Action Alerts

A Forwarded Action Alert from the Maine Association for Community Service Providers (MACSP) regarding urging the Legislature to convene a Special Session to address unfinished business can be found below.  The Appropriations and Financial Affairs Committee convened on 5/30, and unanimously approved funding for increased DSP rates.  Although the funding was approved by the Committee, it will not be actualized unless the Legislature convenes for a Special Session.  If the Legislature does not convene a Special Session and pass funding for the DSP rate increases, the rates will revert back to the previous, lower rates on 7/1/2018.  The effect to the system of care should the rate increase not be actualized was discussed in more detail at the May 14th Coalition meeting (click here for the minutes), and more information can be found in previous action alerts (scroll down), and in the forwarded action alert below.  Thank you.  Cullen
 
Please see this forwarded message by Lydia Dawson, Maine Association for Community Service Providers (MACP)
Forwarded Action Alert from MACSP:  Call legislators and urge them to convene a Special Session
 
TIME IS RUNNING OUT FOR THE LEGISLATURE TO CALL A SPECIAL SESSION. WE NEED THEM BACK NOW BEFORE ITS TOO LATE.
 
WE NEED TO KEEP CALLING. We are 24 days from June 30th and a 12% cut to services for Mainers with intellectual and developmental disabilities. Legislative leadership needs to begin pulling legislators together NOW for a special session to ensure this issue can be voted on in time to prevent a devastation of services.
 
CALL YOUR LOCAL LEGISLATOR NOW AND ASK THEM:
 
1) Are you willing to come back for a special session to vote for the funding approved by Appropriations for direct care workers?
2) Will you contact your caucus leadership and ask them to set a date?
 
**If your legislator is a member of Appropriations (http://legislature.maine.gov/house/jt_com/afa.htm) thank them for approving funding for direct care workers, then ask questions #1 & #2!
 
Contact info:  
I know everyone is tired and has called many times.
 
Please, keep calling. Please keep calling this week and every single day until we have answers. Ask everyone you know to call too. Don’t let these days slip through our fingers without knowing we have done absolutely everything we can.
 
Lydia Dawson, Esq.
Executive Director
Maine Association for Community Service Providers
PO Box 149 | Hallowell, ME 04347
(207) 623-5005
www.meacsp.org
TWO ACTION ALERTS:  Below is an Action Alert from the Maine Coalition for Housing and Quality Services, and a Forwarded Action Alert from the Maine Association for Community Service Providers (MACSP), both regarding ways in which you can take action to respectfully urge the Legislature to convene a Special Session to see through legislation left on the Special Appropriations Table (“the Table”), much of which has broad bipartisan support.  This was discussed in more detail at the May 14th Coalition meeting (click here for the minutes), and more information can be found in the action alerts below. 
 
Thank you for taking action!  Cullen
 
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ACTION ALERT: Contacting Legislative leadership, asking them to convene a Special Session to address unfinished business in the Legislature
The Legislature adjourned on 5/3, leaving numerous bills (about 100) on the Table, including bills the Coalition has been following.  It’s possible the Legislature could convene a Special Session to address the unfinished business – it would take the Governor or Legislative leadership to do so.  There are many critical bills on the Table and there is a need for the Legislature to go back in session.  One of the bills on the Table, for example, is LD 976, the DSP rate increase bill (more information on this can be found in the Forwarded Action Alert below).  If this bill is not enacted the rates will revert back to the previous, lower rates on 7/1/2018. 
 
I have sent a letter on behalf of various groups, including the Coalition, to the Legislative Leadership, urging them to reconvene to address the bills on the Table, which have broad, bipartisan support, and for which there is money available for funding.  Copies of these letters can be found here and here, and you can use these to create your own letters urging the Legislature to reconvene.  Contacting Legislative leadership is easy – you can email your messages/letters to:  
Your message can be simple:
  • Please convene a Special Session of the 128th Legislature to ensure people with intellectual/developmental disabilities in Maine have access to the services they need in order to be included as part of their communities.
  • Please convene a Special Session of the 128th Legislature in order to address the unfinished business on the Special Appropriations Table. 
  • There are many bills on the Table that relate to services for very vulnerable populations, including people with intellectual/developmental disabilities.  These bills have broad, bipartisan support, and there is money available with which these bills could be funded.
 
Thank you for raising your voice.  Cullen

Forwarded Action Alert from MACSP:  Petition requesting the Legislature convene a Special Session to fund LD 967
Please see this forwarded message by Lydia Dawson, Maine Association for Community Service Providers (MEACP) - Wednesday, May 23, 2018.
 
CALLING ON ALL MAINERS!
 
Sign this petition to ask legislators to come back for a special session to support Maine's direct care workers and save services for people with intellectual and developmental disabilities ("IDD"): https://www.surveymonkey.com/r/X9T2VHD 
 
Mainers with IDD are in danger of losing critical services provided by direct care workers. Due to underfunding, direct care workers currently make pennies above minimum wage to provide this vital support. If the legislature doesn't come back and fund LD 967, rates for services provided by direct care workers will be cut by 12% on June 30 resulting in closures of homes and community programs for Mainers with IDD throughout Maine.
 
We are calling on the legislature to come back for a special session to keep their promise and fund LD 967 now before it's too late.
 
Please share on your social media, distribution lists, and to friends and neighbors! We need everyone and anyone who care about this critical issue to sign!
 
Lydia Dawson, Esq.
Executive Director
Maine Association for Community Service Providers
PO Box 149 | Hallowell, ME 04347
(207) 623-5005
www.meacsp.org
Below is a a forwarded ACTION ALERT from the Maine Association for Community Service Providers (MACSP) regarding a LD 967 Hall of Flags Rally on Wednesday, May 5th.
 
The Maine Coalition for Housing and Quality Services has been following LD 967, which is currently sitting on the Special Appropriations Table in the Legislature pending funding for enactment.  This bill would address the second year of funding for Direct Support Professional (DSP) rate increases, which was not included in the biennial budget during the last year’s legislative session.  If this bill is not enacted the rate increases currently in effect will end on 6/30/2018, and revert back to the previous, lower rates.  The Coalition has featured presentations and discussions on this topic over the past two years (click here for the November 2016 minutes which features a presentation on the DSP shortage), which revealed that wages paid to DSPs have greatly affected staff hiring, retention, and turnover, as DSPs can find comparable compensation working entry level retail positions.  Due to the high turnover and vacancy rates, agencies have been unable to adequately provide services for people in need. 
 
Please see the forwarded ACTION ALERT below.
 
Thank you for raising your voice, telling your story, and taking action.
​
Maine Association for Community Service Providers (MACSP) ACTION ALERT
From MACSP Executive Director Lydia Dawson:
​
Hi all,
 
This is it. This is our last shot at having LD 967 funded and protecting our State against devastating cuts to services for Maine people with intellectual and developmental disabilities. WE NEED EVERYONE.
 
LD 967 FUNDING RALLY ON WEDNESDAY (5/2)
  • MEET AT 9:45 IN THE HALL OF FLAGS. We’ll meet at 9:45am and move up together to line the House and Senate hallways. Plan to be at the State House by 9:15/9:30 to get through security.
  • WEAR ALL BLACK. Dress head to toe in black to show unity and the gravity of the situation.
  • BRING A SIGN THAT SAYS ONE OF THE THREE FOLLOWING PHRASES. Again to show unity, ONLY use the below phrases:
    • “You Promised – LD 967 To Support Mainers with IDD”
    • “You Promised – LD 967 To Support Direct Care Workers”
    • “You Promised – LD 967 To Support IDD Services”
 
WE NEED EVERYONE.  THIS IS OUR LAST CHANCE TO SHOW THE IMPACT THIS WILL HAVE ON OUR STATE.  LET’S MAKE IT BIG. RSVP NUMBERS TO ME.
 
EMAIL AND CALL AS MANY LEGISLATORS AS YOU CAN AND TELL THEM LD 967 MUST BE FUNDED:
Share this email with anyone who can help in these efforts! THE TIME IS NOW!
 
Lydia Dawson, Esq.
Executive Director
Maine Association for Community Service Providers
PO Box 149 | Hallowell, ME 04347
(207) 623-5005
www.meacsp.org
[email protected]
Continued Action Alert:  Proposed Tax Reform Bill in Congress – please contact Maine’s Delegation, specifically Senator Collins, asking her to oppose the tax reform bill: 
​
Congress is working to hurriedly pass major tax reform legislation, which includes real threats to housing, health care, and services.  Both the House and Senate passed different versions of the bill; the differences between the two bills have been negotiated in Conference Committee and a final bill has emerged.  This revised bill will have to be passed in the House and Senate in order to become law, and the vote is expected tomorrow.  Some key points about the tax bill and how it would affect vulnerable populations, including people with disabilities are noted below:
  1. This bill is estimated to increase the deficit by $1.46 trillion over the next ten (10) years (estimates range from $1T to $2.2T).  Any budget deficit such as this would have to be offset by drastic cuts to other programs.  This would include Non-Defense Discretionary (NDD) programs, including all HUD programs, and entitlement programs like Medicare, Medicaid, and Social Security.  An increase to the deficit of this magnitude would also trigger "sequestration" cuts to these same programs.
  2. The bill repeals the Affordable Care Act (ACA) "individual mandate", which would leave 13 million people uninsured by 2027, 10x the population of Maine.  Hundreds of thousands of these are people with disabilities.  This would drive up health insurance premiums.  Senator Collins has stated that she wouldn’t be opposed to repealing the individual mandate if other ACA-related legislation currently proposed in Congress were enacted.  However, the bills she supports to accomplish this will not be sufficient to offset the effects of the proposed tax reform legislation (according to the Center on Budget and Policy Priorities). 
In order for people with intellectual/developmental disabilities to achieve community inclusion they need housing, healthcare, and support services, all of which are in jeopardy with the tax reform bill moving through Congress.  The Conference Committee has completed its work and the House and Senate will vote this week on the tax bill.  Senator Collins voted for the Senate version; Senator King did not and has posted a statement here: King Statement on Senate Passage of Tax Bill, Saturday, December 2, 2017
Now is the time to reach out to Senator Collins asking her to oppose the tax reform bill.  Contacting the Senator is easy.  You can:
Email your messages/letters to:
 
Submit your messages/letters through the Senators’ web form:  https://www.collins.senate.gov/contact
 
Call one of her offices.  Phone lines may be busy, feel free to call different offices:
  • Augusta office:   207-622-8414
  • Bangor office:  207-945-0417
  • Biddeford office:  207-283-1101
  • Caribou office:  207-493-7873
  • Lewiston office:  207-784-6969
  • Portland office:  207-780-3575
  • Washington, D.C. office:  202-224-2523
 
Your message can be very simple:  
  • Please oppose the tax reform bill, and any version of tax reform legislation that would reduce resources for affordable housing, health care, and support services.  In order for people with intellectual/developmental disabilities to have community inclusion they need housing, health care, and support services.  All of these will face significant cuts or elimination because of the tax reform bill moving through Congress.
  • Please carefully examine any current or future proposal through the lens of the most vulnerable people in Maine.  Any legislation must do right by them.  I, and the people I care for are counting on you.
 
You may also want to consider thanking Senator King for opposing the tax reform bill.  To do so, you can:
Email your messages/letters to:
 
Submit your messages/letters through the Senators’ web form:  https://www.king.senate.gov/contact  
 
Thank you for raising your voice and taking action.  Please do this today; this is being pushed through extremely fast.
Action Alert:  Proposed Tax Reform Bill in Congress:
Congress is working to hurriedly pass major tax reform legislation, which includes real threats to housing and services.  Congress is discussing very complex reform to a tax system that’s very complicated in and of itself.  Right now, the only significant vehicle for the development of affordable housing is the Low-Income Housing Tax Credit (LIHTC); the proposed tax reform bill would eliminate two if not all three of the ways in which this affordable housing is created.  The legislation eliminates the Historic Tax Credit, and the 4% LIHTC, and changes the corporate liability for 9% LIHTC.  This is complicated, but in practice what this means is that we would see the distinct lack of ability to create affordable housing.  Additionally, the tax reform bill would create a $1.5 trillion budgetary hole, which would then have to be offset by cuts to Non-Defense Discretionary (NDD) programs, including HUD programs like Section 8, as well as entitlement programs, including Medicaid.  In order for people with intellectual/developmental disabilities to have community inclusion they need housing, healthcare, and support services, all of which are in jeopardy with the current versions of the tax reform bill moving through Congress. 
 
The House passed its version of the tax bill yesterday (11/16), and the Senate is poised to vote on its version before Thanksgiving.  Now is the time to reach out to Senator Collins who is undecided, and Senator King to thank him for opposing the proposed tax reform bill.  Sending a letter to the senators is easy.  Simply email your messages/letters to:
 
Your message can be very simple: 
  • In order for people with intellectual/developmental disabilities to have community inclusion they need housing, healthcare, and support services, all of which face significant cuts or elimination in the tax reform bill moving through Congress. 
  • Please make sure that any changes preserve all resources for affordable housing, healthcare, and services for people with disabilities so they can continue to be part of their community.  I am counting on you and watching this very carefully. 
 
Thank you for raising your voice and taking action.
Continued Action Alert:  Proposed rule changes for Section 21 and Section 29 – Public comment period is ending tomorrow (at 11:59pm) for Section 29, and Sunday (at 11:59pm) for Section 21:
 
DHHS recently released Proposed Rule Changes for Section 21 and Section 29.  Please click here for information from the Department regarding the specific rule changes, and what they mean for you, your family members, and/or people for whom you provide care.
 
As you may know, the Department utilized the emergency rule-making process for both Section 21 and Section 29, which includes changes such as raising the rates for Section 21 and 29, raising the cap for community and work supports in Section 29, adding shared living as an option to Section 29, and removing employment supports from the Section 29 cap making it a stand-alone service outside of the cap.  Because the Department used the emergency rule-making process, those rules were provisionally accepted immediately and went into effect on September 29th. 
 
DHHS has moved quickly to put into effect the raised caps for Section 29 and the temporary increase in rates for Direct Service Professionals under Sections 21 and 29.  They are to be commended for their responsiveness to our request to expedite these changes.  Also, the Department is to be commended for looking at support for employment as outside of the Section 29 cap.  This is advantageous, consistent with employment first, and something the Coalition has long supported. 
 
