January 10, 2022
Minutes
Minutes
Attendees via Zoom: Alan Cobo-Lewis, Alexandria Twombly, Alli Vercoe, Amy Moller, Ann-Marie Mayberry, Andrea Liming, Betsy Hopkins, Betsy Mahoney, Bonnie Robinson, Brenda Smith, Bryan Gorgon, Carol Snyder, Chris Call, Darla Chafin, David Cowing, Debbie Dionne, Diane Boas, Heidi Mansir, Helen Hemminger, J Richardson Collins, Janet Dibiase, Jodi Benvie, Julie Brennan, Kim Humphrey, Laura Cordes, Lauren Wille, Libby Stone-Sterling, Linda Lee, Lisa Wesel, Lorraine DeFreitas, LyAnn Grogan, Maggie Hoffman, Margaret Cardoza, Mark Kemmerle, Michaela York, Nicholas Orr, Paula Bush, Rachel Dyer, Ray Nagel, Rob, Robin Levesque, Shane Ashe, Sharlene Adams, Shelly Zielinski, Stephanie Capano, Sue Murphy, Teresa Barrows, Todd Goodwin, Trena Jackson, Vickey Rand, Cullen Ryan, and about five people who joined the meeting in progress and/or left prior to its conclusion.
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Minutes from the last meeting were accepted. For the sake of time, Cullen read the names of participants.
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). meacsp.org Topic: Introduction to the Second Session of the 130th Legislature: Bills to watch, what to expect, and related discussion including how people can advocate to effect positive change in the Legislative Session.
Cullen: Today we have Laura Cordes, Executive Director of MACSP, introducing the Second Session of the 130th Legislature. Laura will highlight bills to watch, what to expect, and the ways people can advocate to effect positive change in the Legislative Session. Laura acts as a watchdog at the State House and regularly updates this group on what’s going on in the Legislature, highlighting opportunities for people to take action, and often even speak with one voice to effect collective change. Thank you for being here today, Laura!
Laura Cordes: Thank you for having me today! For people who may not be familiar with MACSP: The Maine Association for Community Service Providers (MACSP) is an association of organizations that provide supports and services to children and adults with intellectual disabilities, Autism and Brain Injuries in Maine. MACSP’s mission is to represent individuals and organizations that support persons with disabilities to live, learn, and work in the community of their choice through legislative action, organizational advocacy, training, and public education. Our members represent more than seventy organizations operating in all sixteen counties of Maine providing comprehensive services across the state. MACSP has been part of the Coalition well before my time. Time flies – I joined MACSP right before the pandemic. I’ve been proud to represent providers, and I love the networking, even though it’s been mostly virtual, that I’ve been able to do with all of you. It’s also been an opportunity for me to get information on bills that this group worked on before my time, this group’s expertise, and information on the relationships this group has developed and fostered with Legislators over the years.
The Second Session of the 130th Legislature, known as the short session, began the first Wednesday of January, and is scheduled to end the second Wednesday in April. The House and the Senate were convened in person to start the Session, but all Committee meetings moving forward will be held virtually moving forward due to the surge in the Omicron variant – at least through the end of January. I think that the Zoom option has increased participation in Public Hearings, as it saves travel time to Augusta etc.
I created a Google Doc last session and amended it for this Session that includes the LDs, LRs, and carry over bills as I know them. This is a working document and can be edited. If there’s something you’d like to add feel free to email myself, Cullen, or Vickey. I’ll do my best throughout the session to update this document. The document is organized into carried over bills from 2021 and new bills for this session. The document also includes key Committees, their members, and their contact information. There are also useful links, the first of which can take you to the Legislature’s homepage and is where you can find your legislators. (Click here for the Google Doc for the 2nd Session of the 130th Legislature that Laura reviewed in-depth.).
Committee and public hearings have started as of this week. The Maine Legislature does a two-year Biennial Budget. It is expected that the Governor will release a Supplemental Budget to adjust for income and expenses in the current fiscal year. When this occurs, the Governor will release her budget proposal, then Legislators, Committees, etc. respond to that Budget. What I’m hearing is that the Governor will probably come out with her Budget in mid-to late-January. The Budget would go to the Appropriations and Financial Affairs (AFA) Committee, with an opportunity to provide public comments.
(Laura reviewed the carried over bills from 2021. Please see the document for information on the bills that Laura provided.)
Laura: Several bills that this group followed closely last year were carried over, including bills pertaining to: Establishing a family care-giver tax credit; rate increases for Targeted Case Management; improving behavioral health for children; improving the IEP process; enhancing the Maine Developmental Services Oversight and Advisory Board (MDSOAB) and establishing the Mortality Review Panel; addressing the workforce crisis; eliminating the waitlists; and establishing a behavioral add-on rate. Bills can be carried over at any point in the process so long as they haven’t been enacted into public law, such as bills that were on the Special Appropriations Table that were not funded off the Table prior to adjournment, bills that passed out of Committee but not passed by the House and/or Senate, bills that had a Public Hearing but not a Work Session, etc. Bills that have had Public Hearings and were carried over will likely not receive additional opportunities for public comment/testimony.
-It was stated that parent consent to change an IEP was included in LD 552.
Laura: Regarding LD 716 – this bill included changes to the MDSOAB and established a Mortality Review Panel. Money was included in the Biennial Budget to establish a Mortality Review Panel; however, other components included in the bill to enhance the MDSOAB were not addressed and would be in the carried over bill.
Cullen: The Mortality review Panel goes back to the OIG report, which highlighted that there were people who died while receiving services and there was wide agreement each mortality ought to be investigated so the system can learn and evolve from it.
