire and retain personal care assistants.
B. If the commissioner determines that an increase in one or more of the reimbursement rates is necessary after the review required in this subsection, the commissioner shall adopt rules to accomplish the required rate increase. In making a determination under this subsection, the commissioner shall consider using any savings realized from an expansion of consumer-directed services to increase wages and benefits for personal care assistants.
C. The commissioner shall determine rates of reimbursement that include allowable administrative costs and that use available resources to maximize wages and benefits for personal care assistants and hours of services for consumers.
9. Rulemaking. The commissioner shall adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter 2-A, except that rules regarding consumer cost sharing under subsection 4 are major substantive rules as defined by that subchapter.
Sec. WW-3. Resolve 2003, c. 113, §1 is amended to read:
Sec. 1. Review and report. Resolved: That the Department of Human Services, Bureau of Elder and Adult Services work with the Direct-care Worker Coalition that has been meeting to discuss the recruitment and retention of direct-care workers in the field of long-term care. The department shall report back to the joint standing committee of the Legislature having jurisdiction over health and human services matters by January 15, 2005. The department shall invite the participation of consumers, and representatives of consumers, including consumers who utilize the program of state-funded consumer-directed personal care assistance services pursuant to the Maine Revised Statutes, Title 26, section 1412-H, a representative of the Maine Independent Living Center, organizations representing personal assistants, direct-care workers, representatives of providers of long-term care services and other interested parties. The work of the coalition must include options for achieving parity with other programs providing long-term care services to adults and children with developmental disabilities, a review of data on wages and benefits, an explanation of administrative expenses of agencies providing or coordinating long-term care services, priorities for achieving funding and recommendations for legislation. The work of the coalition must include a review of the program of state-funded consumer-directed personal care assistance services and the recruitment and retention of personal care assistants employed in or through those programs. The joint standing committee of the Legislature having jurisdiction over health and human services matters may report out legislation to the First Regular Session of the 122nd Legislature regarding the recruitment and retention of long-term care workers.
Sec. WW-4. Transfer of responsibility. Responsibility for administering the MaineCare Physically Disabled Home and Community Benefits program and the MaineCare Consumer-directed Attendant Services program, referred to in this section as the "programs," are transferred from the Department of Labor to the Department of Human Services on the effective date of this Part. Notwithstanding any other provision of law, the following requirements apply to the transfer in this Part of the programs from the Department of Labor to the Department of Human Services.
1. Program costs. The programs must operate within the limitations of legislative appropriations and allocations through authorized and agreed upon cost-saving measures.
2. Program stability. For fiscal year 2004-05 the programs are not subject to redesign. For fiscal year 2004-05 the programs retain Alpha One as the authorized agent of the Department of Human Services.
3. Waiver application. Collaborative and cost-effective efforts must be undertaken to further approval of a consumer-directed home care waiver by the federal Centers for Medicare and Medicaid Services.
4. Working group. The Department of Human Services shall convene a working group of interested consumers, providers of personal care services, a representative of the Maine Independent Living Center, organizations representing personal assistants, advocates and department personnel to identify strategies for improving services and to develop an intake system for consumers seeking assistance.
5. Transition provisions. The following provisions apply to the transfer of programs under this Part.
A. All existing rules, regulations and procedures in effect with regard to the programs transferred to the Department of Human Services under this Part, in operation or adopted in or by the Department of Labor remain in effect and continue until rescinded, revised or amended by the Department of Human Services.
B. All existing contracts of the Department of Labor with regard to the programs transferred to the Department of Human Services under this Part remain in effect and continue until rescinded, revised or amended by the Department of Human Services.
Sec. WW-5. Program of state-funded consumer-directed personal care assistance services. The following provisions apply to the program of state-funded consumer-directed personal care assistance services administered by the Department of Human Services and the Department of Labor.
1. Rulemaking by Department of Labor. The Department of Labor, Bureau of Rehabilitation Services shall adopt rules for the program of state-funded consumer-directed personal care assistance services under the Maine Revised Statutes, Title 26, section 1412-H. Except as otherwise provided by law, rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. The rules adopted pursuant to this section must:
A. Affirm the principles of consumer-direction and consumer accountability;
B. Provide for independent assessment and reassessment of consumer eligibility and service need using an entity selected by the department; and
C. Provide for authorization of services that is based on assessment of the consumer's functional strengths and needs and that conforms to legislative appropriations and other applicable state and federal requirements.
