MAINE
The Maine Legislature acted on a number of long-term care issues in 2002, ranging from redefining levels of assisted living services to requiring reviews of reimbursement, training and certification of direct-care staff in the long-term care system. A blue ribbon commission reviewed long-term care financing issues, and a work group on community living issued a draft report on expanding self-directed services and creating a statewide information and referral system on all disability services.
Assisted Living
Major change affecting the state's rules governing assisted living facilities resulted from recommendations from a Commission to Study Assisted Living, which issued its report in December 2001. The commission concluded that the existing licensing requirements for different levels of assisted living could be "confusing and cumbersome and should be streamlined." The Legislature established three categories of assisted housing programs: independent housing with services, assisted living services, and residential care facilities. Housing that provides personal care services but not medication administration or nursing services did not need to be licensed.
The legislation also set reimbursement rate standards for certain facilities. The minimum reimbursement rates for residential care facilities is $433 per month for facilities with up to four beds and $601 per month for facilities of five or six beds. The legislation permits shared staffing between residential care facilities and other levels of assisted housing on the same premises, as long as such arrangements are clearly documented and staffing remains adequate to meet the needs of residents. The effective date of the legislation was October 1, 2002.
Work Force
Lawmakers also directed the Department of Human Services, the State Board of Nursing, and the State Board of Education to review rules regarding the training and certification of unlicensed direct-care staff. Another bill requires the Department of Human Services to review its rules for reimbursing personal care assistant home care services, identify barriers to those services, and revise its rules to improve delivery of those services.
Planning and Reports
The Legislature also established a Blue Ribbon Commission to Address the Financing of Long-Term Care in April 2002. The commission issued an interim report on November 6 supporting a proposed bill-to be considered in the Legislature's Special Session-imposing a licensing fee on nursing facilities and intermediate care facilities. The proposed legislation also would increase reimbursement for long-term care services, provided the fees and reimbursement increases are tied together. The commission proposed continuing its work in 2003 " ... to identify funding and structural issues in long-term care and to propose new approaches to financing."
The Plan Development Workgroup for Community-Based Living, comprised of representatives from five state agencies, issued a draft report on October 2, 2002, Communities, Individuals and Choices: A Roadmap for Meeting Individual Needs in Integrated Settings and Programs. The Work group plans to complete the report sometime during 2003. The draft includes recommendations on the following.
- Expanding self-directed services, offering individuals budgets that cover the entire range of home and community-based services needed, and permitting the individual to determine which services to purchase.
- Organizing services around the person served, not for provider convenience, and allowing individuals and families to have the option of having one independent person facilitate service integration.
- Creating a statewide, integrated information and referral system that covers all disability-related services.
- Building respect for direct-care workers through a public relations plan, and exploring increasing the educational and training requirements for certain direct-care services.
- Building standards for quality and accountability into the design of services.
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