Laura: There has been some confusion in the advocacy world around LD 1573, the bill that would implement the recommendations of the Commission to Study Long-Term Care Workforce Issues. The bill itself did not pass and was carried over. However, some provisions of the bill were included in the Biennial Budget, such as the rate increases to 125% of minimum wage. It’s worth noting that the rate increases have not actually gone into effect, though they were supposed to as of 1/1/2022. The Department recently released a memo pertaining to this, stating that when the rates do come out, they will be retroactive to 1/1/2022; however, the rate increases will not go into effect until the Governor’s supplemental budget passes, which is expected to include additional funding to pay for this increase as well as additional cost of living increases. It may be a few more months until providers can access the funds needed to actualize these increases – a disappointment for providers and direct support staff.
-A provider asked if the fact that LD 1573 didn’t pass and that aspects were just adopted as part of the Governor’s Budget means that the funding can be taken out of future budgets. He also asked how the Department came up with its new rate methodology.
Laura: My understanding is that the rate increases will remain in the budget moving forward.
-It was stated that the Department has released its Primary Care Plus initiative proposed rule. It was asked what this might mean in terms of services for people with ID/DD.
Laura: I’m happy to look into this further.
Rachel Dyer – Maine Developmental Disabilities Council: This is a question that could be addressed to the MaineCare Advisory Committee. Perhaps they could provide more information. I’d be happy to send an email to make this connection.
(Laura reviewed the new bills that will be heard this Session. Please see the document for more in-depth information on these bills.)
Laura: The list of new bills is likely to grow. The Legislative Council met to review approximately 300 emergency bills submitted by legislators; about 150 of those bills got through (click here for the final list of bills). Not all new bills have bill text yet – these bills will get language in the next couple weeks.
-A parent stated that when she read the bill text for LD 1773 it appeared to ask the Department to stop the process for the implementation of the Department’s rule which would implement changes relevant to the federal HCBS Settings Final Rule. She stated that as the shared living provider for her son this is very concerning. Not coming into compliance with the Federal Rule would put 66% of the HCBS funding at risk.
Laura: I think we have a difference of opinion regarding what this bill does. I don’t believe this bill would stop the Rule from going into effect, rather it would allow more communication between the Department and the Legislature. And it would give providers more time to come into compliance, but still well before the due date for Federal compliance.
Alan Cobo-Lewis: I think the concerns providers have about coming into compliance are valid. When it comes to the actual text of the Rule, it looks very similar to the Federal Rule. The few things I wanted the State to change upon my first read are actually requirements of the Federal Settings Rule. I think many provider issues are about the transition plan and not the Rule itself. That being said, I’m never against Rules being considered Major Substantive.
Laura: This topic is something that’s important to all of us and that we’ll continue to discuss here.
-A parent asked if Betsy could provide more clarity around this.
Betsy Hopkins: The comments on the Rule are still being reviewed by the AG’s office, so we’re not in a place to comment on this until after that has concluded.
-A provider stated that from a technical perspective, if Maine’s HCBS Settings are not approved by the Federal Government there is the potential to lose 66% of the state’s HCBS funding. It was stated that providers told the Department that its interpretation of the Federal Rule was an overreach. Other states have far fewer requirements than Maine is proposing. In a recent call, Derek Fales stated that it was discovered that Maine’s interpretations are much more exacting and far more than the Federal minimums, and that they were proud of that fact. Now would be the time for providers, family members, self-advocates, etc. to look at what Maine is asking and if it’s feasible from a funding and staffing perspective, and if it’s overall practical. And then, wage your opinion on everything that you’ve looked at.
-A parent stated that her son’s needs are not being met with current staffing. The current rate is about $11.85 per hour. She stated that her understanding is that the Department’s methodology regarding rates have changed. She asked what 125% of minimum wage actually means.
Laura: This is a separate issue and a wrinkle in the Department’s implementation of the Legislature’s directive to have rates be at least 125% of minimum wage. After the budget was passed the Department changed the methodology for rates without stakeholder engagement. They did include an increase to the rate over the summer, bringing the rates to minimum wage or perhaps a little more – but nowhere near 125% of minimum wage. The rate model the Department adopted has components that would reduce the rate significantly.
Betsy Hopkins: I’ll say there is discrepancy and disagreement between what Laura is saying and what the Department has been saying regarding the rate methodology. Having said that, it’s really the Office of MaineCare Services that would best answer questions about rates. I know that Laura shared information from a memo that’s gone out that discusses this and what that means for 125% of minimum wage. The budget allotted to meet 125% of minimum wage is not sufficient, which was discovered after the First Session ended last year. As such, additional money needs to be included in a Supplemental Budget to actualize these rate increases. About the rate methodology questions, I can’t answer those detailed questions regarding which rate methodology was used and how and why and what it will look like at this point.
Laura: To address the overall question of will this be enough – the Governor’s Supplemental Budget has yet to be released but I don’t believe it will be sufficient. However, between now and when the budget is released things could change and I remain hopeful. We’re all working towards the same goal to ensure that the intent of 125% of minimum wage is met.
Back to the list of new bills. The following bills have public hearings scheduled. If you want to submit testimony online or give your testimony live you can do so online (click here).
Alan Cobo-Lewis: As Laura said, LD 1798, An Act To Ensure Health Insurance Coverage for Certain Adults with Disabilities, is scheduled for a Public Hearing tomorrow, 1/11/22, at 10am in front of the Committee on Health Coverage, Insurance and Financial Services. This bill requires health insurance policies that offer coverage for a dependent child to cover adults with disabilities who are unable to sustain themselves through employment. As such, it appears the bill would require state-regulated health insurance that covers dependents to offer coverage for dependents with disabilities beyond age 26 – as forty other states have implemented. I think this would have a number of uses, including:
If adults with significant disabilities could access additional health insurance through a policy covering their family, as this bill would achieve, some of them could at least get some of their needs for these services met while awaiting service offers on the waitlists for more comprehensive Section 21 services. I urge you to submit testimony in favor of LD 1798, as it has numerous benefits for people with disabilities in Maine.
