EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb1020*
HOUSE BILL 1020
J1 2lr2037
CF SB 868
By: Delegates K. Young and Proctor
Introduced and read first time: February 10, 2022
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Developmental Disabilities Administration – Self–Directed Services 2
(Self–Direction Act of 2022) 3
FOR the purpose of requiring the Developmental Disabilities Administration to establish 4
and provide training materials to coordinators of community services on 5
self–directed services; requiring coordinators of community services to educate a 6
certain recipient on self–directed services at certain times; providing for the services 7
and manner of delivering services that the Administration provides to a recipient 8
who receives self–directed services; requiring that home– and community–based 9
services waiver recipients receive support broker services; requiring the 10
Administration to submit a certain waiver application for a certain purpose by a 11
certain date; requiring the Administration to leverage certain federal funding for a 12
certain purpose; and generally relat ing to Developmental Disabilities 13
Administration services. 14
BY repealing and reenacting, with amendments, 15
Article – Health – General 16
Section 7–101 17
Annotated Code of Maryland 18
(2019 Replacement Volume and 2021 Supplement) 19
BY adding to 20
Article – Health – General 21
Section 7–408 through 7–410 22
Annotated Code of Maryland 23
(2019 Replacement Volume and 2021 Supplement) 24
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 25
That the Laws of Maryland read as follows: 26
Article – Health – General 27 2 HOUSE BILL 1020
7–101. 1
(a) In this title the following words have the meanings indicated. 2
(b) “Administration” means the Developmental Disabilities Administration. 3
(c) (1) “Admission” means the process by which an individual with an 4
intellectual disability is accepted as a resident in a State residential center. 5
(2) “Admission” includes the physical act of the individual entering the 6
facility. 7
(d) (1) “Alternative living unit” means a residence that: 8
(i) Provides residential services for individuals who, because of 9
developmental disability, require specialized living arrangements; 10
(ii) Admits not more than 3 individuals; and 11
(iii) Provides 10 or more hours of supervision per unit, per week. 12
(2) “Alternative living unit” does not include a residence that is owned or 13
rented by: 14
(i) 1 or more of its residents; or 15
(ii) A person who: 16
1. Is an agent for any of the residents; but 17
2. Is not a provider of residential supervision. 18
(e) “Claim” has the meaning stated in § 2–601 of this article. 19
(f) “Deputy Secretary” means the Deputy Secretary for Developmental 20
Disabilities. 21
(g) “Developmental disability” means a severe chronic disability of an individual 22
that: 23
(1) Is attributable to a physical or mental impairment, other than the sole 24
diagnosis of mental illness, or to a combination of mental and physical impairments; 25
(2) Is manifested before the individual attains the age of 22; 26
(3) Is likely to continue indefinitely; 27 HOUSE BILL 1020 3
(4) Results in an inability to live independently without external support 1
or continuing and regular assistance; and 2
(5) Reflects the need for a combination and sequence of special, 3
interdisciplinary, or generic care, treatment, or other services that are individually planned 4
and coordinated for the individual. 5
(h) “External support” means: 6
