Aging and Disability CONNECTIONSIssue 3 - August 2023
Director’s MessageBudget Passed by Legislature is Good News for Older Adults and Individuals with Disabilities
On July 11, Governor Mills signed the second part of the State budget passed by the Legislature, advancing access, quality and innovation in services for older adults and individuals with disabilities. Together with the first part of the budget enacted earlier this year, significant new investments have been made in several areas.
In Elder Justice, the budget provides funding for high priority items from the Elder Justice Roadmap, including the Elder Service Connections program, which helps Adult Protective Services (APS) clients make meaningful changes in their lives. The budget also expands access to civil legal services for older adults, such as assistance with eviction notices and adds 10 APS positions to address the steady increase in referrals that has occurred since 2015.
The budget makes significant new investments in Healthy Aging and Long-Term Services and Supports. These include funds for Area Agencies on Aging to expand their Aging and Disability Resource Centers, which serve as points of information and referral to individuals needing services. It also includes a significant investment of state funds to continue providing historically high levels of home delivered meals as one-time federal COVID funding tapers off. The budget also includes funding for rate increases and other payments to a broad range of long-term services, including home care, assisted living and nursing facilities. The budget also eliminates the asset test for the Medicare Savings Program, which helps Medicare beneficiaries with their co-payments and other cost sharing.
Programs for individuals with Intellectual and Developmental Disabilities (IDD) and Brain Injury also saw a big increase in the budget, including authorization and initial funding for a new Lifespan waiver program, currently under development and slated for launch in 2025. In the meantime, funding was included in the budget to enroll 50 new individuals per month in the Section 29 waiver, and all of Maine’s waiver programs (Aging, Brain Injury, Related Conditions, and IDD) are slated to receive cost of living increases over the biennium.
This budget enables the Department to provide access to more people and to innovate with new service models like the Elder Service Connections and Lifespan programs. The Legislature also passed two important service quality bills submitted by the Department this session, PL 2023, c. 89, which authorizes a new licensing approach for IDD and Brain Injury providers, and PL 2023, c. 309, which authorizes licensing of personal care agencies for the first time. The Office of Aging and Disability Services (OADS) will be working closely with the Division of Licensing and Certification to implement both of these new quality policies by July 2024.
For more on the biennial DHHS budget, see this summary.
Now, on to implementation!
~Paul Saucier, Director
Efforts to Improve Quality In Long Term Care Across Maine According to the National Academies of Science, Engineering & Medicine (NASEM), “the way the United States finances, delivers and regulates care in nursing home settings is ineffective, inefficient, inequitable, fragmented, and unsustainable.” This results in poor resident outcomes, a demoralized workforce, and wasteful and poorly aligned government spending. COVID-19 “lifted the veil” on some of these deficiencies. Sadly, approximately 25 percent of all COVID-related deaths across the U.S. occurred in nursing home residents and staff.
In April 2022, NASEM released its comprehensive consensus study, The National Imperative to Improve Nursing Home Quality. This almost 600-page publication documents nearly two years of work by an ad-hoc Committee on the Quality of Care in Nursing Homes, primarily funded by the John A. Hartford Foundation. The final report identifies the many deficiencies in delivery and funding while outlining seven high-level goals and work plans to transform the status quo. The delivery of person-centered care by well-trained staff needs to provide the foundation. Payment reform, transparency, and integration of technology are required drivers. Finally, enhanced approaches to quality assurance and quality improvement are critical to ensuring the delivery of the best possible care while maximizing the quality of life for residents living in nursing homes.
OADS, the Office of MaineCare Services (OMS), and the Division of Licensing and Certification have undertaken an ambitious initiative to strengthen quality in Maine’s nursing and residential care facilities, using the NASEM recommendations as a guide. Ongoing efforts include rate reform to support fair payment to facilities for care, integrating meaningful quality measures into care and services provided to residents, and assessing capacity and needs of Maine’s long-term services and supports system as the number of older Mainers continues to grow.