For submitting testimony online and/or signing up to testify live: Click this link, select “Public Hearing,” select the Committee from the drop-down menu (Health Coverage, Insurance, and Financial Services), choose the date of the Public Hearing (January 11, 2022 10:00AM), select the bills for which you are providing testimony (LD 1798), check off the “I would like to present my testimony live” box if you would like to do so (if so also select if you are for, against, or neither for nor against the proposed legislation), upload your testimony by clicking “Choose File” or copy/paste your testimony in the box provided, then enter you contact information and Submit/Register.
Laura: There are a few more bills I want to note:
Discussion:
-A self-advocate stated that bills in the Legislature can become very political in nature. She stated that she doesn’t go to a restaurant and hear the waitress complain about not getting paid enough. She stated that the rate/wage conversation is a delicate one and that rather than having polarizing sides, a thorough dialogue is ideal.
-A parent stated that different from the example provided, these services are covered by tax-payer dollars. As such, this discussion pertains directly to this group – not only as family members or individuals, but as taxpayers. She stated that she feels like the discussion is very respectful here.
-A self-advocate stated that the meeting is very respectful. However, in previous Administrations she’s witnessed different communication styles some of which could be considered more aggressive. She asked providers to consider how communicating about not having enough money etc. might sound to consumers. She stated that phrasing things from a positive standpoint is always helpful.
-A parent stated that it might be helpful that when there are discussions regarding money to detail how it affects people receiving services so that it’s person-centered.
Cullen: Thank you very much, Laura, for taking the time to provide such a thorough review of what’s to come in this Legislative Session. I will say that I believe that the Legislature is filled with people who really want to make things better for this population. I have come to believe that not everyone knows how to do that perfectly. However, people around this table are experts and well-poised to inform Legislators so that they get it right. I’ve heard time and time again that when Legislators hear from more than two or three people, they really start to pay attention. Your voice is important, and I would encourage you throughout this legislative session to have a story you can tell to add to any testimony you provide so Legislators can better understand your world. I encourage you to raise your voice and be heard, so that these folks trying to do good can do so most effectively with the benefit of your education and advocacy. Thank you again, Laura; well done!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins: I’ll start off with a couple of things.
OADS Stakeholder Meetings: Early on in the pandemic we had weekly stakeholder meetings. These were primarily geared towards providers to get up-to-date information on COVID. We received feedback that these were very helpful. When things eased around the pandemic we moved back to monthly meetings. Tomorrow is our stakeholder meeting. We’re moving those to twice each month – the 2nd and 4th Tuesdays of the month. Tomorrow’s meeting will include guidance and will be a good opportunity to hear the most recent information on COVID, the Omicron variant, and other important information.
Mortality Review Panel: The Mortality Review Panel was discussed earlier. The CDC is still in the process of hiring the person to oversee the Mortality Review Panel. Potential panel participants are also being reviewed.
-A parent asked if there’s a report out on the causes of death, for the purpose of writing the quality indicators.
Betsy: APS has a report they provide to the Legislature with detailed information on this.
-A parent asked if the panel includes the waitlist and if its retrospective.
Betsy: Yes, it includes anyone who is eligible in our system. I’m not sure if it’s retrospective.
Bonus Payments
Laura Cordes: Will there be some updated guidance released soon?
Betsy: Yes, there will be. That’s one of the things that will be discussed on the Stakeholder call tomorrow.
Other FMAP Projects
Listening Session Notice:
Office of Aging and Disability Services Virtual Listening Session
Rights and Basic Protections for Individuals with an Intellectual Disability, Autism Spectrum Disorder, or Acquired Brain Injury
The Department of Health and Human Services, Office of Aging and Disability Services is hosting a virtual listening session to gather input on creating a rule regarding the rights and basic protections for individuals with an intellectual disability, Autism Spectrum Disorder, or acquired brain injury.
This new rule arises from P.L. 2021, Ch. 284 which directed the Commissioner to convene a task force to develop and make recommendations on rules and procedures regarding the rights and basic protections of persons with acquired brain injuries. The task force’s recommendations can be found here. The Department will consider the task force’s recommendations and other stakeholder comments as we promulgate this new rule on rights and basic protections for individuals with an intellectual disability, Autism Spectrum Disorder, or acquired brain injury. The Department must adopt this rule by July 1, 2022.
This listening session is not a formal comment period or a replacement for the formal comment period outlined in the Maine Administrative Procedure Act.
Listening Session Date:
Thursday, January 20, 2022, at 11:30 a.m.
All are welcome to attend. To register, please use the link below. Interpreter services will be provided during the listening session. Written comments may also be submitted to [email protected] until Friday, February 4, 2022.
To support this discussion, we ask participants to consider the following questions:
Please register in advance for this meeting (click here to register). After registering, you will receive a confirmation email containing information about joining the meeting.
Cullen: Thank you very much, Betsy, for being here today and for providing all of this information!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows: We’ve said this for quite a while but we’re continuing working with OADS to work on a smoother transition from Children’s Behavioral Health Services and the Office of Aging and Disability Services. As you can imagine this is a very large undertaking. We’ve taken a broad brush with this work. We hope to come to this group in March to provide a presentation on this work and to gather feedback. OCFS is also part of the work with the LD 924 Task Force. We’re working with DOL, DOE, OADS, and numerous stakeholders on this initiative. OCFS has also joined the Acquired Brain Injury Council, which had been primarily focused on adults. We’re working with a smaller group to bring in expert training to OCFS providers on how to screen for brain injury in young children. It appears there hasn’t been a lot of research on this, though there are some experts and screening tools that we could consider adopting.