(1) Periodic monitoring of the circumstances of an individual with respect 7
to: 8
(i) Personal management; 9
(ii) Household management; and 10
(iii) The use of community resources; and 11
(2) Rendering appropriate advice or assistance that may be needed. 12
(i) “Fee–for–service” means a method for payment that requires a person to 13
submit a claim for payment to the Department for each service performed. 14
(j) “Group home” means a residence that: 15
(1) Provides residential services for individuals who, because of 16
developmental disability, require specialized living arrangements; 17
(2) Admits at least 4 but not more than 8 individuals; and 18
(3) Provides 10 or more hours of supervision per home, per week. 19
(k) “Habilitation” means a process by which a provider of services enables an 20
individual to acquire and maintain life skills to cope more effectively with the demands of 21
the individual’s own person and environment and to raise the level of the individual’s 22
mental, physical, social, and vocational functioning. 23
(L) (1) “INDIVIDUAL–DIRECTED FAMILY GOOD S AND SERVICES ” MEANS 24
SERVICES, EQUIPMENT, THERAPIES, TRANSPORTATION , OR SUPPLIES FOR 25
INDIVIDUALS WHO SELF–DIRECT SERVICES THAT: 26
(I) RELATE TO A NEED OR G OAL IDENTIFIED IN TH E 27
PERSON–CENTERED PLAN ; 28
(II) MAINTAIN OR INCREASE INDEPENDENC E; 29 4 HOUSE BILL 1020
(III) PROMOTE OPPORTUNITIES FOR COMMUNITY LIVING AND 1
INCLUSION; AND 2
(IV) ARE NOT AVAILABLE UNDER A WAIVER SERVICE OR 3
SERVICES PROVIDED UN DER THE STATE PLAN ESTABLISHED IN SUBTITLE 3 OF THIS 4
TITLE. 5
6
(2) “INDIVIDUAL–DIRECTED FAMILY GOOD S AND SERVICES ” 7
INCLUDES ANY OTHER G OODS OR SERVICES AUT HORIZED UNDER GUIDAN CE ISSUED 8
BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES UNDER § 9
1915(C) OF THE SOCIAL SECURITY ACT. 10
[(l)] (M) (1) “Individual support services” means an array of services that are 11
designed to increase or maintain an individual’s ability to live alone or in a family setting. 12
(2) “Individual support services” include: 13
(i) In–home assistance with meals and personal care; 14
(ii) Counseling; 15
(iii) Physical, occupational, or other therapies; 16
(iv) Architectural modification; and 17
(v) Any other services that the Administration considers 18
appropriate to meet the individual’s needs. 19
(3) “Individual support services” does not include full day or residential 20
services. 21
[(m)] (N) “Intellectual disability” means a developmental disability that is 22
evidenced by significantly subaverage intellectual functioning and impairment in the 23
adaptive behavior of an individual. 24
[(n)] (O) “Knowingly” has the meaning stated in § 2–601 of this article. 25
[(o)] (P) “Live independently” means: 26
(1) For adults: 27
(i) Managing personal care, such as clothing and medication; 28
(ii) Managing a household, such as menu planning, food preparation 29
and shopping, essential care of the premises, and budgeting; and 30 HOUSE BILL 1020 5
(iii) Using community resources, such as commercial establishments, 1
transportation, and services of public agencies; or 2
(2) For minors, functioning in normal settings without the need for 3
supervision or assistance other than supervision or assistance that is age appropriate. 4
[(p)] (Q) “Meaningful day services” means employment supports or home– and 5
community–based supports, other than residential services, that assist an individual in 6
developing and maintaining skills, interests, and personalized connections that may create 7