The comment period is still open for a short while.  People who have reviewed these changes have found some unintended consequences and inconsistencies within provisions of the rule changes, and those (and ideas of how to comment) are outlined in bullet form below: 
Section 21:
  • Though the rates have been increased for Section 21, the caps were not increased correspondingly.  There is concern that a possible unintended consequence could be that people will reach the cap on Section 21 utilizing fewer hours of services than before, because the cap wasn’t adjusted for the rate increase.  One might want to encourage DHHS to make the Section 21 cap increase in a manner that corresponds with the rate increase.
  • When the Department included shared living in Section 29 it removed employment supports from the cap.  Employment supports appear completely uncapped in Section 29.  The Department ought to be commended for encouraging successful employment through these rule changes.  In the rules, it appears that Section 21 employment supports are still capped.  This appears to be an inconsistency, and one might want to encourage support for employment within Section 21 as well as Section 29.
 
Section 21 & Section 29:
  • The Legislature set aside funding to increase the reimbursement rates; in their calculations, they had the rates starting on October 1st.  However, instead of starting the new rates on October 1st, the Department made the rate increases retroactive to July 1st.  Functionally, it appears that the increase in the rate for service is about 25% less than originally thought, because the same amount of funding is spread across twelve months instead of nine.  One might want to encourage that this be corrected so that the increase for service rate actually occurs for a full year as intended by the Legislature.
  • The mechanism for the retroactive rate increases appears unnecessarily challenging for providers.  It appears that providers must give the state back all the money they’re received for those services, retrospectively to July, then seek reimbursement for the full amount at the increased rate.  It’s estimated that it could take the state up to two months to reimburse providers.  Providers also must wait for the go-ahead to begin billing at the higher rate.  This could cause significant financial burdens for providers.  One might want to encourage DHHS to simplify reimbursement in a manner that will be most feasible for service providers. 
 
PUBLIC COMMENT INFORMATION:  Public comments for the two proposed rules relating to Section 29 are due tomorrow, Friday, 11/10; public comments for the proposed rule changes for Section 21 are due on Sunday, 11/12.  See below for more information and how to submit comments.

  • Section 21, Chapter III (Major Substantive Rule Change, to address rate increases approved for FY 2018)
Written comments due: 11/12/17 by 11:59pm  Click here to submit comments.

  • Section 29, Chapter II (Rule change addressing the increase to the Section 29 cap, added services, and services available but removed from the caps)
Written comments due: 11/10/17 by 11:59pm  Click here to submit comments.

  • Section 29, Chapter III (Major Substantive Rule Change, to address rate increases approved for FY 2018)
Written comments due: 11/10/17 by 11:59pm  Click here to submit comments.
 
(Click here for more information on the proposed rule changes, including how to submit written comments)
 
How to submit comments:  You can submit comments online through the links above, and doing so is easy – simply click the links above where it says “click here for public comments” for the corresponding rule change, enter your name, contact information, and type your comments in the space provided.  All mandatory fields are highlighted in yellow.  You can also email your written comments directly to Rachel Posner, the agency contact, at [email protected] Your comments don’t have to be long and your message can be simple.
 
Thank you for raising your voice and taking action.
Action Alert:  Proposed rule changes for Section 21 and Section 29 – Public Hearings and public comment period: 
DHHS recently released Proposed Rule Changes for Section 21 and Section 29.  Please click here for information from the Department regarding the specific rule changes, and what they mean for you, your family members, and/or people you provide care for.
 
As you may know, the Department utilized the emergency rule-making process for both Section 21 and Section 29, which includes changes such as raising the rates for Section 21 and 29, raising the cap for community and work supports in Section 29, added shared living as an option to Section 29, and removed employment supports from the Section 29 cap, making it a stand-alone service, outside of the cap.  Because the Department used the emergency rule-making process, those rules were provisionally accepted immediately and went into effect on September 29th.  The Department then released proposed rule changes for Section 21 and Section 29 for these same changes, which includes a public comment period, for permanent adoption.  DHHS has moved quickly to put into effect the raised caps for Section 29 and the temporary increase in rates for Direct Service Professionals under Sections 21 and 29.  They are to be commended for their responsiveness to our request to expedite these. 
 
However, people who have carefully reviewed the proposed rule changes have expressed some possible concerns and/or possible unintended consequences of provisions of the rule changes.  Below is a partial list of some of the common concerns reviewers have expressed:
  • Though the rates have been increased for Section 21, the caps were not increased correspondingly.  There is concern that a possible unintended consequence could be that people will reach the cap on Section 21 utilizing fewer hours of services than before, because the cap wasn’t adjusted for the rate increase. 
  • When the Department included shared living in Section 29 it removed employment supports from the cap.  Employment supports appear completely uncapped in Section 29.  However, on Section 21 employment supports are still capped.  This appears to be an inconsistency.
  • The Legislature set aside funding to increase the reimbursement rates; in their calculations, they had the rates starting on October 1st.  However, instead of starting the new rates on October 1st, the Department made the rate increases retroactive to July 1st.  Functionally, it appears that the increase in the rate for service is about 25% less than originally thought, because the same amount of funding is spread across twelve months instead of nine. 
  • The mechanism for the retroactive rate increases appear worrisome to providers.  It appears that providers must give the state back all the money they’re received for those services, retrospectively to July, then the State reimburses providers the full amount at the increased rate.  It’s estimated that it could take the state up to two months to reimburse providers.  Providers also must wait for the go-ahead to begin billing at the higher rate.  This could cause unintended financial burdens for providers.
 
PUBLIC HEARING & PUBLIC COMMENT INFORMATION:
 
  • Section 21, Chapter III (Major Substantive Rule Change, to address rate increases approved for FY 2018)
Public hearing: 11/1/17 at 9:00am, at the Augusta Armory (179 Western Ave, Augusta, ME)
Written comments due: 11/12/17 by 11:59pm  Click here to submit comments.
 
  • Section 29, Chapter II (Rule change addressing the increase to the Section 29 cap, added services, and services available but removed from the caps)
Public hearing: 10/31/17, 2017 at 9:00 am, at the Augusta Civic Center, Kennebec-Penobscot Room (76 Commerce Drive, Augusta, ME)
Written comments due: 11/10/17 by 11:59pm  Click here to submit comments.
 
  • Section 29, Chapter III (Major Substantive Rule Change, to address rate increases approved for FY 2018)
Public hearing: 10/31/2017 at 1:00 pm, at the Augusta Civic Center, Kennebec-Penobscot Room (76 Commerce Drive, Augusta, ME)
Written comments due: 11/10/17 by 11:59pm  Click here to submit comments.
 
(Click here for more information on the proposed rule changes, including how to submit written comments)
 
Testifying at the public hearings – Key things to note if you testify in person:
  • There will likely be a three minute limit on testimony.
  • If you prepare written testimony, please bring 25 copies to the hearing. 
But don’t let this stop you if it is a barrier!  You don’t need to speak for three minutes if that is intimidating.  You can simply go up, state your name, briefly tell your story, and express the needs of you and/or someone you care for and how the proposed rule changes may affect you and your family.  This can be redundant with what others have said. 
 
How to submit comments:  You can submit comments online and doing so is easy – simply click the links above where it says “click here for public comments” for the corresponding rule change, enter your name, contact information, and type your comments in the space provided.  All mandatory fields are highlighted in yellow.  Your comments don’t have to be long and your message can be simple.
 
Thank you for raising your voice and taking action.
Forwarded, Revised ACTION ALERT:

This Action Alert was originally from Maine Disability Alerts, however it has been updated with more information and links to past Coalition Action Alerts for convenience.

Some US Senators are trying one last time to repeal and replace the Affordable Care Act. According to the Center on Budget and Policy Priorities (CBPP), the Cassidy-Graham bill includes many of the harmful provisions from the House’s American Health Care Act (AHCH) and the Senate’s Better Care Reconciliation Act (BCRA), including the per capita caps and block granting that would ultimately take millions of dollars out of Medicaid. (follow this link for information from previous action alerts; follow this link for information from CBPP on the bill)

Now is the time to contact Senator Collins, thank her for her support in opposing previous efforts to repeal the Affordable Care Act, and ask her to:
  • Please vote against the Cassidy-Graham bill; and
  • Please oppose any restructuring of Medicaid, such as block grants, per capita caps, or anything similar, because they would restrict MaineCare’s ability to give people, including people with intellectual/developmental disabilities, the care they need. Our growing waitlists demonstrate that we have insufficient resources already.

Contacting Senator Collins is easy – Simply click here and you’ll be on the contact section of her website. On the left-hand side of the screen, there is a simple form –type in your name, address, email, and your comments in the space provided. Your comments don’t have to be long and your message can be simple. Please take a few minutes now to tell your story and appeal to Senator Collins.

You can also call Senator Collins’ office and deliver this same message.
  • Senator Collins: D.C. office: 202-224-2521
  • Portland Office: Portland 207-780-3573
  • Augusta Office: 207-622-8414
  • Bangor Office: 207-945-0417
  • Caribou Office: 207-493-7873
  • Biddeford Office: 207-283-1101
  • Lewiston Office: 207-784-6969
Please send something personal. Let Senator Collins know how important it is to have services for people with intellectual/developmental disabilities. These personal stories will help inform the Senator, so that she can make a good decision for people in Maine.

Thank you for your collective advocacy.
ACTION ALERT - DHHS Section 1115 Waiver Application to CMS - Immediate action needed
The Department of Health and Human Services (DHHS) has formally submitted its Section 1115 waiver application to CMS (Centers for Medicare and Medicaid Services).  This particular waiver affects people who are considered to be “able-bodied,” but it would be precedent-setting for all of Maine’s other waiver programs if approved.  The application went through a state public comment period, and two public hearings were held.  Many of the comments during this public comment period expressed concerns about people being able to access healthcare and services if this waiver should go through. 

DHHS has made revisions to the original proposal based on comments received during the public comment period.  However, an analysis by Maine Equal Justice Partners indicates that the majority of the provisions that will affect people's access to healthcare and critical services still remain.

The application is in 30-day federal comment period, which ends at 11:00pm on 9/16.  Maine Equal Justice Partners (MEJP) believes this will limit people’s access to services. MEJP is encouraging people to submit comments, and they’re willing to help.  MEJP has information on the original proposal, comments received, changes made due to comments received, and the final application package sent to CMS.  They are preparing to file a lawsuit, in the event that the application is approved; they will build their case based on the comments submitted to CMS.

Some of the 1115 waiver proposals of concern, partially summarized by MEJP, include:
  • Some people would be limited to just 3 months of MaineCare coverage every 36 months;
  • Some Mainers, even those with income below the poverty level, would be required to pay monthly MaineCare premiums or face financial penalties and loss of health coverage;
  • Parents, children, and pregnant women could lose MaineCare coverage if they have even modest assets;
  • There would be an elimination of retroactive Medicaid eligibility;
  • There would be an elimination of hospital presumptive eligibility determinations; and  
  • MaineCare recipients would be charged a $10 co-payment for Hospital Emergency Department visits that have a primary diagnosis which the Department has deemed to be indicative of non-emergency utilization - even if a doctor advised them to go to the ER or it is the only option available.
 
(Click here for Maine Equal Justice Partners full analysis of the waiver application)
(Click here to view the submitted application, which includes a summary of comments and how the State considered those comments in the development of the final application) 
(Click here to view a summary of changes from the Department)

I encourage you to submit written public comments to CMS to help educate them about the effect of the proposed policy on the populations in need of services in Maine.  Comments are due on Saturday, 9/16 by 11:00pm.  In your written comments, it is often a good strategy to include concrete, real life experiences that clearly illustrate the effect this waiver would have on people with intellectual disabilities in Maine.  You can talk about what services do to help people with intellectual/developmental disabilities gain and retain stability and inclusion in the community.  This is the opportunity to tell your story and how unrestricted access to healthcare and adequate services are vital for people with intellectual/developmental disabilities in Maine.

To submit comments, simply click this link, and you'll be on the page on the CMS' website where you can submit comments for Maine's Section 1115 Waiver Application.  You can type or copy and paste your comments in the box provided, or attach a document.  You can even submit comments without identifying yourself.  Contact MEJP for assistance in submitting comments.  They are happy to provide assistance. 

Please take the time to weigh in on this precedent setting proposal.  Thank you for raising your voice and taking action
Action Alert:  DHHS, Office of MaineCare Services proposed rule changes to Section 21 & Public Comment Period
On July 11th the Office of MaineCare Services sent out notices for rule-making proposals for Chapter II, Section 21, which is currently out for public comment, with the comment period ending on Monday, August 21st.  A Public Hearing was held on August 8th.  The Department provided a concise summary for the proposed rule change, which can be accessed by clicking this link (along with other related information).  The full proposed rule is available by clicking here.  Information on the public comment period, and how to provide comments can be found below.
 
Jennifer Fales, Initiatives and Clinical Review Program Manager of Developmental Services, DHHS-OADS, presented at the July Coalition meeting (click here for the minutes), stating that the intent of the Section 21 proposed rule changes is to expand the Section 21, Priority 1 language to allow for more Priority 1 offers, primarily to address aging and/or terminally ill caregivers.  According to the summary she provided, the intent is to allow some people who have been lingering on the Priority 2 waitlist to be given Priority 1 offers. 
 