Cullen: Thank you Teresa, that’s all very exciting!
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Libby Stone-Sterling had to leave the meeting early but sent the following via email: Voc Rehab is adding a new statewide virtual peer mentoring service for youth (14-21) that will be available beginning February 1 and will focus on assisting young people to meet their education and employment goals through connection with trained and certified virtual peer mentors.
SMACT (Southern Maine Advisory Council on Transition)
The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy ([email protected]). SMACT meetings occur the first Friday of each month throughout the school year. The 12/3 meeting was cancelled due to unforeseen circumstances. The January meeting was on Friday, 1/7/2022, and featured a presentation from the National Alliance on Mental Illness, Maine about their mission and youth services.
Disability Rights Maine (DRM) Update:
Lauren Wille: We’ve been working a lot on our website, including posting a lot of videos. We have a general informational video about DRM. DRM, in partnership with the University of Maine Center for Community Inclusion and Disability Studies, Maine Developmental Disabilities Council and Speaking Up For Us, collaborated on a series of COVID-19 vaccination public service announcements to help increase the vaccination rate among individuals with disabilities and the people who support them.
Alan Cobo-Lewis: We’re now shooting videos of parents of children with disabilities and of the child themselves (with consent).
LD 924 Task Force Update:
Linda Lee: I wanted to update the group on the LD 924 Task Force One Minute Parent-to-Parent Survey. I’m very excited to report that we’ve had more than 100 responses with more coming in (see the original survey link below) and about half of these said they would like to participate in a longer university-based study. These will be presented to the Task Force in the next few weeks, after which time I can bring the results to this group. I want to thank everyone who assisted in this survey. We also created, at parent request, a survey for those still in High School (see the new survey link below).
Please take ONE MINUTE NOW to answer the YES or NO questions for one of the surveys below. If you have a few extra minutes, please add your comments in the boxes below the questions. Your answers will be kept confidential within the Task Force members, and your name will not be shared. Please feel free to contact us if you have any questions or concerns: Linda Lee: [email protected] and/or Maggie Hoffman: [email protected].
1) Click here for the original One Minute Parent-to-Parent Survey2) Click here for the new One-minute Parent-To-Parent Survey For parents/Guardians of teens ages 14 – 18 (or aging out of high school)
Cullen: Thank you, Linda, for this information and all your work!
Federal & Housing Updates:
Cullen:
State Legislature Update: No additional updates
Other Business:
The next meeting will be on Monday, February 14, 2022, 12-2pm, via Zoom*.
Featured Speaker & Topic TBD.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2022 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Minutes from the last meeting were accepted. For the sake of time, Cullen read the names of participants.
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). meacsp.org Topic: Introduction to the Second Session of the 130th Legislature: Bills to watch, what to expect, and related discussion including how people can advocate to effect positive change in the Legislative Session.
Cullen: Today we have Laura Cordes, Executive Director of MACSP, introducing the Second Session of the 130th Legislature. Laura will highlight bills to watch, what to expect, and the ways people can advocate to effect positive change in the Legislative Session. Laura acts as a watchdog at the State House and regularly updates this group on what’s going on in the Legislature, highlighting opportunities for people to take action, and often even speak with one voice to effect collective change. Thank you for being here today, Laura!
Laura Cordes: Thank you for having me today! For people who may not be familiar with MACSP: The Maine Association for Community Service Providers (MACSP) is an association of organizations that provide supports and services to children and adults with intellectual disabilities, Autism and Brain Injuries in Maine. MACSP’s mission is to represent individuals and organizations that support persons with disabilities to live, learn, and work in the community of their choice through legislative action, organizational advocacy, training, and public education. Our members represent more than seventy organizations operating in all sixteen counties of Maine providing comprehensive services across the state. MACSP has been part of the Coalition well before my time. Time flies – I joined MACSP right before the pandemic. I’ve been proud to represent providers, and I love the networking, even though it’s been mostly virtual, that I’ve been able to do with all of you. It’s also been an opportunity for me to get information on bills that this group worked on before my time, this group’s expertise, and information on the relationships this group has developed and fostered with Legislators over the years.
The Second Session of the 130th Legislature, known as the short session, began the first Wednesday of January, and is scheduled to end the second Wednesday in April. The House and the Senate were convened in person to start the Session, but all Committee meetings moving forward will be held virtually moving forward due to the surge in the Omicron variant – at least through the end of January. I think that the Zoom option has increased participation in Public Hearings, as it saves travel time to Augusta etc.
I created a Google Doc last session and amended it for this Session that includes the LDs, LRs, and carry over bills as I know them. This is a working document and can be edited. If there’s something you’d like to add feel free to email myself, Cullen, or Vickey. I’ll do my best throughout the session to update this document. The document is organized into carried over bills from 2021 and new bills for this session. The document also includes key Committees, their members, and their contact information. There are also useful links, the first of which can take you to the Legislature’s homepage and is where you can find your legislators. (Click here for the Google Doc for the 2nd Session of the 130th Legislature that Laura reviewed in-depth.).
Committee and public hearings have started as of this week. The Maine Legislature does a two-year Biennial Budget. It is expected that the Governor will release a Supplemental Budget to adjust for income and expenses in the current fiscal year. When this occurs, the Governor will release her budget proposal, then Legislators, Committees, etc. respond to that Budget. What I’m hearing is that the Governor will probably come out with her Budget in mid-to late-January. The Budget would go to the Appropriations and Financial Affairs (AFA) Committee, with an opportunity to provide public comments.