opportunities for paid employment, increased independence, or meaningful relationships 8
with other individuals in the community. 9
(R) “PERSON–CENTERED” MEANS THAT A PLAN FOR SERVICES: 10
(1) REFLECTS WHAT IS IMPO RTANT TO THE INDIVID UAL AND FOR THE 11
INDIVIDUAL’S HEALTH AND WELFARE ; AND 12
(2) IS DEVELOPED WITH INP UT FROM THE INDIVIDU AL OR THE 13
INDIVIDUAL’S REPRESENTATIVE , IF APPLICABLE. 14
[(q)] (S) “Provider” means an individual who is licensed or certified under 15
Subtitle 9 of this title and provides services to: 16
(1) A recipient; or 17
(2) An individual with a developmental disability who receives funding for 18
services from a source other than the Administration. 19
[(r)] (T) “Recipient” means an individual who receives services funded by the 20
Administration under this title. 21
[(s)] (U) “Release” means a permanent, temporary, absolute, or conditional 22
release of an individual from a State residential center. 23
[(t)] (V) “Residential services” means individualized support and services that 24
assist an individual in developing and maintaining skills in living in the community. 25
(W) (1) “SELF–DIRECTED SERVICES ” MEANS WAIVER PROGRAM 26
SERVICES: 27
(I) FOR WHICH PARTICIPANT S OR THEIR REPRESENTATIVE S 28
HAVE DECISION–MAKING AUTHORITY OVE R AND TAKE DIRECT RE SPONSIBILITY FOR 29
MANAGEMENT OF THE SE RVICES WITH THE ASSI STANCE OF AVAILABLE SUPPORTS; 30
AND 31 6 HOUSE BILL 1020
(II) THAT ARE PROVIDED IN A MANNER THAT FURTHE RS THE 1
RIGHT OF INDIVIDUALS WITH DISABILITIES, REGARDLESS OF THE PH YSICAL OR 2
INTELLECTUAL CAPACIT Y OF THE INDIVIDUALS , TO MAKE CHOICES ABOU T AND 3
DIRECT ALL ASPECTS O F THEIR LIVES , INCLUDING THROUGH CO NTROL OVER 4
RECEIPT OF, AND FUNDING FOR , SUPPORT SERVICES . 5
(2) “SELF–DIRECTED SERVICES ” INCLUDES SERVICES THAT : 6
(I) PROVIDE AN INDIVIDUAL WITH : 7
1. THE DECISION–MAKING EMPLOYER AUTH ORITY TO 8
RECRUIT, HIRE, TRAIN, AND SUPERVISE THE IN DIVIDUALS WHO FURNIS H THE 9
INDIVIDUAL’S SERVICES; AND 10
2. THE BUDGET AUTHORITY OVER HOW FUNDS IN A 11
BUDGET ARE SPENT; 12
(II) MAXIMIZE THE OPPORTUN ITIES OF AN INDIVIDUAL TO LIVE 13
AS INDEPENDENTLY AS POSSIBLE IN THE MOST INCLUSIVE COMMUNITY –BASED 14
SETTING OF THE INDIVIDUAL’S CHOICE; 15
(III) EMPOWER AN INDIVIDUAL TO EXERCISE CHOICE A ND 16
CONTROL OVER NEEDED LONG–TERM SERVICES AND SUP PORTS; AND 17
(IV) HELP TO MAINTAIN AND IMPROVE HEALTH AND QUALITY O F 18
LIFE IN THE INDIVIDUAL’S COMMUNITY . 19
[(u)] (X) “Services” means residential, day, or other services that provide for 20
evaluation, diagnosis, treatment, care, supervision, assistance, or attention to individuals 21
with developmental disability and that promote habilitation of these individuals. 22
[(v)] (Y) “Services coordination” means a service that consists of the following 3 23
major functions that are designed to assist an individual in obtaining the needed services 24
and programs that the individual desires in order to gain as much control over the 25
individual’s own life as possible: 26
(1) Planning services; 27
(2) Coordinating services; and 28
(3) Monitoring service delivery to the individual. 29
[(w)] (Z) “State residential center” means a licensed facility operated by the 30 HOUSE BILL 1020 7
State that provides residential and habilitation services to individuals with an intellectual 1
disability who are at least 18 years old and meet the criteria set forth in § 7–502 of this 2
title. 3
(AA) “SUPPORT BROKER ” MEANS A PERSON WHO ADVOCATES ON BEH ALF OF 4
AND AS DIRECTED BY A N INDIVIDUAL WHO USE S SELF–DIRECTED SERVICES , 5