Earlier this year, the Department launched the Nursing Home and Residential Care Facility Innovation and Quality Advisory Council. The council is comprised of multiple stakeholders from across the state, lending their voices and experiences to improving quality. The kickoff meeting took place on April 26, 2023, and was opened by the Chair of NASEM’s Committee on the Quality of Care in Nursing Homes, Dr. Betty Ferrell.
Dr. Ferrell is a friend of Maine and Director and Professor of Nursing Research and Education at the City of Hope, Duarte, California. In her remarks, she described Maine’s newly organized Advisory Council as an example of what NASEM had hoped for and that the exhaustive report would serve as a template for innovative work that states, health systems, and facilities take on the imperative to improve the experiences of residents living in nursing and residential care facilities.
The Lifespan Waiver The Lifespan Waiver development process is well under way, with strong support from the Legislature. Authorizing language proposed by the Department was incorporated into the state budget enacted in June, and initial funding was included to launch the program in 2025.
Also in June, a Concept Paper and a plain language summary of the proposed waiver were posted on the OADS’ Lifespan website: HCBS Lifespan Project | Department of Health and Human Services (maine.gov). The Concept Paper, developed with extensive input from the Lifespan Stakeholder Advisory Group, provides an overview of the goals of Lifespan, as well as examples of proposed services and definitions for public comment. As one of four public comment opportunities for the waiver, the responses to the Concept Paper will be integrated into the Lifespan waiver application with the U.S. Centers for Medicare and Medicaid Services (CMS). In addition to collaborative input with many external stakeholder groups, Lifespan reflects a strong collaboration across DHHS, with engagement by the Commissioner’s Office, the Office of MaineCare Services, and the Office of Child and Family Services.
The Maine State Plan on AgingThe Maine State Plan on Aging allows OADS to receive federal funding through the Older Americans Act to support a wide range of home and community-based services delivered by the aging network in Maine. The five area agencies on aging, Maine Legal Services for the Elderly, the Maine Long Term Care Ombudsman Program, and Adult Protective Services are part of the aging network in Maine. The State Plan on Aging is also a strategic plan that outlines the goals, objectives, strategies, and performance measures for how programs and services will meet the needs of older individuals and their family caregivers. The current State Plan on Aging expires on September 30, 2024. OADS has started the planning process for the next State Plan on Aging to continue to receive this federal funding. The new State Plan on Aging is due by July 1, 2024. We invited a diverse group of internal and external stakeholders to be part of an Advisory Committee to help guide the development of the new State Plan on Aging. The first meeting was on July 11, 2023. The Advisory Committee will have an opportunity to review the needs assessment survey instruments before implementation in the fall of 2023, the report of findings from the needs assessment, and a draft of the new State Plan on Aging before the plan is published for public comment in spring 2024. Please watch for announcements of public listening sessions in September 2023.
Initial HCBS Recruitment and Retention Bonus Data Becomes AvailableOn June 15 the Department published a blog with newly gathered information on the outcomes of the direct support worker (DWS) recruitment and retention bonus initiative. DHHS began distributing approximately $120 million in payments to MaineCare-funded HCBS providers for recruitment and retention bonuses targeted to DSWs and supervisors across the State in February of 2022. The initiative was funded with federal dollars through the American Rescue Plan Act as part of Maine’s HCBS Improvement Plan. To date, DHHS has compiled data from a sample of 293 agency reports, which represents just over 80 percent of participating agencies and 24,499 individual workers. The data reported by these agencies suggests that the recruitment and retention bonuses helped stabilize the HCBS workforce in the wake of the COVID-19 pandemic. Workers in every county in Maine received bonuses, the average bonus amount was $3,429, and 81.9 percent of workers who received a bonus remained employed at their agencies at the end of the reporting period. This suggests that retention, along with successful recruitment of new workers, yielded a net increase in the direct support workforce.