(Laura reviewed the carried over bills from 2021. Please see the document for information on the bills that Laura provided.)
Laura: Several bills that this group followed closely last year were carried over, including bills pertaining to: Establishing a family care-giver tax credit; rate increases for Targeted Case Management; improving behavioral health for children; improving the IEP process; enhancing the Maine Developmental Services Oversight and Advisory Board (MDSOAB) and establishing the Mortality Review Panel; addressing the workforce crisis; eliminating the waitlists; and establishing a behavioral add-on rate. Bills can be carried over at any point in the process so long as they haven’t been enacted into public law, such as bills that were on the Special Appropriations Table that were not funded off the Table prior to adjournment, bills that passed out of Committee but not passed by the House and/or Senate, bills that had a Public Hearing but not a Work Session, etc. Bills that have had Public Hearings and were carried over will likely not receive additional opportunities for public comment/testimony.
-It was stated that parent consent to change an IEP was included in LD 552.
Laura: Regarding LD 716 – this bill included changes to the MDSOAB and established a Mortality Review Panel. Money was included in the Biennial Budget to establish a Mortality Review Panel; however, other components included in the bill to enhance the MDSOAB were not addressed and would be in the carried over bill.
Cullen: The Mortality review Panel goes back to the OIG report, which highlighted that there were people who died while receiving services and there was wide agreement each mortality ought to be investigated so the system can learn and evolve from it.
Laura: There has been some confusion in the advocacy world around LD 1573, the bill that would implement the recommendations of the Commission to Study Long-Term Care Workforce Issues. The bill itself did not pass and was carried over. However, some provisions of the bill were included in the Biennial Budget, such as the rate increases to 125% of minimum wage. It’s worth noting that the rate increases have not actually gone into effect, though they were supposed to as of 1/1/2022. The Department recently released a memo pertaining to this, stating that when the rates do come out, they will be retroactive to 1/1/2022; however, the rate increases will not go into effect until the Governor’s supplemental budget passes, which is expected to include additional funding to pay for this increase as well as additional cost of living increases. It may be a few more months until providers can access the funds needed to actualize these increases – a disappointment for providers and direct support staff.
-A provider asked if the fact that LD 1573 didn’t pass and that aspects were just adopted as part of the Governor’s Budget means that the funding can be taken out of future budgets. He also asked how the Department came up with its new rate methodology.
Laura: My understanding is that the rate increases will remain in the budget moving forward.
-It was stated that the Department has released its Primary Care Plus initiative proposed rule. It was asked what this might mean in terms of services for people with ID/DD.
Laura: I’m happy to look into this further.
Rachel Dyer – Maine Developmental Disabilities Council: This is a question that could be addressed to the MaineCare Advisory Committee. Perhaps they could provide more information. I’d be happy to send an email to make this connection.
(Laura reviewed the new bills that will be heard this Session. Please see the document for more in-depth information on these bills.)
Laura: The list of new bills is likely to grow. The Legislative Council met to review approximately 300 emergency bills submitted by legislators; about 150 of those bills got through (click here for the final list of bills). Not all new bills have bill text yet – these bills will get language in the next couple weeks.
- LD 1773, An Act to Make MaineCare Rules Pertaining to Global Home And Community-Based Services – Referred to HHS Committee
-A parent stated that when she read the bill text for LD 1773 it appeared to ask the Department to stop the process for the implementation of the Department’s rule which would implement changes relevant to the federal HCBS Settings Final Rule. She stated that as the shared living provider for her son this is very concerning. Not coming into compliance with the Federal Rule would put 66% of the HCBS funding at risk.
Laura: I think we have a difference of opinion regarding what this bill does. I don’t believe this bill would stop the Rule from going into effect, rather it would allow more communication between the Department and the Legislature. And it would give providers more time to come into compliance, but still well before the due date for Federal compliance.
Alan Cobo-Lewis: I think the concerns providers have about coming into compliance are valid. When it comes to the actual text of the Rule, it looks very similar to the Federal Rule. The few things I wanted the State to change upon my first read are actually requirements of the Federal Settings Rule. I think many provider issues are about the transition plan and not the Rule itself. That being said, I’m never against Rules being considered Major Substantive.
Laura: This topic is something that’s important to all of us and that we’ll continue to discuss here.
-A parent asked if Betsy could provide more clarity around this.
Betsy Hopkins: The comments on the Rule are still being reviewed by the AG’s office, so we’re not in a place to comment on this until after that has concluded.
-A provider stated that from a technical perspective, if Maine’s HCBS Settings are not approved by the Federal Government there is the potential to lose 66% of the state’s HCBS funding. It was stated that providers told the Department that its interpretation of the Federal Rule was an overreach. Other states have far fewer requirements than Maine is proposing. In a recent call, Derek Fales stated that it was discovered that Maine’s interpretations are much more exacting and far more than the Federal minimums, and that they were proud of that fact. Now would be the time for providers, family members, self-advocates, etc. to look at what Maine is asking and if it’s feasible from a funding and staffing perspective, and if it’s overall practical. And then, wage your opinion on everything that you’ve looked at.
-A parent stated that her son’s needs are not being met with current staffing. The current rate is about $11.85 per hour. She stated that her understanding is that the Department’s methodology regarding rates have changed. She asked what 125% of minimum wage actually means.
Laura: This is a separate issue and a wrinkle in the Department’s implementation of the Legislature’s directive to have rates be at least 125% of minimum wage. After the budget was passed the Department changed the methodology for rates without stakeholder engagement. They did include an increase to the rate over the summer, bringing the rates to minimum wage or perhaps a little more – but nowhere near 125% of minimum wage. The rate model the Department adopted has components that would reduce the rate significantly.