However, people carefully reviewing this have expressed concerns with some of the specific language included in the proposed rule changes, and how it may have some unintended consequences.  Below is a partial list of the proposed changes, along with some of the common comments and concerns reviewers have expressed (please see the full text of the Section 21 proposed rule changes for more information):
  • The proposed rule changes for Section 21 includes a new category for Priority 1.  In addition to being in need of adult protective services, it is proposed that Priority 1 status include a category for people whose caregivers are age 65+ or have a terminal illness and cannot continue to provide necessary supports, and includes added requirements that the person has also been hospitalized, institutionalized, or had their health, safety, or welfare in imminent danger. 
    • Reviewers have expressed that it is unclear in the proposed rule why this new category would not already fall within the need for adult protective services based on the way it is written and that the inclusion of this language in the proposed rule may actually limit Priority 1, and access to adult protective services.  A common suggested improvement to this section is changing the language to “the member meets one of the following criteria,” rather than having to meet all of the proposed criteria. 
  • The proposed rule changes include “a review of whether a member’s needs can be met through services for which they are eligible under the State Plan or Section 29” and prohibits Priority 1 status for anyone who the Department determines can have their needs met in another program.  
    • Reviewers have expressed concerns that the proposed rule does not explain what having one’s needs met through another service looks like and it doesn’t outline the process through which the Department would help someone access those services, and if it is dependent upon their availability.  People have suggested that this language be removed, or explained with more clarity.
  • The proposed rule would establish an annual recertification process for the Section 21 waitlist.  Every year, the individual or guardian must annually resubmit “verification of the member’s continued interest in remaining on the waitlist” and “information necessary to re-determine the member’s priority level.”  If this is not received within 6 months of the annual review date, the member will be removed from the waitlist. 
    • Reviewers have expressed concerns that the inclusion of this language could result in people being erroneously and/or inappropriately removed from the waitlist entirely, because they do not understand the recertification process or can’t access the necessary forms or information needed to re-determine priority.  People have also suggested that this responsibility ought to fall to the Department, primarily through case managers and would ask the Department to eliminate the language that would result in people being removed from the waitlist.
 
PUBLIC COMMENTS:
Deadline for comments:  Comments must be received by midnight, Monday, August 21, 2017. 
How to submit comments:  You can submit comments online and doing so is easy – simply click this link, enter your name, contact information, and type your comments in the space provided.  All mandatory fields are highlighted in yellow.  Your comments don’t have to be long and your message can be simple.  (Click here for alternative ways to submit public comments)
ACTION ALERT:  Funding for services at the federal level (letter writing/email campaign)
On Thursday, June 22nd, the US Senate released the Better Care Reconciliation Act (BCRA), its bill to repeal and replace the Affordable Care Act (ACA).  The Senate bill is very similar to the House’s American Health Care Act (AHCA), in its proposed reforms and reductions to Medicaid/MaineCare (see previous action alerts for more information).  The Senate is poised to vote as early as next week on this bill.
 
The proposed healthcare bill includes reforms to Medicaid (MaineCare) that will very likely limit services for people with intellectual and developmental disabilities in Maine.  Changes include converting Medicaid funding to a per capita cap arrangement.  The targeted Medicaid cuts and this per capita cap arrangement would very likely result in significant cuts to services funding for people with disabilities, seniors, and others who would be competing for the same pool of very limited funds.  This is very dangerous, because in Maine (and other small and relatively poor states) we don’t have the resources to fully pay for MaineCare; the federal government pays close to $2 for every $3 dollars spent on services.  Maine doesn’t have any other funding mechanism to support people with intellectual/developmental disabilities or other disabilities.  If the BCRA or anything similar were to pass, we can expect a drastic reduction in the amount of funding in MaineCare.  This would be felt quite dramatically in services provided by Section 21, Section 29, and other sections of MaineCare. 
 
Here’s why:  Medicaid reimbursements play a significant role in Maine’s budget (and you can see from the current impasse, it is not easy to make our budget work).
If Medicaid were cut, Maine can expect to be in an immediate funding crisis for everything in its budget. 
 
Senator Collins sits in a key position in regards to whether this legislation passes in the Senate.  Although she has expressed concerns with the bill, we need her to vote against this bill entirely, because elderly, disabled, and vulnerable populations in Maine cannot handle any cuts to Medicaid/MaineCare.
 
Now is the time to contact Senator Collins and ask her to:
  • Please vote against the Better Care Reconciliation Act (BCRA); and
  • Please oppose any restructuring of Medicaid, such as block grants, per capita caps, or anything similar, because they would restrict MaineCare’s ability to give people, including people with intellectual/developmental disabilities, the care they need.  Our growing waitlists demonstrate that we have insufficient resources already.
 
Click here for a draft letter to Senator Collins.  Use it as a guide.  The letter includes space for people to tell their stories, and explain how imperative MaineCare services are to people with intellectual and developmental disabilities in Maine.  Sending a letter to the Senator is easy – simply add in your information to replace red and italicized sections of the draft letter, and email it to:
  • Elizabeth Allen ([email protected]) Senator Collins’ Health and Medicaid/Medicare staffer.
 
You can also call Senator Collins’ office and deliver this same message.  Senator Collins’ D.C. office: (202) 224-2521.  But please do email a letter whether you call or not.  Your story is important and those details will not be captured in a phone call. 
 
Please take a few minutes now to tell your story and appeal to Senator Collins.  I can’t think of something that would more dramatically affect support services advocated for by this Coalition, than this vote.  Please send something personal.  Let Senator Collins know how important it is to have services for people with intellectual/developmental disabilities.  These personal stories will help inform the Senator, so that she can make a good decision for people in Maine. 
 
Thank you for your collective advocacy.
ACTION ALERT – Funding for services at the state level (email/phone campaign)
The Coalition has been following two bills under consideration by the Maine Legislature, LD 323 and LD 967. 
 
LD 323, which would provide funding to eliminate the waitlist for Section 21 adult developmental services in Maine for persons with intellectual disabilities or autism, was voted Ought to Pass unanimously by the Health and Human Services (HHS) Committee (13-0), and the full House has followed suit (137-0).  The Senate has also passed LD 323.  However, because the bill has a fiscal note of approximately $33 million a year in state funds, it is now sitting on the Special Appropriations Table pending enactment.  In order for the bill to be enacted, the Appropriations and Financial Affairs (AFA) Committee must vote to fund it.
 
LD 967, as amended, which would increase the rates for Direct Support Professionals (DSPs) to the 2007 rates plus a 10% increase, passed a vote in the House, passed in the Senate, and went back to the House, where a 2/3rd majority vote was required to enact it under emergency status; it passed unanimously and moved to the Senate, where it was placed on the Special Appropriations Table pending enactment.  Just as with LD 323, in order for this bill to be enacted, the AFA Committee must vote to fund it.
 
Now is the time to contact members of the Legislature, and/or members of the Appropriations and Financial Affairs (AFA) Committee directly to educate them about your story, including how the waitlists have affected you or your family, or someone for whom you provide care or support, and express your support for these bills.  
 
Contacting members of the AFA Committee is easy – click the link below and you will be right on the Committee’s website.  Committee members are listed on the left side of the screen.  When you click on a name, that Legislator’s contact information will be displayed.  There are also links to contact information for the House and Senate below, which bring you to each chamber’s member directory.  You can call or send a quick email.  It doesn’t have to be long and your message can be simple:

“Please vote to fund LD 323.  This bill would cure the Section 21 waitlist.  Doing so would provide essential services to 1550 people waiting for them, so they can work and be included as part of the community.  Additionally, please vote to fund LD 967.  This will increase the rates for Direct Support Professionals, so that they can provide critical services.  Please support the portion of the Governor’s budget that raises the caps on Section 29 services so working families can continue their careers.  Thank you for your consideration.”
 
-Click here for the Appropriations and Financial Affairs Committee contact information
-Click here for contact information for the House of Representatives
-Click here for contact information for the Senate
 
Thank you for taking action!
UPDATED CONTINUED ACTION ALERT:  Funding for services at the federal level (letter writing/email campaign)
On May 4th, by a vote of 217-213 along party lines, the House passed the American Health Care Act (AHCA), a bill to replace the Affordable Care Act (ACA).  The Senate is now working on its version. 
 
As discussed at the 3/13 meeting of the Coalition (click here for the March minutes), the proposed healthcare bill includes reforms to Medicaid (MaineCare) that will very likely affect people with intellectual and developmental disabilities in Maine, including converting Medicaid funding to a per capita cap arrangement, with an additional option for states to administer Medicaid under a block grant arrangement.  Other proposed changes include cuts to Special Education, changes for people with pre-existing conditions, and additional language regarding high-risk pools.  These cuts are dramatic, estimated to be $839 billion over the next ten years, and clearly cuts of those magnitude will markedly reduce funds for services under Section 21, Section 29, and other sections of MaineCare.
 
Under the current MaineCare program, people with disabilities are eligible for and receive an array of services.  Under a per capita cap or block granting of MaineCare, Maine will get far less federal funding and there will be fewer protections for people with disabilities.
 
Now is the time to contact Senator Collins and Senator King and ask them to:

  • Please vote against the American Health Care Act (AHCA); and
  • Please oppose any restructuring of Medicaid, such as block grants, per capita caps, or anything similar, because they would restrict MaineCare’s ability to give people the care they need.  Our growing waitlists demonstrate that we have insufficient resources already.
 
Below are links to draft letters to Senator Collins and Senator King.  The letters include space for people to tell their stories, and explain how imperative MaineCare services are to people with intellectual and developmental disabilities in Maine.  Sending a letter to the Senators is easy – simply add in your information to replace red and italicized sections of the draft letters (click here for the draft letter to Senator Collins, click here for the draft letter to Senator King), and email them to:
  • Senator Collins’ staff:  Elizabeth Allen ([email protected]) Senator Collins’ Health and Medicaid/Medicare staffer; and Elizabeth McDonnell ([email protected]) Senator Collins’ Legislative Director.
  • Senator King’s staff:  Marge Kilkelly ([email protected]) Senator King’s Health & Medicaid/Medicare staffer; and Chad Metzler ([email protected]) Senator King’s Legislative Director.
 
Additionally, our action alert and a meeting with some concerned parents in early May helped educate Senator King about the need to protect MaineCare.  He did exactly that on May 17th; Senator King took to the floor of the Senate to share the stories of two Maine people with disabilities who would be affected should the American Health Care Act (AHCA) pass.  If you haven’t already, please take a few moments to watch Senator King’s compelling speech here.  If you reached out to him – thank you!  If you have not yet done so, please thank him for his tremendous leadership on this issue. 
 
By telling your story and the importance of MaineCare for people with intellectual and developmental disabilities in Maine, you can help our members of Congress understand why funding for services are vital.  Thank you for your collective advocacy!
ACTION ALERT 1: Forwarded Action Alert from Autism Society of Maine:  Phone call campaign
 
The Autism Society of Maine and Autism Society national want to educate you on what the changes in MaineCare (Medicaid) will mean to you and your family. The purpose for this information is to help people with disabilities, their families, and advocates/allies understand the impact of the changes proposed in the AHCA and give them the tools to advocate. This site was developed by Center for Public Representation with facts and figures about individuals who have MaineCare in Maine. 

Please go to the Center for Public Representation's website and review how the proposed changes will impact Maine residents. Here you will also see Maine Representatives contact information (this information is also included below for convenience).

On June 6 there is a rally in DC, if you can make great, if not DO YOUR PART - call your Representatives and Senator's from Maine. Tell them how you feel and what this will do for your child/adult.

Together we can make a difference.

Sincerely,
Cathy E. Dionne
Executive Director
Autism Society of Maine

Information from the Center for Public Representation's website:
Maine stands to lose $5 billion in federal funding for Medicaid, CHIP, and financial assistance for marketplace coverage through the proposed American Health Care Act (AHCA).  Medicaid provides 97,113 people with disabilities in Maine with access to critical care that helps them live independently. AHCA cuts Medicaid funding by imposing a “per capita cap” on Medicaid, with the capped amounts growing every year. 41,078 Mainers with disabilities are at risk of losing coverage.

If you care about people with disabilities – if you or someone you love is supported by Medicaid, please take action NOW. 
You matter, your story about Medicaid is critical, and your call makes a difference. 

It is absolutely essential to make the case to your representatives Senator Collins, Senator King, and Governor LePage about the impact of the Medicaid per capita caps on community services and supports for individuals with disabilities.

Call the main Capitol line at: (202) 224-3121 (You’ll be directed to an operator at the Capitol switchboard who can direct you to both of your senators.)
Please, whether you’re a lifelong activist or haven’t voted in years – take five minutes today to help defend essential services for people with disabilities.

Your Representatives
Senator Susan M. Collins
413 Dirksen Senate Office Building
Washington DC 20510
(202) 224-2523
Contact Form
 
Senator Angus S. King, Jr.
133 Hart Senate Office Building
Washington DC 20510
(202) 224-5344
Contact Form
 
Governor Paul R. LePage
Office of the Governor
#1 State House Station
Augusta, ME 04333-0001
(207)-287-3531
Contact Form
Request a Meeting
 
Key messages:
  • Do NOT support the American Health Care Act.  
  • Do NOT allow Medicaid to be gutted.  Per Capita Caps would decimate the program on which people with disabilities and seniors rely for critical healthcare and community services.  
  • Do NOT allow states to opt out of requiring health plans to cover basic health care and keep it affordable for people with pre-existing conditions, including people with disabilities.
 
Learn More About Medicaid in Maine and the Potential Impact of the AHCA:  
Reports on State Impact:
UPDATED CONTINUED ACTION ALERT 2:  Letter writing / email campaign
Dear advocates, friends, and families of people with disabilities: 
 
On May 4th, the American Health Care Act (AHCA), the U.S. House of Representatives’ bill to replace the Affordable Care Act (ACA), passed the House by a vote of 217-213.  The bill is now in the Senate for consideration.  The Senate appears poised to begin discussion on the AHCA bill the week of June 5th, and may try to pass this legislation by the end of June, a far more expedited process than was originally anticipated (see the forwarded action alert from Autism Society of Maine below for additional information).
 
As discussed at the 3/13 meeting of the Coalition (click here for the March minutes), the proposed healthcare bill includes reforms to Medicaid (MaineCare) that will very likely affect you and/or your sons and daughters, including converting Medicaid funding to a per capita cap arrangement, with an additional option for states to administer Medicaid under a block grant arrangement.  Other proposed changes include cuts to Special Education, changes for people with pre-existing conditions, and additional language regarding high-risk pools.  These cuts are dramatic, estimated to be $839 billion over the next ten years, and clearly cuts of those magnitude will markedly reduce funds for services under Section 21, Section 29, and other sections of MaineCare.
 
Under the current MaineCare program, people with disabilities are eligible for and receive an array of services.  Under a per capita cap or block granting of MaineCare, Maine will get far less federal funding and there will be fewer protections for people with disabilities.  Maine stands to lose $5 Billion for people with disabilities over the next several years if this bill passes the Senate.
 