2023 BIAA-ME Brain Injury Resource FairThe Brain Injury Association of America - Maine Chapter (BIAA-ME) held the 2023 BIAA-ME Brain Injury Resource Fair on Thursday, March 23, at the Augusta Armory. Maine brain injury survivors, caregivers, professionals, and others from across Maine gathered to explore resources, supports, and services and connect with the Maine brain injury community. Exhibitors included OADS, brain injury providers, employment support, legal and advocacy organizations, assistive technology and adaptive equipment experts, mental health and substance use services providers, and many others. The event featured 50 exhibitors and had over 200 participants.
Online Brain Injury Screening and Support System (OBISSS)OADS in partnership with the Brain Injury Association is piloting the Online Brain Injury Screening and Support System “OBISSS.” This pilot will begin with behavioral health agencies in Androscoggin, Kennebec, and Aroostook counties. This voluntary online screening system is designed to determine lifetime exposure to brain injury and to identify associated challenges that may be present for youth and adults. The OBISSS tool utilizes the validated and reliable OSU TBI-Identification Method, is self-administered, and setting-driven. This means that someone can complete the OBISSS screen on their own, or with the help of a provider across any setting. The system collects additional demographic information from each individual, and once screened, identifies impairment on a number of challenges using the Symptoms Questionnaire for Brain Injury (SQBI). Tip sheets are delivered, responding to identified challenges, to the individual and the provider.
Elder Justice Initiatives Receive Legislative ApprovalOADS is excited to share that the final piece of the FY24-25 biennial budget signed into law on July 11, 2023, includes significant investments to reduce abuse, neglect, and exploitation of older adults and adults with disabilities in Maine. A DHHS blog post outlining the budget’s Elder Justice initiatives in more detail is available here. In addition, the blog post includes information about a recently published Adult Protective Services (APS) data trends report that highlights several valuable pieces of information regarding the APS program and the clients served by APS. You can read the full report here.
SIS-A Assessment IncentiveThe SIS-A implementation project began with several informational sessions with the assessment vendor Maximus in December 2022. Assessor training has been completed, and valid assessments began in March of 2023. Approximately 160 assessments have been completed, with monthly assessment counts continuing to rise. Maximus and OADS have provided regular communication and held meetings with stakeholders, including members and families, community case managers, providers, and advocacy groups. There is broad encouragement for the voluntary participation of members and families, as the SIS-A will help provide important information to the state about the service needs in OADS’ system. This information will support the design of Lifespan and provide information which will support the development of individual person-centered plans.
OADS is pleased to announce that Maximus will support an incentive to Section 21 or 29 members or individuals on the waitlists who volunteer to take the SIS-A. The first 800 eligible individuals who complete a valid SIS-A assessment (including individuals who have already completed assessments to date) with Maximus will receive a one-time payment of $100. OADS and Maximus recognize that an assessment takes time and effort to attend, and we want to encourage everyone to participate.
If you have questions about the SIS-A, please see the Frequently Asked Questions document or send emails to Maine-SIS@maximus.com.
OADS Policy UpdatesNew Long-Term Services and Supports Program Rule
HOME BASED SUPPORTS AND SERVICES FOR OLDER AND DISABLED ADULTS - Home Based Supports and Services for Older and Disabled Adults is a new program rule to support older and disabled adults in their homes. This program combines two current programs, In-Home and Community Support Services for Elderly and Other Adults (also called Section 63) and Consumer Directed Personal Assistance Services (also called Chapter 11). Starting October 1, 2023, participants of these two programs will receive home support services through the one streamlined program. OADS made this change to simplify the system of home supports, making access easier for consumers to understand, and provider agencies to administer. Services include nursing, personal care, homemaking, respite, home modification, care coordination and other assistance older and disabled adults may need to continue to live in their communities. Click this link for the new rule: Home-Based Supports and Services for Older and Disabled Adults rule effective October 1, 2023.
Individuals who are receiving Section 63 or Chapter 11 services on September 30 will be automatically moved to the new program on October 1. If you have any questions or have long-term care needs visit Get Support on the OADS website for more information.