Betsy Hopkins: I’ll say there is discrepancy and disagreement between what Laura is saying and what the Department has been saying regarding the rate methodology. Having said that, it’s really the Office of MaineCare Services that would best answer questions about rates. I know that Laura shared information from a memo that’s gone out that discusses this and what that means for 125% of minimum wage. The budget allotted to meet 125% of minimum wage is not sufficient, which was discovered after the First Session ended last year. As such, additional money needs to be included in a Supplemental Budget to actualize these rate increases. About the rate methodology questions, I can’t answer those detailed questions regarding which rate methodology was used and how and why and what it will look like at this point.
Laura: To address the overall question of will this be enough – the Governor’s Supplemental Budget has yet to be released but I don’t believe it will be sufficient. However, between now and when the budget is released things could change and I remain hopeful. We’re all working towards the same goal to ensure that the intent of 125% of minimum wage is met.
Back to the list of new bills. The following bills have public hearings scheduled. If you want to submit testimony online or give your testimony live you can do so online (click here).
- LD 1774, An Act Clarifying The Right to Legal representation For Individuals Subject To Guardianship – Public Hearing Friday, 1/14 at 9am in front of the Judiciary Committee
- LD 1775, Resolve, Regarding MaineCare Funding for Maine Schools – Public Hearing Tuesday, 1/11 at 9:30am in front of the Education and Cultural Affairs Committee
- LD 1798, An Act To Ensure Health Insurance Coverage for Certain Adults with Disabilities – Public Hearing Tuesday, 1/11 at 10am in front of the Health Coverage, Insurance and Financial Services Committee
Alan Cobo-Lewis: As Laura said, LD 1798, An Act To Ensure Health Insurance Coverage for Certain Adults with Disabilities, is scheduled for a Public Hearing tomorrow, 1/11/22, at 10am in front of the Committee on Health Coverage, Insurance and Financial Services. This bill requires health insurance policies that offer coverage for a dependent child to cover adults with disabilities who are unable to sustain themselves through employment. As such, it appears the bill would require state-regulated health insurance that covers dependents to offer coverage for dependents with disabilities beyond age 26 – as forty other states have implemented. I think this would have a number of uses, including:
- Providing people with autism receiving Section 29 access to behavioral consults.
- Providing people with autism on the wait list for Section 29 access to behavioral consults.
- Providing some people with autism who receive Medicaid but don’t qualify for waiver services access to behavioral consults.
- Providing some people who don't qualify for Medicaid access to insurance; and
- Contributing toward the long-term sustainability of MaineCare by establishing third-party liability which would allow MaineCare to be reimbursed for services for people who receive private health insurance as well as MaineCare.
If adults with significant disabilities could access additional health insurance through a policy covering their family, as this bill would achieve, some of them could at least get some of their needs for these services met while awaiting service offers on the waitlists for more comprehensive Section 21 services. I urge you to submit testimony in favor of LD 1798, as it has numerous benefits for people with disabilities in Maine.
For submitting testimony online and/or signing up to testify live: Click this link, select “Public Hearing,” select the Committee from the drop-down menu (Health Coverage, Insurance, and Financial Services), choose the date of the Public Hearing (January 11, 2022 10:00AM), select the bills for which you are providing testimony (LD 1798), check off the “I would like to present my testimony live” box if you would like to do so (if so also select if you are for, against, or neither for nor against the proposed legislation), upload your testimony by clicking “Choose File” or copy/paste your testimony in the box provided, then enter you contact information and Submit/Register.
Laura: There are a few more bills I want to note:
- LD 1867, An Act To Codify MaineCare Rate System Reform – Referred to HHS Committee. This bill formalizes the Department’s reimbursement rate system reform effort by establishing rate development principles and processes, including specifying rule-making requirements for rate adjustments among other things.
- LD 1869, An Act To Provide Clarity and Assistance to Rural Maine Providers In the Implementation of the Medicaid Home and Community-Based Service Waiver Rule – Referred to HHS Committee. This bill pertains to the FMAP increase, and the Legislature receiving reports regarding how the State wishes to spend FMAP dollars.
Discussion:
-A self-advocate stated that bills in the Legislature can become very political in nature. She stated that she doesn’t go to a restaurant and hear the waitress complain about not getting paid enough. She stated that the rate/wage conversation is a delicate one and that rather than having polarizing sides, a thorough dialogue is ideal.
-A parent stated that different from the example provided, these services are covered by tax-payer dollars. As such, this discussion pertains directly to this group – not only as family members or individuals, but as taxpayers. She stated that she feels like the discussion is very respectful here.
-A self-advocate stated that the meeting is very respectful. However, in previous Administrations she’s witnessed different communication styles some of which could be considered more aggressive. She asked providers to consider how communicating about not having enough money etc. might sound to consumers. She stated that phrasing things from a positive standpoint is always helpful.
-A parent stated that it might be helpful that when there are discussions regarding money to detail how it affects people receiving services so that it’s person-centered.
Cullen: Thank you very much, Laura, for taking the time to provide such a thorough review of what’s to come in this Legislative Session. I will say that I believe that the Legislature is filled with people who really want to make things better for this population. I have come to believe that not everyone knows how to do that perfectly. However, people around this table are experts and well-poised to inform Legislators so that they get it right. I’ve heard time and time again that when Legislators hear from more than two or three people, they really start to pay attention. Your voice is important, and I would encourage you throughout this legislative session to have a story you can tell to add to any testimony you provide so Legislators can better understand your world. I encourage you to raise your voice and be heard, so that these folks trying to do good can do so most effectively with the benefit of your education and advocacy. Thank you again, Laura; well done!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins: I’ll start off with a couple of things.