Now is the time for advocates, parents, and friends of people with disabilities to contact Senator Collins and Senator King and ask them to:
 
  • Please vote against the American Health Care Act (AHCA); and
  • Please oppose any proposal calling for a block grant, per capita cap, or any other restructuring that would restrict MaineCare’s ability to give people with disabilities the care they need.
 
Attached are draft letters to Senator Collins and Senator King.  The letters include space for individuals, parents, guardians, and family members to tell their stories, and explain how imperative MaineCare services are to them and/or their loved ones with disabilities.  Sending a letter to the Senators is easy – simply add in your information to replace red and italicized sections of the draft letters (click here for the draft letter to Senator Collins, click here for the draft letter to Senator King), and email them to:
  • Senator Collins’ staff:  Elizabeth Allen ([email protected]) Senator Collins’ Health and Medicaid/Medicare staffer; and Elizabeth McDonnell ([email protected]) Senator Collins’ Legislative Director.
  • Senator King’s staff:  Marge Kilkelly ([email protected]) Senator King’s Health & Medicaid/Medicare staffer; and Chad Metzler ([email protected]) Senator King’s Legislative Director.
 
Additionally, our action alert and a meeting with some concerned parents in early May helped educate Senator King about the need to protect MaineCare.  He did exactly that on May 17th; Senator King took to the floor of the Senate to share the stories of two Maine people with disabilities who would be affected should the American Health Care Act (AHCA) pass.  Please take a few moments to watch Senator King’s compelling speech here.  If you reached out to him – thank you!  If you have not yet done so, please thank him for his tremendous leadership on this issue. 
 
By telling your story and the importance of MaineCare for yourself, your family, loved one, or person you work to help, you can help our members of Congress understand why funding for services are vital.  Thank you for taking action and raising your voice!
ACTION ALERT 3 – Forwarded Action Alert from Maine Disability Alerts: Email campaign
 
A bill currently under consideration by the Maine Legislature, LD 323, would eliminate the wait list for Section 21 adult developmental services in Maine for persons with intellectual disabilities or autism, addressing a problem that has festered for years.
 
The HHS Committee has unanimously (13-0) endorsed LD 323, and the full House has followed suit (137-0). The Senate has also passed LD 323.
 
But because the bill has a fiscal note of about $33 million a year in state funds, it is now sitting on the "Special Appropriations Table", where it will die unless the Appropriations Committee votes to fund it.
 
Democrats and Republicans are currently fighting about funds for public schools and income taxes on top earners (amounts of money roughly ten times what's in LD 323). Please do not let them forget about the crucial need to finally eliminate the wait list.
 
Please contact the following legislators to ask them to fund LD 323 off the Special Appropriations Table to finally eliminate the wait list for adult developmental services. Remind them that there are more than 1500 adults with significant disabilities sitting on the wait list. (When emailing Republicans, it's probably worthwhile to mention that LD 323 was sponsored by Republican Rep Richard Malaby.)
  1. Ask these members of Appropriations to fund LD 323 to eliminate the Section wait list:
    Sen James Hamper (R-Oxford) [email protected]
    Sen Cathy Breen (D-Falmouth) [email protected]
    Sen Roger Katz (R-Augusta) [email protected]
    Rep Drew Gattine (D-Westbrook) [email protected]
    Rep Aaron Frey (D-Bangor) [email protected]
    Rep Brian Hubbell (D-Bar Harbor) [email protected]
    Rep Erik Jorgensen (D-Portland) [email protected]
    Rep John Martin (D-Eagle Lake) [email protected]
    Rep Stedman Seavey (R-Kennebunkport) [email protected]
    Rep Heather Sirocki (R-Scarborough) [email protected]
    Rep Denise Tepler (D-Topsham) [email protected]
    Rep Jeffrey Timberlake (R-Turner) [email protected]
    Rep Tom  Winsor (R-Norway) [email protected]
  2. Ask your senator to contact colleagues on Appropriations to ask them to fund LD 323. You can get contact info for your senator at http://legislature.maine.gov/house/townlist.htm
  3. Thank your representative (House member) for joining the unanimous vote for LD 323, and ask them to contact colleagues on Appropriations to ask them to fund LD 323. You can also get contact info for your senator at http://legislature.maine.gov/house/townlist.htm
  4. Contact legislative leadership and ask them to fund LD 323:
    Speaker Sara Gideon (D-Freeport) [email protected]
    Rep Erin Herbig (D-Belfast, House majority leader) [email protected]
    Rep Jared Golden (D-Lewiston, House majority whip) [email protected]
    Rep Kenneth Fredette (R-Newport, House Republican leader) [email protected]
    Rep Ellie Espling (R-New Gloucester, House Republican whip) [email protected]
    Senate President Michael Thibodeau (R-Waldo) [email protected]
    Sen Garrett Mason (R-Androscoggin, Senate majority leader) [email protected]
    Sen Andre Cushing (R-Penobscot, Senate majority whip) [email protected]
    Sen Troy Jackson (D-Aroostook, Senate Democratic leader) [email protected]
    Sen Nathan Libby (D-Androscoggin, Senate Democratic whip) [email protected]
ACTION ALERT
Dear advocates, friends, and families of people with disabilities: 
 
On May 4th, the American Health Care Act (AHCA), the U.S. House of Representatives’ bill to replace the Affordable Care Act (ACA), passed the House by a vote of 217-213.  The bill now goes to the Senate for consideration. 
 
As discussed at the 3/13 meeting of the Coalition (click here for the March minutes), the proposed healthcare bill includes reforms to Medicaid (MaineCare) that will very likely affect you and/or your sons and daughters, including converting Medicaid funding to a per capita cap arrangement, with an additional option for states to administer Medicaid under a block grant arrangement.  Other proposed changes include cuts to Special Education, changes for people with pre-existing conditions, and additional language regarding high-risk pools.  These cuts are very significant, estimated to be more than $800 billion over the next ten years, and clearly cuts of those magnitude will dramatically reduce funds for services under Section 21, Section 29, and other sections of MaineCare.
 
Under the current MaineCare program, people with disabilities are eligible for and receive an array of services.  Under a per capita cap or block granting of MaineCare, Maine will get far less federal funding and there will be fewer protections for people with disabilities.  Maine stands to lose millions of dollars for people with disabilities over the next several years if this bill passes the Senate.
 
Now is the time for advocates, parents, and friends of people with disabilities to contact Senator Collins and Senator King and ask them to:
 
  • Please vote against the American Health Care Act (AHCA); and
  • Please oppose any proposal calling for a block grant, per capita cap, or any other restructuring that would restrict MaineCare’s ability to give people with disabilities the care they need.
 
Attached are draft letters to Senator Collins and Senator King.  The letters include space for individuals, parents, guardians, and family members to tell their stories, and explain how imperative MaineCare services are to them and/or their loved ones with disabilities.  Sending a letter to the Senators is easy – simply add in your information to replace red and italicized sections of the draft letters (click here for the draft letter to Senator Collins, click here for the draft letter to Senator King), and email them to:
  • Senator Collins’ staff:  Elizabeth Allen ([email protected]) Senator Collins’ Health and Medicaid/Medicare staffer; and Elizabeth McDonnell ([email protected]) Senator Collins’ Legislative Director.
  • Senator King’s staff:  Marge Kilkelly ([email protected]) Senator King’s Health & Medicaid/Medicare staffer; and Chad Metzler ([email protected]) Senator King’s Legislative Director.
 
Thank you for taking action and raising your voice!
Additional information for the Action Alert regarding LD 323 and the forwarded Action Alert for LD 967 (see full action alerts below)
The public hearings for both LD 323 and LD 967 are held beginning at 9am on Monday, 4/3 (see the action alerts for more detailed information, including the location of the hearing).  The morning public hearing block usually runs until 1pm.  The Committee will work through all of the bills scheduled for the hearing (on Monday, the HHS Committee has 5 bills on the schedule), one by one, usually in the order they appear on the calendar (these bills are number 3 and 5 respectively on the calendar). However, the Committee may take up bills in a different order.  If you are preparing written testimony, you would typically prepare two pieces of testimony (one for each bill), but since these bills are related, you could very easily prepare testimony for both and combine your testimony into one letter - just name both bills at the top of your written testimony:  LD 323, “An Act To Fully Fund the Waiting List for the Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder Waiver,” and LD 967 "An Act to Ensure Access to Community Services for Individuals with Intellectual Disabilities or Autism."
ACTION ALERT:  
There is an opportunity for families and other interested parties to testify in support of LD 323, “An Act To Fully Fund the Waiting List for the Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder Waiver.”
 
Representative Malaby has introduced LD 323, that, if passed, would fully fund the waiting list for Section 21, which as of December 2016 had 1399 people waiting for services. 
 
The Coalition has advocated for years to eliminate the Section 21 waiting list, and access to Section 21 services is pivotal to the Developmental Services Lifelong Continuum of Care, in order to create a flexible system that can meet each person where he or she is at in terms of service needs.  This is an important initiative introduced by Representative Malaby, and its passage would be very significant.
 
A public hearing for this bill is scheduled for Monday, April 3rd at 9:00 AM in front of the Health and Human Services (HHS) Committee in the Cross Building, Room 209 (Burton M. Cross Building, 111 Sewall St, Augusta, ME 04330. This building is connected to the Capitol, and there is free parking in the lot surrounding it, or in the garage across the street.)
 
This means you now have an opportunity to testify and educate Legislators on this committee about your sons’ and daughters’ needs and tell your story, including how the waitlists have affected your family. 
 
Preparing written testimony is likely the most effective and efficient means of communicating your support to the Committee.  Written testimony may be submitted in person at the public hearing (please bring 25 copies for the Committee), or if you cannot attend the hearing in person, you may email written testimony to Jill LaPlante, Health and Human Services Committee Clerk:  [email protected]   
 
Key things to note if you testify in person:
  • There will be a three minute limit on testimony.
  • If you prepare written testimony, please bring 25 copies for the Committee to the hearing. 
 
But don’t let this stop you if it is a barrier!  You don’t need to speak for three full minutes if that is intimidating.  You can simply go up, state your name, briefly tell your story, and express your support for fully funding the waiting list.  This can be redundant with what others have said. 
 
You can also contact members of the Health and Human Services Committee directly to offer messages of support for this bill.  Contacting members of the Committee is easy – click the link below and you will be right on the HHS Committee’s website.  Committee members are listed on the left hand side of the screen.  When you click on a name, that Legislator’s contact information will be displayed.  You can call or send a quick email.  It doesn’t have to be long and your message can be simple:
“Please support LD 323, which would fully fund the Section 21 waiting list.  Doing so would help provide essential services that allow people with intellectual and developmental disabilities to work and be included as part of the community.  Thank you for your consideration.”
 
Health and Human Services Committee Contact Information.
 
I hope you will testify on Monday April 3rd and/or contact Committee members and let your voice be heard!   ​
Please see the forwarded Action Alert from Community Connect ME below:

Hi all,
 
Please come to the Public Hearing on Monday April 3 on LD 967: An Act to Ensure Access to Community Services for Individuals with Intellectual Disabilities or Autism. We encourage people to bring or send in written testimony and/or show your support in person. E-mail your testimony to the Health and Human Services Committee. Their e-mails are below. For more info about the HHS committee the link to their website is also below. 
 
You may also show your support by attending a press conference about LD 967 at 10:00AM at the Welcome Center in the State House.
 
MACSP (Maine Association for Community Service Providers) has provided talking points (click here).
 
Date: April 3, 2017
Time: 9:00AM April 3, 2017 
Place: Room 209, Cross State Office Building 
RE: Public Hearing on LD 967 An Act to Ensure Access to Community services for Persons with Intellectual Disabilities or Autism
 
For people preferring to mail their testimony, Todd Goodwin, of Community Partners Inc has offered receive your letters and make hard copies for committee members and bring them to Mondays hearing. His address is below as well. If you wish to mail him your testimony he will need to receive it by noon on Friday, March 31st. 
 
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
-- 
 
Chairs
Senator Eric Brakey and Senator is the (R) 
Representative Patricia Hymanson is the (D)
 
For more info about HHS Committee use this link:  http://legislature.maine.gov/house/jt_com/hum.htm
 
Todd Goodwin’s contact information for mailed written testimony to be delivered to the Committee:  
Todd Goodwin
Chief Executive Officer
Community Partners, Inc.
443 Main Street, PO Box 363
Biddeford, ME 04005
Office:  207-282-7113 x108
Cell:  207-651-0026
www.cpime.org
 
Kim Fulmer Humphrey
Founder of Community Connect ME
[email protected]
207-754-3435
 
84 Boulder Drive
Auburn, ME 04210
 
Keep up with the progress of this bill or to meet others in your area or share topics of interest
Join Community Connect ME closed Facebook group
https://www.facebook.com/groups/1138916499562998/?ref=aymt_homepage_panel
ACTION ALERT:
The Governor’s Biennial Budget includes funding to raise the Section 29 cap, doubling the amount of hours available to people being served by the Section 29 waiver.  Improving Section 29 is something that the Coalition included in its Developmental Services Lifelong Continuum of Care, in order to create a flexible system that can meet each person where he or she is at in terms of service needs.  Some, including myself, expect the doubling of the cap may solve the service needs for perhaps 80% of the 1399 people on the waiting list for Section 21 services.  It might also allow a parent to work full time while a son or daughter received support.  This budget initiative also has supports for employment as something delivered outside of the cap (not counting towards the home and community support hours).  Support for employment is a key focus of the Developmental Services Continuum of Care originated and supported by the Coalition.  This is an excellent initiative by DHHS and having it included in the Governor’s budget is very significant.
 
Now is the time to contact members of the Health and Human Services Committee and the Joint Standing Committee on Appropriations and Financial Affairs to offer messages of support for this portion of the Governor’s budget.  Contacting members of the Committees is easy – click the links below and you will be right on the corresponding Committee’s website.  Committee members are listed on the left hand side of the screen.  When you click on a name, that Legislator’s contact information will be displayed.  You can call or send a quick email.  It doesn’t have to be long and your message can be simple:
 
“Please support funding in the Governor’s Biennial Budget (Biennial Budget Block C – Developmental Disabilities) which would increase the Section 29 cap to $47,550.  Doing so would help create a range of options that allow parents to keep their jobs, yet be home to continue to facilitate care and support for their sons and daughters as they enter adulthood.  Thank you for your consideration.”
 