INCLUDING BY ASSISTI NG THE INDIVIDUAL OR THE INDIVIDUAL’S FAMILY OR OTHER 6
REPRESENTATIVE WITH : 7
(1) MAKING INFORMED DECIS IONS IN ARRANGING FO R, DIRECTING, 8
AND MANAGING SERVICE S THE INDIVIDUAL REC EIVES; 9
(2) ACCESSING AND MANAGIN G IDENTIFIED SUPPORT S AND 10
SERVICES BEST SUITED FOR THE INDIVIDUAL ; AND 11
(3) PERFORMING OTHER TASKS AS ASSIGNED BY THE INDIVIDUAL . 12
[(x)] (BB) “Support services” means supports that assist an individual to maintain 13
or improve the individual’s functional abilities, enhance interactions, or engage in 14
meaningful relationships in the home or community. 15
[(y)] (CC) “Treatment” means any education, training, professional care or 16
attention, or other program that is given to an individual with developmental disability. 17
[(z)] (DD) “Vocational services” means a service that provides job training and 18
placement, supported employment and training in acceptable work behaviors, and 19
vocationally–related social and other skills. 20
[(aa)] (EE) “Waiver program” means each Medicaid Home – and 21
Community–Based Services Waiver funding program submitted by the Department and 22
approved by the federal Centers for Medicare and Medicaid Services in accordance with § 23
1915(c) of the Social Security Act that is overseen and administered by the Administration. 24
[(bb)] (FF) “Waiver program services” means services funded by the 25
Administration in accordance with a waiver program, including: 26
(1) Meaningful day services; 27
(2) Residential services; and 28
(3) Support services. 29
7–408. 30
8 HOUSE BILL 1020
(A) THE ADMINISTRATION , IN CONSULTATION WITH STAKEHOLDERS , 1
SHALL ESTABLISH AND PROVIDE TRAINING MATERIALS TO COORDINATORS OF 2
COMMUNITY SERVICES ON SELF–DIRECTED SERVICES , INCLUDING TRAINING 3
MATERIALS ON SELF–DIRECTED SERVICES POLICIES AND RESOURC ES. 4
(B) AS PART OF THE PROCESS OF DEVEL OPING A PERSON–CENTERED PLAN 5
OF SERVICE FOR A RECIPIENT, A COORDINATOR OF COMMUN ITY SERVICES SHALL 6
EDUCATE THE RECIPIENT ON THE AVAILABILITY OF SELF–DIRECTED SERVICES : 7
(1) WHEN THE INDIVIDUAL B EGINS RECEIVING SERV ICES FROM A 8
COORDINATOR OF COMMU NITY SERVICES; AND 9
(2) AT LEAST ONCE EACH YEAR THAT THE INDIVI DUAL IS RECEIVING 10
SERVICES FROM A COOR DINATOR OF COMMUNITY SERVICES. 11
(C) A COORDINATOR OF COMMU NITY SERVICES SHALL REPORT TO THE 12
ADMINISTRATION , IN THE FORM AND MANN ER REQUIRED BY THE ADMINISTRATION , 13
THAT THE COORDINATOR OFFERED SELF –DIRECTED SERVICES TO AN INDIVIDUAL 14
IN ACCORDANCE WITH THIS SECTION. 15
7–409. 16
(A) THE ADMINISTRATION SHALL PROVIDE TO A R ECIPIENT WHO RECEIVE S 17
SELF–DIRECTED SERVICES : 18
(1) INDIVIDUAL–DIRECTED FAMILY GOOD S AND SERVICES IN AN 19
AMOUNT BASED ON THE RECIPIENT’S NEEDS AND INCLUDED IN THE RECIPIENT ’S 20
PERSON–CENTERED PLAN OF SER VICE AS CALCULATED ON AN ANN UAL BASIS; 21
(2) ACCESS TO THE RECIPIE NT’S PLAN OF SERVICE AND BUDGETS 22
FOR THE PLAN OF SERV ICE THROUGH THE DEPARTMENT ’S LONG TERM SERVICES 23
AND SUPPORTS SOFTWARE SYSTEM ; 24
(3) UP TO 40 HOURS OF SUPPORT BRO KER SERVICES EACH MO NTH, 25
AS NEEDED BY THE RECIPIENT ; 26
(4) AN OPTION FOR A FAMIL Y MEMBER OR LEGAL GU ARDIAN OF THE 27
RECIPIENT TO PROVIDE SERVICES FOR THE REC IPIENT, IF: 28
(I) THE RECIPIENT OR AN INDIVIDUAL AUTHORIZE D TO MAKE 29
CARE DECISIONS ON BE HALF OF THE RECIPIEN T CHOOSES THE FAMILY MEMBER TO 30
PROVIDE THE SERVICES ; AND 31
HOUSE BILL 1020 9
(II) THE RECIPIENT ALSO HI RES A SUPPORT BROKER ; 1
(5) REIMBURSEMENT PAID ON A PER –MILE BASIS FOR 2
TRANSPORTATION PROVI DED TO THE RECIPIENT BY AN INDIVIDUAL WHO IS NO T 3