OADS Stakeholder Meetings: Early on in the pandemic we had weekly stakeholder meetings. These were primarily geared towards providers to get up-to-date information on COVID. We received feedback that these were very helpful. When things eased around the pandemic we moved back to monthly meetings. Tomorrow is our stakeholder meeting. We’re moving those to twice each month – the 2nd and 4th Tuesdays of the month. Tomorrow’s meeting will include guidance and will be a good opportunity to hear the most recent information on COVID, the Omicron variant, and other important information.
Mortality Review Panel: The Mortality Review Panel was discussed earlier. The CDC is still in the process of hiring the person to oversee the Mortality Review Panel. Potential panel participants are also being reviewed.
-A parent asked if there’s a report out on the causes of death, for the purpose of writing the quality indicators.
Betsy: APS has a report they provide to the Legislature with detailed information on this.
-A parent asked if the panel includes the waitlist and if its retrospective.
Betsy: Yes, it includes anyone who is eligible in our system. I’m not sure if it’s retrospective.
Bonus Payments
- We are making good progress toward final approval with the federal government and continue to estimate that the first payment will be made in January.
- The 9817 Spending Plan was approved in November
- The related Appendix K for waiver services was approved last week
- We anticipate approval of the related Disaster State Plan Amendment (for the state plan services) soon
Laura Cordes: Will there be some updated guidance released soon?
Betsy: Yes, there will be. That’s one of the things that will be discussed on the Stakeholder call tomorrow.
Other FMAP Projects
- Beyond the bonus payments, we anticipate funds for other 9817 projects will become available in the spring, once we’ve worked through complex claiming and accounting processes and other issues. In the meantime, we are doing preparatory work on several projects.
- We are developing criteria for HCBS setting remediation grants
- We are developing criteria for Innovation grants
- We expect to share drafts of each of these and hold a listening session in the near future
- In addition to the bonus initiative:
- We have begun work on the Portability and Advancement project and will convene various stakeholder meetings in February
- We are working with DOL on the first healthcare workforce media campaign, funded via the Governor’s ARPA bill. Several of you have already been involved in stakeholder work for that project.
- OBH and OADS will follow with additional 9817-funded media campaigns later in the year.
- We have been working with the Long Term Care Ombudsman on a series of direct worker discussion groups which have yielded invaluable information that will inform all of the media campaigns. (Several groups, 58 workers). The groups have also provided a core group of workers from which a Worker Advisory Council is being formed to advise us on all of our workforce initiatives.
- The Department announced last week that, in addition to increasing rates to ensure at least 125% of minimum wage, the Department is accelerating Cost of Living adjustments for several HCBS services, including Sections 12, 18, 19, 20, 21, 29, and 96. These will be effective retroactively to January 1.
- Funding for the further increases is subject to legislative approval, state rulemaking and approval by CMS. We are still working out the details and timing of implementation. The Department will send out a communication regarding implementation dates for these adjustments as soon as possible. In the interim, the Department is working to finalize an e-message indicating specific fee schedules, where applicable, and additional detail associated with these adjustments.
- The increases will be particularly significant for Section 21:
- The new supplemental budget initiative the Department is now proposing would result in an increase for Section 21 providers of $46.4 million, in addition to the $15.6 million that is already in the biennial budget for Section 21 for January 1 wage adjustments.
- In addition to these rate increases, under both the 129th and the 130th Legislative sessions, the Department advanced other Section 21 rate increases that went into effect January 1, 2021, and July 1, 2021, at a total cost in this biennium of $73.2 million.
- The bonus payments that will be received shortly by providers are in addition to these amounts.
Listening Session Notice:
Office of Aging and Disability Services Virtual Listening Session
Rights and Basic Protections for Individuals with an Intellectual Disability, Autism Spectrum Disorder, or Acquired Brain Injury
The Department of Health and Human Services, Office of Aging and Disability Services is hosting a virtual listening session to gather input on creating a rule regarding the rights and basic protections for individuals with an intellectual disability, Autism Spectrum Disorder, or acquired brain injury.
This new rule arises from P.L. 2021, Ch. 284 which directed the Commissioner to convene a task force to develop and make recommendations on rules and procedures regarding the rights and basic protections of persons with acquired brain injuries. The task force’s recommendations can be found here. The Department will consider the task force’s recommendations and other stakeholder comments as we promulgate this new rule on rights and basic protections for individuals with an intellectual disability, Autism Spectrum Disorder, or acquired brain injury. The Department must adopt this rule by July 1, 2022.
This listening session is not a formal comment period or a replacement for the formal comment period outlined in the Maine Administrative Procedure Act.
Listening Session Date:
Thursday, January 20, 2022, at 11:30 a.m.
All are welcome to attend. To register, please use the link below. Interpreter services will be provided during the listening session. Written comments may also be submitted to [email protected] until Friday, February 4, 2022.
To support this discussion, we ask participants to consider the following questions:
- Do you have language, ideas, or concepts that you believe should be included in a new rule addressing the rights and basic protections for individuals with an intellectual disability, Autism Spectrum Disorder, or an acquired brain injury?
- If so, what is your rationale for the Department to consider implementing these suggestions?
- Are there other states’ processes and rules that govern rights and basic protections that Maine should consider?
Please register in advance for this meeting (click here to register). After registering, you will receive a confirmation email containing information about joining the meeting.