Health and Human Services Committee Contact Information.
Joint Standing Committee on Appropriations and Financial Affairs Contact Information.
 
I hope you will contact Committee members and let your voice be heard!   ​
This action alert is in the form of a letter, drafted by Betsy Mahoney, a parent, for use by friends, families, and caregivers of people with disabilities to contact Senator Collins regarding the Affordable Care Act (ACA), and a potential Medicaid restructuring should the ACA be repealed, which would likely affect people with disabilities who receive Medicaid-funded services (such as Sections 21 and 29).  The draft letter to Senator Collins is linked below and requires only brief work on your part to personalize and send via email. 

ACTION ALERT

Dear friends and families of people with disabilities: 
 
Immediately after Donald Trump's inauguration on January 20, 2017, Congress is set to vote on whether to repeal the Affordable Care Act, which is currently helping tens of thousands of Mainers access health care.
 
The specific problem for families of people with disabilities that receive services under MaineCare (Sec. 21 and 29) is that if Congress repeals the ACA, it may later (perhaps in March) replace the current Medicaid plan with a "block grant"* (see below for more information) or a per capita cap.  Under either proposal, Maine will get far less federal funding and there will be fewer protections for people with disabilities.
 
Under the current Medicaid program, people with disabilities are eligible for and receive an array of services.  Under a block grant, there would be no guarantee of eligibility or services.  Under a per capita system, Medicaid would be unable to respond to changes in best medical practices or new advancements in medical care.
 
While Senator Angus King is not in favor of eliminating the ACA, Senator Susan Collins is undecided, but has stated that she is ambivalent about repealing the ACA unless there is a good replacement. 
 
Parents and friends of people with disabilities need to contact Senator Collins and ask her to:

  • Vote against repealing the ACA, and
  • Oppose any proposal calling for a block grant or any other restructuring that would restrict Medicaid’s ability to give our loved ones with disabilities the care they need.
 
Click here for a draft letter to Senator Collins.  The letter includes space for parents, guardians, and family members to tell their stories, and explain how imperative MaineCare services are to their loved ones with disabilities.  Sending a letter to the Senator is easy – simply add in your information to replace red and italicized sections of the attached draft letter, and email it to Jay Lim ([email protected]), Senator Collins’ housing staffer.  
 
Thank you for raising your voice!
(*A block grant would cap federal Medicaid funding in order to achieve savings for the federal government. Under current law, the federal government picks up a fixed percentage of states’ Medicaid costs: about 57 percent, on average (outside of the ACA’s Medicaid expansion). In contrast, under a block grant, states would receive a fixed dollar amount, with states responsible for all Medicaid costs in excess of the cap. Because a Medicaid block grant is explicitly intended to produce significant federal budgetary savings, block grants are designed in ways that give states considerably less federal funding each year than they would receive under the current financing system. http://www.cbpp.org/sites/default/files/atoms/files/11-30-16health_0.pdf)
Community Connect Action Alert:

ACTION ALERT:
 
• DHHS has just released new proposed rules that could devastate services for our family members with intellectual disabilities and autism.  We advocated against proposed changes last January.  Now we need to stand up once again to protect the services of our loved ones.  

• There will be a Public Hearing 10/19 in Augusta.  Written comments are due 10/29. Please plan to attend, share your story at the public hearing and/or submit your written comments. Public Hearing and submission details, Department of DHHS Concise Summary and links to Proposed Rules are here: http://www.maineparentcoalition.org/proposed-rule-changes.html

IMPORTANT POINTS REGARDING SECTION 21 CHANGES:
1) Families feel shut out of the rule making process.  We have life-long experience with the system, and need to be included.  Months prior to the release of the rules, DHHS disseminated a one-page “Key Message” document that highlighted Section 21 changes. (See:  S-21 Changes Highlights (b) 2-pdf) Then in late September DHHS released the proposed Section 21 and 29 rules (totaling 169 pages) simultaneously with the announcement of the public comment period. During this time period, DHHS cannot discuss it. Details of the new proposal are often unclear and sometimes contradictory. There are cuts and ways to terminate services that are not mentioned in the one-page DHHS Section 21 “Key Message” Change Highlights document.Stakeholders are left under-informed during their one and only chance to influence the outcome of this new proposal.
2) The new rules include unfunded mandates and bureaucratic requirements that make no sense, and will make it even harder for our loved ones to get the care they need. Individuals, families, and guardians will need time to talk to providers to know what impact the proposal will have on individuals served. Realistically, there is not enough time for this to happen before comments are due. In addition, DHHS is implementing the rule in January without first taking the necessary step of conducting a rate assessment to determine whether the new proposal will require rate adjustments to ensure that the proposed changes constitute a workable model. Implementing an improperly evaluated model puts a fragile population at risk.
3) Sweeping changes to services for one of our most vulnerable populations – adults with intellectual disabilities and autism – shouldn’t be rushed through in secret.  Families and providers have much to contribute regarding what is needed, and would like to help the system work better.  We want to be part of the process. The health and safety of the people we love is at stake.  In March of 2016, the voices of individuals, families, and other stakeholders contributed to legislative action that resulted in a bill to make Section 21, Chapter II, Major Substantive. (This would have allowed the legislature to officially review the rule and hold a public hearing). However, the bill was successfully vetoed by the Governor. Once again, the present proposed changes constitute a substantive rule change, and will have a major impact on Maine's safety net.
IN SUMMARY: The collective voice of stakeholders should have the opportunity to thoroughly vet this proposal. DHHS released it without providing genuine opportunities for review, questions, and clarification.  The legislature is not in session, preventing even informal legislative review.  
OUR RECOMME
Informational Notices Regarding Proposed Rule Changes to Section 21 and Section 29
 
There are two proposed rule changes regarding Section 21
 
1) Chapter II, Section 21 Proposed Rule Change:
 
Notice of Agency Rule-making Proposal 
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Proposed Rule: Chapter 101, MaineCare Benefits Manual, Chapter II, Section 21 Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
 
PUBLIC HEARING: 
Date: October 19, 2016
Time: 1:00 PM
Location: 19 Union Street, Conference Room 110,
Augusta ME 04333
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
CONCISE SUMMARY (Click here for the full Proposed Rule):
This waiver renewal proposes rule changes to the Comprehensive Home and Community-Based Services (HCBS) Waiver for persons with Intellectual Disabilities and Autism Spectrum Disorder. The proposed rule includes language that will bring the Department into compliance with new requirements from the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) Settings Rule released on January 16, 2014 (see 42 C.F.R. § 441.301(c)). The Department is seeking and anticipates receiving CMS approval for this section. Chapter II, Section 21 is a routine technical rule and does not require legislative approval prior to final adoption of the rule. 
 
Significant Updates and Changes to Chapter II, Section 21 include:
  • Renaming of the section from Home & Community Benefits for Members with Intellectual Disabilities or Autistic Disorder to Home & Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder.
  • Throughout Section 21, replacement of the term “Mental Retardation” with “Intellectual Disabilities.”
  • Updating references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
  • Added HCBS Settings Rule language to the Introduction.
  • In the Definitions section:
  1. Addition of clarifying language to Administrative Oversight Agency.
  2. Updated definition for Autism Spectrum Disorder.
  3. Addition of Clinical Review Team.
  4. Addition of clarifying language to Medical Add On.
  5. Removal of Mental Retardation.
  6. Addition of clarifying language to Shared Living Provider.
  • Under Personal Plan, the language was updated to ensure that the member is driving the process and that the process is more closely aligned with the CFR §441.301 and §441.303. Direct references to the CFR were included.
  • In the Covered Services section:
  1. Under Career Planning addition of quality oriented language.
  2. Under Communication Aids, removed Facilitated communication and added Augmented communication.
  3. Addition of clarifying language to Community Support Services.
  • In the Limits section:
  1. Addition of language which disallows duplicative services covered by other sections in the MaineCare Benefits Manual.
  2. Under Consultation Services added information regarding limits.
  3. Definition of annual limits for: Occupational Therapy (Maintenance).
  • In the Duration of Care Section added requirements for Provider Termination of a Member’s Services.
  • In Provider Qualifications and Requirements, added:
  1. Additional qualification for Direct Support Professionals.
  2. Provider qualifications necessary to perform an Assistive Technology Assessment.
  3. Residential Settings Owned or Controlled by a Provider.
  4. Shared Living (Foster Care, Adult).
  5. Clarification of Background Check Criteria.
  6. Clarification of Reportable Events & Behavioral Treatment.
 
Appendix V- Added Requirements for Section 21 Providers of Home Support Services, Community Support Services, and Employment Specialist Services.
 
In response to recent changes in HCBS rules, the state is working towards, creating greater emphasis on access to community settings and a more person driven focus in the Person Centered Planning process. No members will be affected through the proposal of this rule.
 
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
 
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173, L.D. 1638
PUBLIC HEARING: 
Date: October 19, 2016
Time: 1:00 PM
Location: 19 Union Street, Conference Room 110,
Augusta ME 04333
 
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before October 7, 2016.
 
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
AGENCY CONTACT PERSON: Andrew Hardy, Comprehensive Health Planner
AGENCY NAME: MaineCare Services
ADDRESS: 242 State St.
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4058, FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
E-Mail: [email protected]
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
 
2) Chapter III, Section 21 Proposed Rule Change:
 
Notice of Agency Rule-making Proposal 
AGENCY: Department of Health and Human Services, MaineCare Services
 
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Proposed Rule: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 21 Allowances for Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
 
PUBLIC HEARING: 
Date: October 19, 2016
Time: 1:00 PM
Location: 19 Union Street, Conference Room 110,
Augusta ME 04333
 
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
CONCISE SUMMARY (Click here for the full Proposed Rule):
This waiver renewal proposes rule changes to the Comprehensive Home and Community-Based Services (HCBS) Waiver for Persons with Intellectual Disabilities and Autism Spectrum Disorder. Chapter III, Section 21 is a companion to Chapter II, Section 21, Home and Community-Based Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder. Chapter III is a major substantive rule and requires legislative approval prior to final adoption of the rule.
 
Significant Updates and Changes to Chapter III, Section 21 includes;
  • Renaming of the Section from “Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder” to “Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autism Spectrum Disorder.”
  • Removal of Calculation of the Per Diem Rate for Agency Home Supports
  • Clarification of the Average Billing Method (the Monthly Average Billing section has been removed).
  • Removal of the Range in Appendix IIA and IIB.
 
The Department will adopt via emergency rulemaking an increase to the rates in Chapter III in accordance with L.D. 1638. The legislature passed L.D. 1638 to authorize an increase in the service provider tax. Chapter III, Section 21 lists the procedure codes, descriptions and reimbursement rates for covered services provided to members under its companion rule, Chapter II, Section 21 Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder.
 
The increased rates will be effective retroactive to April 15, 2016. The following services will have a 1% increase as a result of LD 1638:
  • T2017, Home Support (habilitation, residential, waiver), from $6.27 to $6.33 per quarter hour.
  • T2017 SC, Home Support (habilitation, residential, waiver)-with Medical Add On from $7.50 to $7.57 per quarter hour.
  • T2017 QC, Home Support (habilitation, residential, waiver)-Remote Support-Monitor Only, from $1.62 to $1.63 per quarter hour.
  • T2017 GT, Home Support (habilitation, residential, waiver)-Remote Support-Interactive Support, from $6.27 to $6.33 per quarter hour.
  • T2016, Agency Home Support (habilitation, residential, waiver), from $22.43 to $22.64 per diem.
  • T2016 SC, Agency Home Support (habilitation, residential, waiver) with Medical Add On, from $19.53 to $19.72 per diem
  • T2016 SC, Agency Home Support (habilitation, residential, waiver), from $27.15 to $27.41 per diem.
  • S5140, Shared Living (Foster Care, adult)-Shared Living Model-One member served, from $126.19 to $127.39 per diem.
  • S5140 TG, Shared Living (Foster Care, adult)-Shared Living Model-One member served-increased level of support, from $183.52 to $185.27 per diem.
  • S5140 UN, Shared Living (Foster Care, adult)-Shared Living Model-Two members served, from $63.10 to $63.71 per diem.
  • S5140 UN TG, Shared Living (Foster Care, adult)-Shared Living Model-Two members served-Increased level of support, from $120.42 to $121.57 per diem.
  • T2016 U5, Home Support (habilitation, residential, waiver)-Family Centered Support-One member served, from $104.17 to $105.16 per diem.
  • T2016 TG U5, Home Support (habilitation, residential, waiver)-Family Centered Support-One member served-Increased level of support, from $216.96 to $219.03 per diem.
  • T2016 UN U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Two members served, from $85.8 to $86.61 per diem.
  • T2016 UN TG U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Two members served-Increased level of support, from $196.78 to $198.65 per diem.
  • T2016 UP U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Three members served, from $73.15 to $73.85 per diem.
  • T2016 UP TG U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Three members served-Increased level of support, from $178.40 to $180.09 per diem.
  • T2016 UQ U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Four members served, from $61.99 to $62.58 per diem.
  • T2016 UQ TG U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Four members served-Increased level of support, from $162.16 to $163.71 per diem.
  • T2016 UR U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Five or members served, from $55.29 to $55.82 per diem.
  • T2016 UR TG U5, Home Support (habilitation, residential, waiver)-Family Centered Support-Five or members served-Increased level of support, from $153.42 to $154.88 per diem.
  • T2021, Community Support (day habilitation) from $5.28 to $5.33 per quarter hour.
  • T2021 SC, Community Support (day habilitation) with Medical Add On from $6.51 to $6.57 per quarter hour.
  • Replaced H023 HQ Work Support (supported employment) with the following modifiers below:
  1. H2023 UN Work Support (supported employment)-Group 2 members served, up to $3.46 per ¼ hour.
  2. H2023 UP Work Support (supported employment)-Group 3 members served, up to $2.30 per ¼ hour.
  3. H2023 UQ Work Support (supported employment)-Group 4 members served, up to $1.73 per ¼ hour.
  4. H2023 UR Work Support (supported employment)-Group 2 members served, up to $1.38 per ¼ hour.
  5. H2023 US Work Support (supported employment)-Group 2 members served, up to $1.15 per ¼ hour.
 