2. Rulemaking by Department of Human Services. The Department of Human Services, Bureau of Medical Services shall adopt rules for the MaineCare Physically Disabled Home and Community Benefits program and the Consumer-directed Attendant Services program. Except as otherwise provided by law, rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. The rules adopted pursuant to this section must:
A. Affirm the principles of consumer-direction and consumer accountability;
B. Provide for independent assessment and reassessment of consumer eligibility and service need using an entity selected by the department;
C. Provide for authorization of services that is based on assessment of the consumer's functional strengths and needs and that conforms to legislative appropriations and allocations and other applicable state and federal requirements.
3. Joint review and report. The Department of Labor and the Department of Human Services shall jointly review the departments' programs for consumer-directed personal care assistance services. The review must include participation from consumers and other interested parties, including organizations representing the interests of persons likely to use a surrogate and organizations representing personal care assistants. The departments shall report to the joint standing committee of the Legislature having jurisdiction over labor matters and the joint standing committee of the Legislature having jurisdiction over health and human services matters by January 1, 2005 on the results of their review and the recommendations of the departments.
The report of the departments must include recommendations on the following issues:
A. Guiding principles for expanding eligibility to include consumers who use a surrogate to perform management tasks the consumer would otherwise perform; and
B. Actions to encourage the use of consumer-directed options by promoting consideration of the use of surrogacy as the choice for appropriate consumers.
The departments may not expand the programs to include consumers who use surrogates to perform management tasks the consumers would otherwise perform themselves until the report required in this subsection has been submitted and the per capita costs of the programs are at levels that allow the programs to operate within legislative appropriations and allocations.
Sec. WW-6. Appropriations and allocations. The following appropriations and allocations are made.
HUMAN SERVICES, DEPARTMENT OF
Medical Care - Payments to Providers 0147
Initiative: Transfers funds from the Department of Labor, Rehabilitation Services - Medicaid General Fund program to the Medical Care - Payments to Providers program.
General Fund 2003-04 2004-05
All Other $0 $5,420,320
__________ __________
General Fund Total $0 $5,420,320
Medical Care - Payments to Providers 0147
Initiative: Provides for the allocation of funds for the federal seed of a General Fund appropriation to the Rehabilitation Services - Medicaid program for its share of the MaineCare shortfall in fiscal year 2004-05.
Federal Expenditures Fund 2003-04 2004-05
All Other $0 $2,236,654
__________ __________
Federal Expenditures Fund Total $0 $2,236,654
Medical Care - Payments to Providers 0147
Initiative: Deappropriates and deallocates funds by promoting more consistent authorization of services across comparable home care programs.
General Fund 2003-04 2004-05
All Other $0 ($1,400,000)
__________ __________
General Fund Total $0 ($1,400,000)
Federal Expenditures Fund 2003-04 2004-05
All Other $0 ($3,367,959)
__________ __________
Federal Expenditures Fund Total $0 ($3,367,959)
HUMAN SERVICES, DEPARTMENT OF
DEPARTMENT TOTALS 2003-04 2004-05
GENERAL FUND $0 $4,020,320
FEDERAL EXPENDITURES FUND 0 (1,131,305)
__________ __________
DEPARTMENT TOTAL -
ALL FUNDS $0 $2,889,015
LABOR, DEPARTMENT OF
Rehabilitation Services - Medicaid 0965
Initiative: Appropriates funds to maintain the current level of services in the Consumer-directed Personal Assistance Services Medicaid program.
General Fund 2003-04 2004-05
All Other $0 $1,195,376
__________ __________
General Fund Total $0 $1,195,376
Rehabilitation Services - Medicaid 0965
Initiative: Transfers funds from the Rehabilitation Services - Medicaid program to the Medical Care - Payments to Providers program within the Department of Human Services.
General Fund 2003-04 2004-05
All Other $0 ($5,420,320)
__________ __________
General Fund Total $0 ($5,420,320)
LABOR, DEPARTMENT OF
DEPARTMENT TOTALS 2003-04 2004-05
GENERAL FUND $0 ($4,224,944)
__________ __________
DEPARTMENT TOTAL -
ALL FUNDS $0 ($4,224,944)
SECTION TOTALS 2003-04 2004-05
GENERAL FUND $0 ($204,624)
FEDERAL EXPENDITURES FUND 0 (1,131,305)
__________ __________
SECTION TOTAL -
ALL FUNDS $0 ($1,335,929)
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