EMPLOYED BY THE INDI VIDUAL, IF THE TRANSPORTATIO N IS RELATED TO THE 4
RECIPIENT’S PERSON–CENTERED PLAN OF SER VICE; 5
(6) A BUDGET FOR SELF–DIRECTED SERVICES THAT PROVIDES 6
SUBSTANTIALLY SIMILA R SERVICES AS THOSE PROVIDED TO A RECIPIENT WHO 7
DOES NOT SELF –DIRECT SERVICES , INCLUDING FUNDING FOR MANAGERI AL OR 8
DIRECT SUPPORT POSIT IONS; 9
(7) AN OPTION FOR A RECIPIENT WHO HAS A DEMONSTRATED N EED 10
FOR OVERNIGHT SUPPOR TS TO DIRECT AND CHOOSE THE PROVIDER OF THE 11
OVERNIGHT SUPPORTS , INCLUDING WHETHER TO USE FUNDING IN THE RECIPIENT’S 12
BUDGET FOR SELF –DIRECTED SERVICES AL LOCATED FOR PERSONAL SUPPORT 13
SERVICES FOR OVERNIGHT SUPPOR TS; 14
(8) THE CHOICE OF A VENDOR TO PROVIDE FISCAL MANAGEMENT 15
SERVICES FROM AT LEA ST THREE OPTIONS; 16
(9) THE OPTION TO EMPLOY A REPRESENTATIVE , SUPPORT BROKER , 17
OR TEAM OF INDIVIDUA LS TO SUPPORT THE RECIPIENT IN DIRECTING SERVICE S; 18
AND 19
(10) TRAINING FOR A REPRES ENTATIVE, SUPPORT BROKER , OR TEAM 20
OF INDIVIDUALS ON SE LF–DIRECTED SERVICES . 21
(B) SUBJECT TO SUBSECTION (A)(3) OF THIS SECTION , THE 22
ADMINISTRATION SHALL PROVIDE TO A RECIPIE NT OF SELF–DIRECTED SERVICES 23
ANY SUPPORT BROKER S ERVICES THAT ARE : 24
(1) AUTHORIZED UNDER GUID ANCE ISSUED BY THE CENTERS FOR 25
MEDICARE AND MEDICAID SERVICES IN § 1915(C) OF THE SOCIAL SECURITY ACT; 26
AND 27
(2) SELECTED BY THE RECIP IENT. 28
(C) THE ADMINISTRATION MAY NOT ESTABLISH A LIMIT ON : 29
(1) THE DOLLAR AMOUNT OF INDIVIDUAL–DIRECTED FAMILY GOOD S 30
AND SERVICES PROVIDED TO A RECIPIENT; OR 31
10 HOUSE BILL 1020
(2) THE NUMBER OF HOURS OF OVERNIGHT S UPPORTS PROVIDED TO 1
A RECIPIENT WHO RECEIVES SELF–DIRECTED SERVICES. 2
(D) THE STATE MAY NOT REQUIRE A RECIPIENT TO DEMONSTRATE 3
COMPETENCY BEFORE TH E ADMINISTRATION AUTHOR IZES THE RECIPIENT T O 4
RECEIVE SELF–DIRECT SERVICES . 5
7–410. 6
(A) THE ADMINISTRATION SHALL PROVIDE UP TO 40 HOURS OF SUPPORT 7
BROKER SERVICES EACH MONTH TO A RECIPIENT OF WAIVER SERVICES . 8
(B) SUBJECT TO SUBSECTION (A) OF THIS SECTION, THE ADMINISTRATION 9
SHALL PROVIDE TO A R ECIPIENT OF WAIVER S ERVICES ANY SUPPORT BROKER 10
SERVICES THAT ARE AU THORIZED UNDER GUIDA NCE ISSUED BY THE CENTERS FOR 11
MEDICARE AND MEDICAID SERVICES UNDER § 1915(C) OF THE SOCIAL SECURITY 12
ACT. 13
SECTION 2. AND BE IT FURTHER ENACTED, That on or before January 1, 2023, 14
the Developmental Disabilities Administration shall submit to the Centers for Medicare 15
and Medicaid Services an amendment to the Community Pathways Waiver that includes 16
the overnight supports requirements established under Section 1 of this Act. 17
SECTION 3. AND BE IT FURTHER ENACTED, T hat on or before January 1 each 18
year, beginning in 2023 and ending in 2026, the Developmental Disabilities Administration 19
shall report to the General Assembly, in accordance with § 2–1257 of the State Government 20
Article, on the progress in implementing the requirements established under Section 1 of 21
this Act and the recommendations outlined in the Self–Directed Advocacy Network of 22
Maryland’s “Recommendations to Summary Study Workgroup House Bill 318 of 2021”. 23
SECTION 4. AND BE IT FURTHER ENACTED, Tha t, to the extent authorized by 24
law, the Developmental Disabilities Administration shall leverage federal funding, 25
including funding provided by the Centers for Medicare and Medicaid Services, to pay for 26
the services established under this Act. 27
SECTION 5. AND BE IT FURTHER ENACTED, That this Act shall take effect 28
October 1, 2022. 29