Chapter III, Section 21 lists the procedure codes, descriptions and reimbursement rates for covered services provided to members under its companion rule, Chapter II, Section 21 Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder.
 
No members will be affected through this emergency rule. Providers of Section 21 services will be reimbursed at a higher rate for services.
 
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
 
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173, L.D. 1638
PUBLIC HEARING: 
Date: October 19, 2016
Time: 1:00 PM
Location: 19 Union Street, Conference Room 110,
Augusta ME 04333
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before October 7, 2016.
 
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
AGENCY CONTACT PERSON: Andrew Hardy, Comprehensive Health Planner
AGENCY NAME: MaineCare Services
ADDRESS: 242 State St.
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4058, FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
E-Mail: [email protected]
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
 
There are two proposed rule changes regarding Section 29 
 
1) Chapter II, Section 29 Proposed Rule Change:
 
Notice of Agency Rule-making Proposal 
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Proposed Rule: Chapter 101, MaineCare Benefits Manual, Chapter II, Section 29 Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
 
PUBLIC HEARING: 
Date: October 19, 2016
Time: 9:00 AM
Location: 19 Union Street, Conference Room 110,
Augusta ME 04333
 
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
CONCISE SUMMARY (Click here for the full proposed rule):
This waiver renewal proposes rule changes to the Comprehensive Home and Community-Based Services (HCBS) Waiver for persons with Intellectual Disabilities and Autism Spectrum Disorder. The proposed rule includes language that will bring the Department into compliance with new requirements from the Centers for Medicare and Medicaid Services (CMS) HCBS Settings Rule released on January 16, 2014 (see 42 C.F.R. § 441.301(c)). The Department is seeking and anticipates receiving CMS approval for this section. Chapter II, Section 29 is a routine technical rule and does not require legislative approval prior to final adoption of the rule.
 
Significant Updates and Changes to Chapter II, Section 29 include:
  • Renaming of the section from “Support Services for Members with Intellectual Disabilities or Autistic Disorder” to “Support Services for Members with Intellectual Disabilities or Autism Spectrum Disorder.”
  • Throughout Section 21, replacement of the term “Mental Retardation” with “Intellectual Disabilities.”
  • Updating references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
  • Added HCBS Settings Rule language to the Introduction.
  • In the Definitions section:
  1. Updated definition of Autism Spectrum Disorder.
  2. Addition of Clinical Review Team
  3. Addition of Exploitation
  4. Addition of clarifying language to Medical Add On.
  5. Removal of Mental Retardation.
  6. Addition of clarifying language to On Behalf Of.
  • Under Personal Plan, the language was updated to ensure that the member is driving the process and that the process is more closely aligned with the 42 CFR § 441.301 and 441.303. Direct references to the CFR were included.
  • In the Covered Services section:
  1. Under Career Planning, addition of quality oriented language.
  2. Addition of clarifying language to Community Support Services.
  • In the Limits section:
  1. Removed Assistive Technology and Career Planning from the annual limit of $23,771, for members who receive Home Support (remote or quarter hour).
  2. Under Consultation Services, added information regarding limits.
  3. Definition of annual limits for: Occupational Therapy (Maintenance).
  4. Increased the Home Accessibility Adaptions limit from $5,000.00 in a three year period to $10,000 in a three year period.
  5. Added limits for Out of State Services. (21.07-18 Out of State Services Authorizations for services to be provided out of state will not exceed sixty (60) days of service within a given fiscal year and not exceed sixty (60) days within any six (6) month period except as provided in 42 C.F.R. § 431.52 (b).)
  • In the Duration of Care Section, added requirements for Provider Termination of a Member’s Services.
  • In Provider Qualifications and Requirements, added:
  1. Additional qualification for Direct Support Professionals.
  2. Additional qualifications for Employment Specialist.
  3. Clarification of Background Check Criteria.
  4. Clarification of Reportable Events & Behavioral Treatment.
  • Appendix IV- Added Requirements for Section 29 Providers of Home Support Services, Community Support Services, and Employment Specialist Services.
 
In response to recent changes in HCBS rules, the state is working toward creating greater emphasis on access to community settings and a more person driven focus in the Person Centered Planning process. No members will be affected through the proposal of this rule.
 
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
 
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173, L.D. 1638
 
PUBLIC HEARING: 
Date: October 19, 2016
Time: 9:00 AM
Location: 19 Union Street, Conference Room 110,
Augusta ME 04333
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before October 7, 2016.
 
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
AGENCY CONTACT PERSON: Andrew Hardy, Comprehensive Health Planner
AGENCY NAME: MaineCare Services
ADDRESS: 242 State St.
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4058, FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
E-Mail: [email protected]
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
 
2) Chapter III, Section 29 Proposed Rule Change:
 
Notice of Agency Rule-making Proposal 
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Proposed Rule: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 29 Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
 
PUBLIC HEARING: 
Date: October 19, 2016
Time: 9:00 AM
Location: 19 Union Street, Conference Room 110,
Augusta ME 04333
 
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
CONCISE SUMMARY (Click here for the full Proposed Rule):
This waiver renewal proposes rule changes to the Comprehensive Home and Community-Based Services (HCBS) Waiver for Persons with Intellectual Disabilities and Autism Spectrum Disorder. Chapter III, Section 29 is a companion to Chapter II, Section 29, Support Services for Members with Intellectual Disabilities or Autism Spectrum Disorder. Chapter III is a major substantive rule and requires legislative approval prior to final adoption of the rule.
 
Significant Updates and Changes to Chapter III, Section 29 include;
  • Renaming of the Section from “Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder” to “Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder.”
 
The Department will adopt via emergency rulemaking an increase to the rates in Chapter III in accordance with L.D. 1638. The legislature passed L.D. 1638, An Act to Increase Payments to MaineCare Providers That Are Subject to Maine’s Service Provider Tax, to authorize an increase in the service provider tax. Chapter III, Section 29 lists the procedure codes, descriptions and reimbursement rates for covered services provided to members under its companion rule, Chapter II, Section 29 Support Services for Adults with Intellectual Disabilities or Autistic Disorder.
The increased rates will be effective retroactive to April 15, 2016. The following services will have a 1% increase as a result of LD 1638:
  • T2017, Home Support-Quarter Hour, from $6.27 to $6.33.
  • T2017 QC, Home Support-Remote Support-Monitor Only, from $1.62 to $1.63 per quarter hour.
  • T2017 GT, Home Support-Remote Support-Interactive Support, from $6.27 to $6.33 per quarter hour.
  • T2021, Community Support (day habilitation) from $5.28 to $5.33 per quarter hour.
  • T2021 SC, Community Support (day habilitation) with Medical Add On from $6.51 to $6.57 per quarter hour.
  • Replaced H023 HQ Work Support (supported employment) with the following modifiers below:
  1. H2023 UN Work Support (supported employment-Group 2 members served, up to $3.46 per ¼ hour.
  2. H2023 UP Work Support (supported employment-Group 3 members served, up to $2.30 per ¼ hour.
  3. H2023 UQ Work Support (supported employment-Group 4 members served, up to $1.73 per ¼ hour.
  4. H2023 UR Work Support (supported employment-Group 2 members served, up to $1.38 per ¼ hour.
  5. H2023 US Work Support (supported employment-Group 2 members served, up to $1.15 per ¼ hour.
 
In response to recent changes in HCBS rules, the State is working towards, creating greater emphasis on access to community settings and a more person driven focus in the Person Centered Planning process. No members will be affected through the proposal of this rule.
 
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
 
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173, L.D. 1638
 
PUBLIC HEARING: 
Date: October 19, 2016
Time: 9:00 AM
Location: 19 Union Street, Conference Room 110, Augusta ME 04333
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed above before October 7, 2016.
 
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on October 29, 2016
Click here to submit comments.
 
AGENCY CONTACT PERSON: Andrew Hardy, Comprehensive Health Planner
AGENCY NAME: MaineCare Services
ADDRESS: 242 State St.
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4058, FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
E-Mail: andre[email protected]
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
ACTION ALERT:
Over the past few weeks the Maine Coalition for Housing and Quality Services has been involved in efforts related to MaineCare, specifically the Section 21 proposed rule changes.  DHHS released proposed rule changes that are equally dramatic for other MaineCare sections.  This past fall we discussed the proposed rule changes for Section 17, however only recently the urgency and level of severity came to light.  Section 17 provides services for people with serious and persistent mental illness.  How does this affect you and your loved ones?  There are significant numbers of people with intellectual/developmental disabilities (ID/DD) who are dually diagnosed with a mental illness and are served either by both Section 17 and Section 21, or Section 17 while on the waitlist for Section 21.  The new eligibility criteria could make many people with ID/DD and presenting with mental health related case management needs ineligible for Section 17 services. 
 
In its proposed rule changes, DHHS essentially chose two of many diagnoses (Schizophrenia and Schizoaffective disorder) as eligible diagnoses for Section 17 services.  The proposed rules do include a mechanism for including these other diagnoses as eligible for services, but the process and documentation needed is potentially a barrier.  This is very concerning as it could result in many individuals being discharged from needed case management services, and people currently housed with a BRAP (Bridging Rental Assistance Program) voucher could lose their rental subsidies.  Mental health providers estimate that services that are allowing consumers to stay successfully housed will no longer be available to potentially 8,000 of the approximately 16,000 people currently being helped with this service.  The rule changes are scheduled to take effect on April 8, 2016.  The Portland Press Herald published an editorial regarding the Section 17 rule changes and the effect they would have on vulnerable people in Maine.  Click here for the editorial.  
 
The Health and Human Services (HHS) Committee is holding a public hearing on the Section 17 rule changes this Friday, 4/1 at 1:00 pm in the Cross Building, Room 209! (Burton M. Cross Building, 111 Sewall St, Augusta, ME 04330. This building is connected to the Capitol, and there is parking in the lot surrounding it, or in the garage across the street.)  This means you now have an opportunity to testify and educate Legislators on this committee about how the rule changes might affect you.  Please note that there will be a three minute limit on testimony.  Additionally, if you prepare written testimony, please bring 20 copies for the Committee to the hearing.  But don’t let this stop you if it is a barrier.  You don’t need to speak for three full minutes if that is intimidating.  You can simply go up, state your name, briefly tell your story, and express any worries or concerns you have about the rule changes.  These worries can be redundant with what others have said.  
ACTION ALERT:
The Health and Human Services (HHS) Committee recently reported out the bill that would make the Section 21, Chapter II rule Major Substantive; the Majority Report reported Ought to Pass.  Major Substantive would mean that when DHHS develops its next proposed rule changes they would go to the HHS Committee for a public hearing prior to being finalized.  This would allow an opportunity for more eyes to look at whatever DHHS proposes and an opportunity to testify and educate Legislators about how what is proposed might affect you, as so many of you did very eloquently at the public hearing earlier this month. 
 
The bill will go first to the House, then the Senate, for consideration.  Now is the time to contact members of the Legislature, and doing so is easy – click the links below and you will be right on the Senate and House websites.  When you click on a name you will be on that Legislator’s page which lists contact information.  You can call or send a quick email.  It doesn’t have to be long and your message can be simple: 
 
“The Section 21 Rule ought to be considered Major Substantive.  Such significant rule changes, which could have a dramatic effect on families, ought to have legislative review and the opportunity for public comment.  Thank you for your consideration.”
 
I hope you will contact members of the Legislature and let your voice be heard!   
Senate Contact Information
House Contact Information
 
The HHS Committee’s thoughtful attention to our concerns throughout this Legislative session has been outstanding.  As part of this Action Alert, I hope you can take a moment to thank the ten members of the Committee who signed the Majority Report, which would make the Section 21 rule Major Substantive, for their hard work on this issue.  Their contact information can be found in the Senate and House contact information links above. 
Senators:
                                    Brakey of Androscoggin
                                    Haskell of Cumberland
Representatives:
                                    Gattine of Westbrook
                                    Burstein of Lincolnville
                                    Hamann of South Portland
                                    Head of Bethel
                                    Hymanson of York
                                    Peterson of Rumford
                                    Stuckey of Portland
                                    Vachon of Scarborough
ACTION ALERT:
The Health and Human Services (HHS) Committee is holding its third work session on the Section 21 proposed rule changes Friday 3/11 at 1:30, when they will likely vote to determine whether or not the Section 21 rule will be considered “Major Substantive”.  Major Substantive would mean that when DHHS develops its next proposed rule changes they would go to the HHS Committee for a public hearing prior to being finalized.  This would allow an opportunity for more eyes to look at whatever DHHS proposes and an opportunity to testify and educate Legislators about how what is proposed might affect you, as so many of you did very eloquently on Monday. 
 
Now is the time to contact members of the HHS Committee, and doing so is simple – click the link below and you will be right on HHS Committee website which lists each member of the Committee.  When you click on a name you will be on that Legislator’s page which lists contact information.  You can call or send a quick email.  It doesn’t have to be long and your message can be simple: 
 
“The Section 21 Rule ought to be considered Major Substantive.  Such significant rule changes, which could have a dramatic effect on families, ought to have legislative review and the opportunity for public comment.  Thank you for your consideration.”
 
I hope you will contact the Committee and let your voice be heard!   Please reach out before 1:30 tomorrow (3/11):   HHS Committee Contact Information
ACTION ALERT:
In large part due to our 1308 signatures on the recent petition (our last action alert), the Legislature’s Health and Human Services (HHS) Committee announced today it will be holding a public hearing, as part of its legislative review, on the DHHS proposed rules for Section 21 on Monday, March 7th at 10:00 am in the Cross Building, Room 209! (Burton M. Cross Building, 111 Sewall St, Augusta, ME 04330. This building is connected to the Capitol, and there is parking in the lot surrounding it, or in the garage across the street.)
 
This means you now have an opportunity to testify and educate Legislators on this committee about how the proposed rule might affect you.  This is your opportunity to raise your voice and speak!  We would do well to have plenty of parents, family members, and others speak at this hearing.  
 