Cullen: Thank you very much, Betsy, for being here today and for providing all of this information!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows: We’ve said this for quite a while but we’re continuing working with OADS to work on a smoother transition from Children’s Behavioral Health Services and the Office of Aging and Disability Services. As you can imagine this is a very large undertaking. We’ve taken a broad brush with this work. We hope to come to this group in March to provide a presentation on this work and to gather feedback. OCFS is also part of the work with the LD 924 Task Force. We’re working with DOL, DOE, OADS, and numerous stakeholders on this initiative. OCFS has also joined the Acquired Brain Injury Council, which had been primarily focused on adults. We’re working with a smaller group to bring in expert training to OCFS providers on how to screen for brain injury in young children. It appears there hasn’t been a lot of research on this, though there are some experts and screening tools that we could consider adopting.
Cullen: Thank you Teresa, that’s all very exciting!
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Libby Stone-Sterling had to leave the meeting early but sent the following via email: Voc Rehab is adding a new statewide virtual peer mentoring service for youth (14-21) that will be available beginning February 1 and will focus on assisting young people to meet their education and employment goals through connection with trained and certified virtual peer mentors.
SMACT (Southern Maine Advisory Council on Transition)
The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy ([email protected]). SMACT meetings occur the first Friday of each month throughout the school year. The 12/3 meeting was cancelled due to unforeseen circumstances. The January meeting was on Friday, 1/7/2022, and featured a presentation from the National Alliance on Mental Illness, Maine about their mission and youth services.
Disability Rights Maine (DRM) Update:
Lauren Wille: We’ve been working a lot on our website, including posting a lot of videos. We have a general informational video about DRM. DRM, in partnership with the University of Maine Center for Community Inclusion and Disability Studies, Maine Developmental Disabilities Council and Speaking Up For Us, collaborated on a series of COVID-19 vaccination public service announcements to help increase the vaccination rate among individuals with disabilities and the people who support them.
Alan Cobo-Lewis: We’re now shooting videos of parents of children with disabilities and of the child themselves (with consent).
LD 924 Task Force Update:
Linda Lee: I wanted to update the group on the LD 924 Task Force One Minute Parent-to-Parent Survey. I’m very excited to report that we’ve had more than 100 responses with more coming in (see the original survey link below) and about half of these said they would like to participate in a longer university-based study. These will be presented to the Task Force in the next few weeks, after which time I can bring the results to this group. I want to thank everyone who assisted in this survey. We also created, at parent request, a survey for those still in High School (see the new survey link below).
- We are contacting you as fellow parents of young adults with disabilities regarding two one-minute survey opportunities:
Please take ONE MINUTE NOW to answer the YES or NO questions for one of the surveys below. If you have a few extra minutes, please add your comments in the boxes below the questions. Your answers will be kept confidential within the Task Force members, and your name will not be shared. Please feel free to contact us if you have any questions or concerns: Linda Lee: [email protected] and/or Maggie Hoffman: [email protected].
1) Click here for the original One Minute Parent-to-Parent Survey2) Click here for the new One-minute Parent-To-Parent Survey For parents/Guardians of teens ages 14 – 18 (or aging out of high school)
Cullen: Thank you, Linda, for this information and all your work!
Federal & Housing Updates:
Cullen:
- Federal Budget & Debt Ceiling: On 12/3 Congress passed and the President signed another short-term Continuing Resolution to keep the government open through 2/18/22. The CR maintains current federal funding levels. Advocates are working to ensure that the final FY 22 budget includes the highest possible funding for HUD programs, including Section 8. And, on 12/16 President Biden signed a debt ceiling increase into law, preventing the first-ever U.S. default. The measure lifts the government’s borrowing limit by $2.5 trillion, which is expected to allow the U.S. to cover its obligations into 2023.
- Senate FY 22 T-HUD Budget: On 10/19 the Senate Appropriations Committee released its FY 22 THUD bill. Overall, the bill increases funding for HUD programs in FY22, although at levels lower than those proposed in the House. The Senate bill funds HUD at $65.4 billion, or $5.7 billion above FY21 enacted levels. Unfortunately, the Senate bill does not include the major expansion of rental assistance proposed by both President Biden and the House.
- Congress’ Budget Resolution & “Build Back Better Act” Infrastructure Reconciliation Package: on 11/19 the House voted to approve the Build Back Better Act. On 12/20, Sen. Manchin announced he will not vote for the bill, thwarting its ability to pass. The White House and congressional leadership have pledged to continue working on the bill until it is enacted. Senate Majority Leader Schumer said he will bring up the bill for a vote in 2022, though it appears that it will be later in the year. As negotiations in the Senate continue, the bill will likely be significantly reworked and some priorities in the bill may be removed altogether. Advocates are urging senators to retain the historic investment in affordable housing. As passed by the House, the Build Back Better Act is a $1.75 trillion package – negotiated down from $3.5 trillion – and includes $150 billion in affordable housing investments, including:
- $25 billion in rental assistance for hundreds of thousands of households.
- $65 billion to preserve our nation’s public housing infrastructure.
- $15 billion for the national Housing Trust Fund (HTF) to build and preserve over 150,000 homes affordable to extremely low-income households.
- And $150 billion for Home and Community-Based Services.
- National Housing Trust Fund: There are various efforts in Congress to increase the National Housing Trust Fund, including the Decent, Affordable, Safe Housing for All (DASH) Act which would provide $10 billion in the Housing Trust Fund (HTF) for the next ten years to states to acquire, develop, or rehabilitate deeply affordable housing. In Maine, resources from the HTF are the primary funding mechanism for supportive housing development.
State Legislature Update: No additional updates
Other Business:
The next meeting will be on Monday, February 14, 2022, 12-2pm, via Zoom*.
Featured Speaker & Topic TBD.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2022 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].