Other Policy Changes in Process
The Office of Aging and Disability Services looks to support the lives of older and disabled adults through a variety of programs and services. Your input and comment on rulemaking is important and welcome. Check out the DHHS Rulemaking webpage for information about current and upcoming rulemaking activity, listening sessions, and other news that may be of interest to you. You can also subscribe to get news and information about OADS rulemaking online.
Transition from Children to Adult ServicesWe are delighted to announce the formation of the DHHS team focused on Improving the Transition from Children to Adult Services. This joint pilot project is supported by the Office of Child and Family Services (OCFS) and OADS and funded by the federal American Rescue Plan Act. Our team brings together a group of dedicated professionals passionate about improving the transition process for individuals with intellectual and developmental disabilities (IDD), autism spectrum disorder (ASD), and other related conditions.
The goal of this initiative is to provide training, quality oversight, and resources to provide more consistent approaches to supporting youth with IDD and Autism as they transition from the OCFS children's system to the OADS adult system. The team is working with OCFS and OADS staff to develop and provide information and resources and cross-training for school personnel and community case managers to seamlessly provide person-centered support to individuals as they transition to adulthood. Systems-level reporting will allow the team to prioritize their focus areas for transition training and support, allowing them to identify the greatest needs. OADS participated in the national NTACT-C Community Building Institute along with other transition leaders in Maine from the Department of Education (DOE), Division of Vocational Rehabilitation (DVR), and OCFS, along with several youth leaders and family stakeholders, where we attended training on national best practices in transition and worked as an interagency state team to develop efficiencies in providing transition services and supports across our systems.
Interagency collaboration is critical to the transition success of the people we serve, and the OADS Transition Team has been busy building internal and external connections to DHHS. If you are working with transition-aged youth who may be eligible for OADS services, we encourage you to reach out and introduce yourself to the transition liaisons and let them know if you need information or resources related to transition. The more we connect in our communities and gain stakeholder input, the better we can find new connections, which can improve the overall person-centered planning process.
Evergreen UpdateThis coming winter (2023-2024), OADS plans to transition to the Evergreen client data system for the management of Developmental Disability and Brain Injury Services. OADS launched the Evergreen system for Adult Protective Services activities in June 2020. Please visit the Evergreen project website regularly over the next few months for additional information and updates. We welcome your questions or feedback. Please reach out to us at Evergreen.DHHS@maine.gov and a member of the project team will respond.
Important reminder for OADS EIS Users: All communications will be posted on the Evergreen website to keep you informed of our progress. Communications will also be sent to the EIS email address provided on your EIS user account, therefore please provide an updated email address to the EIS user accounts team (EISSupport.DHHS@maine.gov), if needed.
Attention IDD Service Providers!
Did you know that the COVID Immunization Grant program will reimburse providers of Intellectual and Developmental Disability (IDD) services for hosting COVID/flu vaccination clinics? Eligible clinics should be focused on serving individuals with IDD, their families, and staff. A reimbursement of $2,000 is available for clinic-related costs, such as provider staff expenses, clinic set-up, advertisement, and clean-up costs. The program will cover costs for two vaccine clinics per year, each being eligible for reimbursement (up to a grand total of $4,000 for two clinics). If you would like to participate in the program or learn more, please email Trinity Baker, the OADS Vaccine Outreach Manager, at Trinity.Baker@maine.gov
Consumer Assessment Healthcare Provider Systems (CAHPS)OADS is launching a participant experience survey with members served by Maine’s Home and Community Based Services (HCBS) waivers. Participant experience surveys are an important component of the state’s quality assurance and improvement efforts. Surveys targeting experience of care focus on key aspects of waiver services, such as service provider communication and care coordination. OADS plans to adopt the Consumer Assessment Healthcare Provider Systems (CAHPS) participant experience survey which is nationally validated for HCBS waiver populations. Waiver members will have the opportunity to participate in the survey using a method of their choice (e.g., in-person, telephone, or video conferencing). More information regarding how to participate will be shared later this summer or early fall.