Please note that there will be a three minute limit on testimony.  Additionally, if you prepare written testimony, please bring 20 copies for the Committee to the hearing.  But don’t let this stop you if it is a barrier.  You don’t need to speak for three full minutes if that is intimidating.  You can simply go up, state your name, briefly tell your story, and express any worries or concerns you have about the proposed rule.  These worries can be redundant with what others have said.  If you want to write something up to read or submit to them, you can use the sample document as a guide (click here). 
 
But it is important that you raise your voice.  Please attend this public hearing!  We have power in numbers.  Showing up will demonstrate that you care. 
 
If you plan to testify, please reply to me and Kim Humphrey (she is cc’d – just hit reply all.).  We will compile a list of speakers and come up with an order.  
 
I hope you will participate and let your voice be heard!  Thank you.
Below is a two-pronged action alert for the Maine Coalition for Housing and Quality Services.  The first is a support petition forwarded from Community Connect.  It is quick and you can simply add your name by clicking a link.  The second is an action call to reach out to members of the Health and Human Services Committee of the Legislature, or your Representatives, to ask that they formally review the proposed rule (this action can be a one sentence email).  Both are time sensitive – they require action by early Thursday morning 2/11. Thank you for taking action! 

1. Opportunity to Support Petition Effort: Maine Families Formally Petition Legislature to Intervene Over Proposed Reduction of Disability Services Funding 
The proposed DHHS rule change would substantially reduce services for disabled Mainers and violate current statute.
 
On 1/27/16 Maine families formally petitioned the legislature to intervene over proposed reduction of disability services funding. If you are an individual with a developmental disability, family member, guardian, or caretaker and did not sign the petition but would like to support the petition effort, Community Connect is offering a “show your support” sign-on link.  Please click on the link by noon, Wednesday, Feb 10th and add your name, town and role.  Names will be submitted to the Health and Service Committee. To sign-on follow this link:  https://www.surveymonkey.com/r/NKBNFF9
 
On Feb 3rd, Maine families, with the support of the Maine Association of Community Service Providers, held a press conference to announce their petition of the Maine Legislature to undertake a legislative review of a Department of Health and Human Services rule that would drastically reduce disability services funding and violate current Maine statute. The procedure for the review of state agency rules by the Legislature, under which the petition is submitted, is established in Title 5, Chapter 377-A of the Maine Revised Statutes.  The Health and Human Service Committee will respond to this petition by Feb. 11, 2016. One third of the Committee must agree to independent review in order for action to be taken.
 
Background:
The Maine Department of Health and Human Services (DHHS) has proposed a new assessment model – the Supports Intensity Scale (SIS) – to determine services for Mainers with intellectual and developmental disabilities. Studies and projections definitively demonstrate that the application of the SIS model, as proposed, would result in devastating reductions in services for this vulnerable population. This would needlessly produce substantial risks to the health and safety of the recipients and/or the recipients’ family members, caregivers, and guardians; and result in a considerable reduction in the recipients’ habilitation, normalization, community inclusion, and quality of life.
In response, affected families and advocates are petitioning the Maine Legislature, specifically the Joint Standing Committee on Health and Human Services, to undertake a legislative review.
 
As the petition indicates, the proposed rule raises the following concerns:
  1. Essential, life-sustaining and life-saving services for many individuals will be dramatically cut or eliminated, to the devastating impact of the people served, their families and the communities in which they live.
  2. Current Maine statute, as outlined in Title 34-B, lays out clear expectations regarding person-centered planning as a critical and mandated component of service delivery for persons with disabilities. The new rule would violate that statute.
  3. The assessment procedures and rates inadequately allocate the amount of services and supports required and do not accurately reflect the wide range of needs among the population of service recipients.
  4. Arbitrary service caps and limits would be established through statistical averaging instead of individual need assessments.
  5. The SIS assessment tool is subjective. It is weighted towards the perception and opinion of the person performing the SIS assessment and has strong potential to misinterpret information, as well as miss relevant information that may not be asked for.
 
Media Coverage of Feb. 3, 2016 Press Conference:
http://news.mpbn.net/post/advocates-petition-change-dhhs-scoring-system-providing-services#stream/0
 
http://wgme.com/news/features/top-stories/stories/hundreds-sign-petition-against-dhhs-rule-change-31181.shtml#.VrNuQ8dq5US
 
http://www.wcsh6.com/story/news/2016/02/03/families-petition-legislature-fight-dhhs-rule-change/79776786/
 
2.  Opportunity to ask the Legislature’s Health and Human Services Committee to review the proposed rules:If you wish to see the proposed Section 21 rules receive formalHHS Committee review, which could include a public hearing, please contact members of the HHS Committee, the leadership of both chambers, and/or any Legislator with whom you have had any contact or formed a relationship.  The message is simple:  You want an opportunity to go on the record with the members of the HHS Committee about serious concerns with the proposed Section 21 rules and how they would affect your loved ones.  Below are links to legislative e-mail addresses, as well as contact information for members of the HHS Committee.
 
Senate Contact Information
Email Addresses for House Members
HHS Committee Contact Information
ACTION ALERT:
This morning Todd Goodwin, president of Maine Association for Community Service Providers (MACSP), delivered the petition requesting legislative review of the proposed Section 21 rules to the Executive Director of the Legislature.  It appears that that the petition will be delivered to the HHS committee as early as today but no later than Friday afternoon.  The petition will be reviewed by each member of the Health and Human Services (HHS) Committee and a decision will be made among them regarding whether or not to review the proposed Section 21 rules.
 
The petition raises many of the concerns the Maine Coalition for Housing and Quality Services expressed in its letter of testimony, including (but not limited to) issues of the Supports Intensity Scale (SIS) being weighted more heavily than the Person Centered Planning (PCP) team process, the SIS results potentially not matching support needs, limitation of the three-tiered service packages, and concerns that the Qualified Extra Support Service (QESS) may be unable to meet extraordinary needs due to restrictive staffing requirements.
 
If you wish to see the proposed Section 21 rules receive HHS Committee review, which could include a public hearing, please contact members of the HHS committee, the leadership of both chambers, and/or any Legislator with whom you have had any contact or formed a relationship.  The message is simple:  You want an opportunity to go on the record with the members of the HHS Committee about serious concerns with the proposed Section 21 rules and how they would affect your loved ones.  Below are links to legislative e-mail addresses, as well as contact information for members of the HHS Committee.
 
Senate Contact Information
Email Addresses for House Members
HHS Committee Contact Information
Click here for the comments sent on behalf of the Maine Coalition for Housing and Quality Services regarding the Section 21 Proposed Rule Changes.
ACTION ALERT:
 Some 150 people showed up Tuesday to testify/comment about the proposed rulemaking for Section 21 at the Public Hearing (January 5th).  About 41 people commented over a rather intense 5 hour period.  The predominant and nearly unanimous theme was significant concern about the effects of using the SIS (Supports Intensity Scale) to put people into five categories with three funding schemes.  Concerns were expressed redundantly about this translating into reductions of services for people, particularly people who have significant support needs.  Examples were given about how the proposed rules would result in cuts of over 50% in some cases.  Concerns were also expressed that although DHHS had developed a safety net system for going above and beyond any funding level cap, that system – the Qualified Extra Support Services (QESS) – appears to have a flaw in the increased qualifications the person delivering services would need, including a minimum of 3 years of tenure at an agency.  Because of turnover alone (there are other concerns as well) this flaw could create a barrier for the extra services to be delivered.  That left people worried about effective reductions in services in the new system over the old system.  There was a wide array of press coverage about the hearing and the press conference held by Community Connect.  The following two articles are good examples and they do a good job of capturing the concerns expressed.  I encourage you to read them and familiarize yourself with the proposed rule, a link to which is pasted later in this email.  Comments are still being taken through January 15th, so there is still time to weigh in on this important set of changes! 
http://news.mpbn.net/post/families-caring-adults-intellectual-disabilities-speak-out-against-dhhs-funding-formula
 
http://www.pressherald.com/2016/01/06/out-of-the-spotlight-dhhs-cuts-away-at-humane-care/
Updated information about the proposed rule is pasted below, copied from the emailed ACTION ALERT that I sent out last week: 

​ACTION ALERT
DHHS has released the Proposed Rule changes under MaineCare Benefits Manual, Chapter 21, Section III, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder and Chapter 21, Section II, Home and Community Benefits for Members with Intellectual Disabilities. (Chapter III is a major substantive rule change, however Chapter II is not). 
 
This is a lengthy and complicated set of proposed rule changes.  I encourage you to read them and see what you like and don’t like, and to provide feedback accordingly. 
 
DHHS is implementing a standardized assessment process and resource allocation model for this waiver program.  DHHS is proposing utilizing the Supports Intensity Scale (SIS) as the primary assessment and resource allocation tool. 
 
There are significant number parents who have concerns about parts of this and wish to oppose or ask the department to delay the draft rules until their concerns can be more carefully considered.  Chief among the concerns is the heavy emphasis on one assessment (the SIS) versus a broader approach that takes into account the person as a whole.  Other concerns include a potential for insufficient funding allocations for adequate services, especially for those who are more medically and/or behaviorally challenged.   
 
On the other hand, there are parts of these rule changes that appear to have come from feedback received from families and others within our Coalition.  These include approving 2:1 staffing for community support, and removing some caps from services authorized by the Extraordinary Review Committee; extra support is now proposed to be based on need and documentation provided, without any caps (although they do contain additional qualification requirements that may be difficult to achieve).  Commenting about the rule might present an opportunity to acknowledge the Department’s responsiveness to feedback, and to note parts that you see as in the right direction along with any concerns. 
 
The time to speak your mind about the proposed rule change is NOW, by submitting them as described below.  This is an opportunity for families and other interested parties to have their voices heard and influence the outcome of the rule making process, which will affect many within the developmental disabilities community. 
 
The Department is accepting public comments until midnight tonight, January 15, 2016:
 
Please submit comment/questions to:  
Andrew Hardy, Comprehensive Health Planner II, [email protected]
MaineCare Services
242 State Street, 11 State House Station Augusta, Maine 04333-0011
207-624-4058, FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
ACTION ALERT
There are Proposed Rule changes under Section 17 Community Support Services.
 
The rule changes proposed would essentially exclude any individuals with autism from receiving Section 17, regardless of co-occurring mental health diagnosis/treatment need. If you have an individual with autism and currently have section 17 you should be aware of these rule changes.

DEADLINE for public comment is open until tomorrow December 11 at midnight.
 
The Department of Health and Human Services Maine Care Services is seeking comments by 12/11/15 on Proposed rule changes to Section 17:  Community Support Services. 
Review the proposed rule change here. In summary, changes:
  • Change eligibility requirements to exclude adults (18 years or older) who have a diagnosis of Neurodevelopmental Disorders (this includes Autism Spectrum Disorder and Intellectual Disability) and
  • Requires a clinician written report that the individual would be at risk for homelessness, criminal justice involvement or require mental health inpatient treatment for more than 72 hours or residential treatment
Since many individuals have a dual diagnosis (Autism Spectrum Disorder/Intellectual Disability and Mental Health Disorders), depending on the needs, they may have utilized Section 17 Community Support Services, particularly while waiting for funding for Developmental Services or when Section 29 Home and Community Supports did not provide adequate supports.  Please comment/questions to:  
Heidi Bechard, Comprehensive Health Planner II at [email protected].

Autism Society of Maine
ACTION ALERT
 
Currently the Chapter 5 Regulations Governing Behavioral Support, Modification and Management for People with Intellectual Disabilities or Autism are in an extended public comment period.  The Department extended the timeframe and is offering an additional public hearing option on December 8th because stakeholders requested more time to respond. Written comments are due December 18th.   The link to the regulations is here: 14-197.Ch.5-Proposed.RuleFINAL10.20.15-3.docx
 
Because the Department listened to stakeholders by extending the comment period, we now have an opportunity to reinforce their good actions by sending in comments and/or participating in the public hearing.  Dates, time and locations:
 
Public Hearing:    December 8, 2015, 19 Union Street, Room 110, Augusta, ME, 9:00 am
 
Comment Deadline: Midnight, December 18, 2015
 
A document compiled on points to consider may assist your understanding of the regulations.  Click here for the document.
 
We have an opportunity now to influence the final version of the behavioral regulations policy that will affect many within the developmental disabilities community for years to come.  Please take this opportunity to express your opinion.
There is an opportunity for families and other interested parties to testify on LD 475, “Resolve, To Increase MaineCare Services for Certain Recipients To Allow Them To Remain at Home.”

Representative Stuckey has introduced LD 475, which would raise the dollar cap for Section 29.  This has become a much more robust service but the cap wasn’t raised when additional services were added, and continues to stand at just over 20 hours per week.  Where that is insufficient, the only other option is Section 21.  The proposed increased cap would dramatically extend the range of the Section 29 waiver, allowing it to reach up to 40 hours per week, which is enough to allow a parent to work.

A public hearing is scheduled for Thursday, March 26th at 1:00 PM. 

Key things to note:
  • Testimony is limited to three minutes.
  • When you arrive, you will put your name on a list and be called to testify by the Committee.
  • Location is Room 209, the Health and Human Services Committee, in the Cross Building in Augusta.
There is an opportunity for family’s to testify about the impact of waitlists for their family members this Friday, March 6th beginning at 10:00 AM at the Joint Standing Committee on Appropriations and Financial Affairs. 

David Sorenson, DHHS Director of Media Relations and Policy Research, has kindly offered to speak with any family member if they had further questions.  His contact number is 205-7793

Key things to note: 
  • Testimony is limited to three minutes.
  • When you arrive, you will put your name on a list and be called to testify by the Committee.
  • You can arrive anytime between 10:00 AM and 12:00 PM for this portion of the budget.
  • Location is Room 228, the Appropriations Committee, in the State House in Augusta.
Below is a full action alert as put out by Maine Equal Justice Partners, National Alliance on Mental Illness (NAMI-Maine), and others, asking you to reach out to your state legislators in the next two days to leave a one sentence message asking them to vote to overturn the Governor’s veto of Medicaid Expansion.  Please note that this bill contains a provision (highlighted in green below) designed to: “Implement reforms in programs for adults with intellectual disabilities and use savings to reduce waiting lists for services.”  Please see below and do make your voice heard!  Help ensure everyone has the healthcare they need, and that we have the resources to deliver it most efficiently rather then through emergency services for people who are not covered.


