EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0080*
HOUSE BILL 80
O3, J1 2lr1084
(PRE–FILED) CF 2lr1201
By: Delegate Cullison
Requested: October 29, 2021
Introduced and read first time: January 12, 2022
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Home– and Community–Based Services Waiver – Participation and Applications 2
FOR the purpose of altering the required contents of the home– and community–based 3
services waiver submitted by the Maryland Department of Health to the Centers for 4
Medicare and Medicaid Services; requiring the Department to send an application to 5
a certain number of individuals each month, if the Department maintains a waiting 6
list or registry for the waiver; and generally relating to the home– and 7
community–based services waiver. 8
BY repealing and reenacting, with amendments, 9
Article – Health – General 10
Section 15–132 11
Annotated Code of Maryland 12
(2019 Replacement Volume and 2021 Supplement) 13
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14
That the Laws of Maryland read as follows: 15
Article – Health – General 16
15–132. 17
(a) (1) In this section the following terms have the meanings indicated. 18
(2) “Assisted living program” has the meaning stated in § 19–1801 of this 19
article. 20
(3) “Assisted living services” means services provided by an assisted living 21
program as defined in regulations adopted by the Department. 22
2 HOUSE BILL 80
(4) “Case management services” means services that assist waiver eligible 1
individuals in gaining access to needed waiver services and other needed medical, social, 2
housing, and other supportive services. 3
(5) “Health related care and services” includes: 4
(i) 24–hour supervision and observation by a licensed care provider; 5
(ii) Medication administration; 6
(iii) Inhalation therapy; 7
(iv) Bladder and catheter management; 8
(v) Assistance with suctioning; or 9
(vi) Assistance with treatment of skin disorders and dressings. 10
(6) “Home health care services” means those services defined in § 19–401 11
of this article and in 42 C.F.R. 440.70. 12
(7) “Medically and functionally impaired” means an individual who is 13
assessed by the Department to require services provided by a nursing facility as defined in 14
this section, and who, but for the receipt of these services, would require admission to a 15
nursing facility within 30 days. 16
(8) “Nursing facility” means a facility that provides skilled nursing care 17
and related services, rehabilitation services, and health related care and services above the 18
level of room and board needed on a regular basis in accordance with § 1919 of the federal 19
Social Security Act. 20
(9) “Waiver” means a home– and community–based services waiver under 21
§ 1915(c) of the federal Social Security Act, submitted by the Department to the Centers for 22
Medicare and Medicaid Services. 23
(10) “Waiver services” means the services covered under an approved waiver 24
that: 25
(i) Are needed and chosen by an eligible waiver participant as an 26
alternative to admission to or continued stay in a nursing facility; 27
(ii) Are part of a plan of service approved by the program; 28
(iii) Assure the waiver participant’s health and safety in the 29
community; and 30
HOUSE BILL 80 3
(iv) Cost no more per capita to receive services in the community 1
than in a nursing facility. 2
(b) (1) If authorized by the Centers for Medicare and Medicaid Services, an 3
individual shall be determined medically eligible to receive services if the individual 4
requires: 5
(i) Skilled nursing care or other related services; 6
(ii) Rehabilitation services; or 7
(iii) Health–related services above the level of room and board that 8
are available only through nursing facilities, including individuals who because of severe 9
cognitive impairments or other conditions: 10
1. A. Are currently unable to perform at least two 11
activities of daily living without hands–on assistance or standby assistance from another 12
individual; and 13
B. Have been or will be unable to perform at least two 14
activities of daily living for a period of at least 90 days due to a loss of functional capacity; 15
or 16
2. Need substantial supervision for protection against 17
threats to health and safety due to severe cognitive impairment. 18
(2) The Department shall adopt regulations to carry out the provisions of 19
this subsection. 20
(c) The Department’s waiver shall include the following: 21
(1) [An initial] A cap on waiver participation [at] OF NOT FEWER THAN 22
7,500 individuals; 23
(2) [A limit on annual waiver participation based on State General Fund 24
support as provided in the budget bill] A PLAN FOR WAIVER PART ICIPATION OF NO T 25
FEWER THAN 7,500 INDIVIDUALS; 26
(3) Financial eligibility criteria which include: 27
(i) The current federal and State medical assistance long–term care 28
rules for using services provided by a nursing facility, per §§ 1902, 1919, and 1924 of the 29
federal Social Security Act, and applicable regulations adopted by the Department; 30
(ii) Medically needy individuals using services provided by a nursing 31
facility under the current federal and State medical assistance eligibility criteria governed 32 4 HOUSE BILL 80
by regulations adopted by the Department and § 1919 of the federal Social Security Act; 1
and 2
(iii) Categorically needy individuals with income up to 300% of the 3
applicable payment rate for supplemental security income; 4
(4) Waiver services that include at least the following: 5
(i) Assisted living services; 6
(ii) Case management services; 7
(iii) Family training; 8
(iv) Dietitian and nutritionist services; 9
(v) Medical day care services; and 10
(vi) Senior center plus services; 11
(5) The opportunity to provide eligible individuals with waiver services 12
under this section as soon as they are available without waiting for placement slots to open 13
in the next fiscal year; 14
(6) An increase in participant satisfaction; 15
(7) The forestalling of functional decline; 16
(8) A reduction in Medicaid expenditures by reducing utilization of 17
services; and 18
(9) The enhancement of compliance with the decision of the United States 19
Supreme Court in the case of Olmstead v. L.C. (1999) by offering cost –effective 20
community–based services in the most appropriate setting. 21
(d) This section may not be construed to affect, interfere with, or interrupt any 22
services reimbursed through the Program under this title. 23
(e) (1) (I) IF THE DEPARTMENT MAINTAINS A WAITING LIST OR 24
REGISTRY, EACH MONTH THE DEPARTMENT SHALL SEND A WAIVER APPLICATION : 25
1. IF THERE ARE FEWER TH AN 600 INDIVIDUALS ON THE 26
WAITING LIST OR REGI STRY, TO ALL INDIVIDUALS O N THE WAITING LIST O R 27
REGISTRY; AND 28
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2. IF THERE ARE 600 OR MORE INDIVIDUALS ON THE 1
WAITING LIST OR REGI STRY, TO AT LEAST 600 INDIVIDUALS ON THE W AITING LIST 2
OR REGISTRY. 3
(II) A WAIVER APPLICATION SE NT UNDER SUBPARAGRAPH (I) 4
OF THIS PARAGRAPH SHALL STATE CLEARLY AND CONSPICUOUSLY THAT: 5
1. THE APPLICANT MUST SUBMIT THE APPL ICATION 6
WITHIN 6 WEEKS AFTER RECEIVING THE APPLICATION ; AND 7
2. THE APPLICANT IS REQUIRED TO MEET ALL OF THE 8
ELIGIBILITY CRITERIA FOR PARTICIPATION IN THE WAIVER WITHIN 6 MONTHS 9
AFTER SUBMITTING THE APPLICATION. 10
(2) If a person determined to be eligible to receive waiver services under 11
this section desires to receive waiver services and an appropriate placement is available, 12
the Department shall authorize the placement. 13
(f) The Department, in consultation with representatives of the affected industry 14
and advocates for waiver candidates, and with the approval of the Department of Aging, 15
shall adopt regulations to implement this section. 16
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 17
October 1, 2022. 18