HELP 70,000 PEOPLE GET ACCESS TO CARE

Today, as expected, the Governor vetoed the expansion of Maine Care and effectively saying no to 4000 new jobs in Maine, $1 million a day in federal money coming into Maine that goes to our hospitals, our Health centers, health care providers across Maine and most important access to health care for 70,000+ Mainers. Healthier people mean better workforce and lower health care costs for everyone.  We already are feeling the dramatic and devastating impact resulting from those fellow Mainers who have lost their Maine Care coverage since January 1st and it will likely get worse.  The Statewide Homeless Council heard yesterday from DHHS representatives:  “The #1 service that keeps people housed is MaineCare.” We know the cost borne by other State and local agencies will rise with more people being denied access to health care.  The costs don’t disappear.  What does disappear is 100% funding from our federal government for the next 2+ years with no local match.

Now is the time for action!! Today and tomorrow please call your local Senator and Representatives.  They represent you, your business, your community, and the people of Maine. Urge them to override the Governor’s veto.  The vote to override is likely to happen on Friday April 11.  You must call today or tomorrow to have your voices heard. Even if you have called before, please take the time to do it again. 

If you don’t have your Representative’s or Senator’s phone number you can call the

House 1-800-423-2900 and Senate  1-800-423-6900

Not sure who your State Legislators are?  Look them up at: 

http://www.maine.gov/legis/house/townlist.htm

Please Call Today!

Tell Legislators to

Override the Governor's Veto (LD1487) and

Accept Federal Funds for Health Care

Now that the Governor has vetoed the bill, it goes back to the Senate. Two-thirds of the Senators present must vote to override the veto to keep the bill alive. If they do, the bill then goes to the House of Representatives where two-thirds of those present must vote to override the veto. 

If successful, LD1487 will become law and Mainers, who otherwise can't afford it, will have health care coverage later this year!

Call and leave a message for your legislators.

EVEN IF YOU HAVE CALLED BEFORE - Please call NOW!

Urge them to vote to override the Governor's veto. Urge them to vote so that more Maine people can have coverage who otherwise will not have access to health care.  A vote to override the Governor's veto will bring in hundreds of millions of dollars into Maine to stimulate our economy, and maintain and create jobs.

Your call can make a difference!

It will only take a few minutes. You can leave a message 24 hours a day.

Senators:  1-800-423-6900  Representatives: 1-800-423-2900

When you call, state:

    • Your name,
    • Town that you live in,
    • Your legislator's name, and
    • A brief message. For example: "Please vote to override the Governor's veto of LD1487.  Accept the federal funds that will provide health care.  Maine people will be healthier and our economy will be stronger."
If you would like to talk with your legislator, be sure to leave your number and the best time for her/him to call you back.

Thank you for calling. Please ask at least one more person to do the same.

Here are the key elements of LD 1487:

  • Accept federal funds for Medicaid expansion that would cover close to 70,000 Maine people;
  • Slowly transition MaineCare members to Managed Care after a stakeholder process and rulemaking that includes strong consumer protections;
  • Study to determine the savings to the General Fund from Medicaid expansion, and study to determine whether covering MaineCare members through the Marketplace is more cost effective;
  • Strengthen the Attorney General's ability to investigate fraud in the MaineCare program and prosecute crimes related to misuse of all public funds;
  • Set up a task force to identify policies in MaineCare that penalize or create disincentives for members to increase earnings or hours of employment;
  • Implement reforms in programs for adults with intellectual disabilities and use savings to reduce waiting lists for services; and
  • Notify new enrollees about the length of coverage and the need to sign up with a primary care provider (PCP).
 
Click Here for Biennial Budget for 2014 & 2015

Click Here for LR 1046 Biennial Budget PH Schedule Weeks 3 and 4

Click Here for the Letter on behalf of the Coalition in support  of LD499 3.19.13
Action Alert

Speak Up NOW!

Help protect prescription drug assistance and  

health care services for seniors and people with disabilities.

Right now, Maine legislators are making important decisions about funding for the Medicare Savings Program (MSP) and the Drugs for the Elderly & Disabled program (DEL) in the state biennial budget. 

Now is the time to speak up!

Protect MSP and DEL

Send a quick email or call and leave a message for your legislators.   

Ask your legislators to protect prescription drug assistance and health care services for seniors and people with disabilities.  Urge them to oppose cuts to MSP and DEL.



Email or call today!   Things are moving fast so please email or call your legislators today, then ask one other person to do the same.  

 Who are my legislators?  What are their emails?  Look here.  

Legislature's toll-free message service:
Representatives: 1-800-423-2900 
Senators: 1-800-423-6900

You can leave a message 24 hours-a-day.  When you call, state:
·   Your name
·   Town that you live in
·   The name of your legislator, and
·   A brief message:

"Please protect prescription drug assistance and health care services for seniors and people with disabilities."   

"Don't cut MSP and DEL."

If you would like to talk with your legislator, be sure to also leave your number  

and the best time for her/him to call you back.

Thanks for speaking up! 

For more info, go to:  www.mejp.org 
ACTION ALERT 1: 

Email the Maine Delegation to stop sequestration! Click Here For the Template

Sequestration is an automatic 5.1% cut to every federal program including HUD which has everything to do with housing.  These cuts will take place on March 1st (this Friday) unless Congress acts before or soon after then.

Above is a template you can use to create four separate emails or emailed letters to our Congressional Delegation.  Feel free to create your own letters or use the template as a guide.  If you use the template, the first page lists the salutations for each of the four letters.  Then paste in the body, and replace the [CAPITALIZED] portions as you see fit.  There is a section for you to describe your personal situation.  A sentence will do, but feel free to elaborate as you see fit to paint a picture.  Then add your name at the end, and email your letters to the addresses below.  I have attached sample letters I have sent on behalf of the Coalition for your reference.  They lack the powerful personal stories yours will contain. 

These can be sent to the housing staffers at emails below, if you click on each persons name you will also be able to open a template letter:

Congressman Michaud – Daniel Walls:  [email protected]

Congresswoman Pingree – Matt MacKenzie:  [email protected]

Senator Collins – Jason Woolwine:  [email protected]

Senator King – Lauren.Pfingstagt:  [email protected]

Please cc [email protected] with each email so I can keep count and follow up with each member of Congress! 
ACTION ALERT 2: 

Help us find co-sponsors! 

Representative Peter Stuckey has sponsored a bill on behalf of this Coalition and people with developmental and intellectual disabilities in Maine.  I am pasting it below.  It is also attached as “Resolve as Introduced”.  We have 5 days to help him find co-sponsors!  As Peter is a Democrat in the House, the ideal match would be a Republican Sponsor in the Senate.  But any co-sponsors would be very helpful to its passage.  If you have someone in mind, please contact me, Peter Stuckey [email protected] , or your Representatives directly to ask them to co-sponsor this legislation:

Sponsor: Rep. Stuckey

Drafter: ATB

Doc. Name:       119601 

Date: February 25, 2013

File: For a Printable Copy Click Here

                Resolve, To Direct the Department of Health and Human Services to Reduce and Limit the Adult Developmental Services Waitlists by Implementing a More Efficient, Responsive and Individualized Model of Service Delivery

                Emergency preamble.  Whereas, Acts of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and

                Whereas, children with disabilities have an entitlement under state and federal law to receive services as needed in order to succeed in the most appropriate educational settings but there is no entitlement to services when young adults with disabilities exit the public school system;

                Whereas, intellectual disabilities and autism are life-long conditions requiring various degrees of support, both paid and unpaid, throughout adulthood; and

                Whereas, the MaineCare program Chapter 101, Chapter II, sections 21 and 29 are the only funding mechanisms available to support adults with intellectual disabilities and autism in Maine; and

                Whereas, waitlists for these sections 21 and 29 programs have grown dramatically so that approximately one thousand Maine citizens are on these waitlists, a situation that is unacceptable and demands a solution; and

                Whereas, the individuals on the waitlists are in danger of losing skills every day they go without services and their families experience stress, economic hardship and other pressures associated with caring for adult family members; and

                Whereas, the Maine Coalition for Housing and Quality Services formed in May 2006 has developed a white paper describing a model of service designed to streamline and improve services and this white paper has been generally endorsed by the Department of Health and Human Services and a stakeholder work group formed pursuant to Public Law 2011, chapter 477; and

                Whereas, in the judgment of the Legislature, these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety; now therefore,

                Sec. 1.  Department of Health and Human Services directed to request approval to amend the Section 21 and 29 waivers to permit reimbursement for the use of appropriate technology.  Resolved:  That the Department of Health and Human Services shall request approval from the Centers for Medicare and Medicaid Services to amend the waivers for Section 21, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder, and Section 29, Support Benefits for Adults with Intellectual Disabilities or Autistic Disorder, to permit the reimbursement for use of appropriate electronic technology as a means of reducing the costs of supporting people currently being served.  Appropriate use of technology includes, but is not limited to, increasing independence and reducing reliance on staff during overnight hours.  The department shall submit the application for both waivers by July 1, 2013; and be it further

                Sec. 2.  Rulemaking to implement technology updates.  Resolved:  Upon the approval of the amended waivers by Centers of Medicare and Medicaid Services pursuant to Section 1, the Department of Health and Human Services shall undertake rulemaking to amend the rules on the MaineCare program in Chapter 101, MaineCare Benefits Manual, Chapter II, Sections 21 and 29 to add electronic technology.  Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, title 5, chapter 375, subchapter 2-A; and be it further

                Sec. 3.  Department of Health and Human Services directed to amend the Section 29 waiver to add home support services.  Resolved:  That the Department of Health and Human Services shall request approval from the Centers for Medicare and Medicaid Services to amend the Section 29, Support Benefits for Adults with Intellectual Disabilities or Autistic Disorder, waiver to add home support as a covered service.  Home support is a direct support provided to a member in the member’s home by a direct support professional to improve and maintain a member’s ability to live as independently as possible in their own home and primarily consists of personal assistance, such as meals, cleaning and personal care.  The department shall submit the application for the waiver by July 1, 2013; and be it further

                Sec. 4.  Rulemaking to implement home support services.  Resolved:  Upon approval of the waiver by the Centers of Medicare and Medicaid Services pursuant to Section 3, the Department of Health and Human Services shall undertake rulemaking to amend the rules on the MaineCare program in Chapter 101, MaineCare Benefits Manual, Chapters II, Section 29 to add home support services as a covered service.  Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, title 5, chapter 375, subchapter 2-A; and be it further

                Sec. 5.  Savings generated by electronic technology and home support services.  Resolved:  Savings generated by the use electronic technology and home supports, particularly in preventing the need for individuals to receive services under Section 29, Support Benefits for Adults with Intellectual Disabilities or Autistic Disorder, requiring services under residential services under Section 21, must be used to serve additional people currently on the waiting list for these waiver programs; and be it further

                Sec. 6.  Implementation of adult developmental services working group interim recommendations.  Resolved:  The Department of Health and Human Services shall report to the Health and Human Services Committee and the Appropriations and Financial Affairs Committee by June 1, 2013 describing the status of the implementation of recommendations from interim reports by the adult developmental services working group formed pursuant to Public Law 2011, chapter 477, Section W-1.  The department shall incorporate the following recommendations from the adult developmental services working group for individuals with intellectual disabilities and autism into a plan:

1.     Each person will receive a strength-based standardized individualized assessment of that person’s strengths or needs to inform a person-centered plan.

2.     Each person will be assessed for the natural family and community support networks potentially available to that person.

3.     The state will establish a broad menu option model designed to match the amount and kind of paid support services needed by each individual.

4.     Each person will have a designated community resource assistant whose job it is to help an individual at any age navigate the local array of services.

5.     The state will develop a thorough and accessible information repository.

6.     The state will establish early support and planning for steps to transition from childhood services to adulthood services.

7.     The state will undertake educational efforts in each neighborhood to educate and foster inclusiveness and awareness of the community.

8.     The state’s developmental services will deliver only the paid services needed.

9.     Formal services will be based on individual and realistic needs.

The department shall develop a plan with clear steps and a timeline to ensure that current and future waitlists do not exceed six months.  The Health and Human Services Committee is authorized to report out legislation to the Second Regular Session of the 126th Legislature pursuant to this section.

                Sec 7.  Emergency Clause.  In view of the emergency cited in the preamble, this Resolve takes effect when approved.

SUMMARY

                This emergency resolve requires the Department of Health and Human Services to request approval from the Centers for Medicare and Medicaid Services to amend the MaineCare waivers for Section 21, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder, and Section 29, Support Benefits for Adults with Intellectual Disabilities or Autistic Disorder, to permit the reimbursement for the use of appropriate electronic technology as a means of reducing the costs of supporting people currently being served.  It also requires the department to apply to the Centers for Medicare and Medicaid Services to amend the Section 29 waiver add home support as a covered service.  Home support is a direct support provided to a member in the member’s home by a direct support professional to improve and maintain a member’s ability to live as independently as possible in their own home and primarily consists of personal assistance, such as meals, cleaning and personal care.  Upon approval of the granting of the amended waivers, the department is required to undertake rulemaking to amend the Maine Section 21 and 29 rules to reflect the changes in the waiver.  Any savings from the use of electronic technology and the provision of home support services must be used to serve additional people on Section 21 and 29 waiting lists.

                The resolve also requires the Department of Health and Human Services to report to the Health and Human Services Committee and the Appropriations and Financial Affairs Committee on the status of the recommendations of the adult developmental services working group formed pursuant to Public Law 2011, chapter 477, Section W-1.  The department is required to develop a plan to incorporate the recommendations from the adult developmental services working group including specific steps and a timeline to ensure that current and future waitlists do not exceed six months. 

Helpful Links

Maine Coalition for Housing and Quality Services - This is your Coalition.  Thank you for being a part of it!
c/o Community Housing of Maine, One City Center, 4th Floor, Portland, ME 04101 (207) 879-0347