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Maryland House Bill HB80

Maryland 2022 Regular Session

Maryland House Bill HB80 Compare Versions

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33 EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
44 [Brackets] indicate matter deleted from existing law.
5- Underlining indicates amendments to bill.
6- Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7-amendment.
85 *hb0080*
96
107 HOUSE BILL 80
118 O3, J1 2lr1084
12- (PRE–FILED) CF SB 28
13-By: Delegate Cullison Delegates Cullison, Pendergrass, Pena–Melnyk, Bagnall,
14-Belcastro, Bhandari, Carr, Chisholm, Hill, Johnson, Kaiser, Kelly, Kerr,
15-Kipke, Krebs, Landis, R. Lewis, Morgan, Reilly, Rosenberg, Saab,
16-Sample–Hughes, Szeliga, and K. Young
9+ (PRE–FILED) CF 2lr1201
10+By: Delegate Cullison
1711 Requested: October 29, 2021
1812 Introduced and read first time: January 12, 2022
1913 Assigned to: Health and Government Operations
20-Committee Report: Favorable with amendments
21-House action: Adopted
22-Read second time: March 30, 2022
2314
24-CHAPTER ______
15+A BILL ENTITLED
2516
2617 AN ACT concerning 1
2718
2819 Home– and Community–Based Services Waiver – Participation and Applications 2
2920
3021 FOR the purpose of altering the required contents of the home– and community–based 3
3122 services waiver submitted by the Maryland Department of Health to the Centers for 4
3223 Medicare and Medicaid Services; requiring the Department to send an application to 5
3324 a certain number of individuals each month, if the Department maintains a waiting 6
34-list or registry for the waiver; requiring the Department to apply to the Centers for 7
35-Medicare and Medicaid Services for an amendment to the home – and 8
36-community–based services waiver; and generally relating to the home– and 9
37-community–based services waiver. 10
25+list or registry for the waiver; and generally relating to the home– and 7
26+community–based services waiver. 8
3827
39-BY repealing and reenacting, with amendments, 11
40- Article – Health – General 12
41-Section 15–132 13
42- Annotated Code of Maryland 14
43- (2019 Replacement Volume and 2021 Supplement) 15
28+BY repealing and reenacting, with amendments, 9
29+ Article – Health – General 10
30+Section 15–132 11
31+ Annotated Code of Maryland 12
32+ (2019 Replacement Volume and 2021 Supplement) 13
4433
45- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
46-That the Laws of Maryland read as follows: 17
34+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14
35+That the Laws of Maryland read as follows: 15
4736
48-Article – Health – General 18 2 HOUSE BILL 80
37+Article – Health – General 16
38+
39+15–132. 17
40+
41+ (a) (1) In this section the following terms have the meanings indicated. 18
42+
43+ (2) “Assisted living program” has the meaning stated in § 19–1801 of this 19
44+article. 20
45+
46+ (3) “Assisted living services” means services provided by an assisted living 21
47+program as defined in regulations adopted by the Department. 22
48+ 2 HOUSE BILL 80
4949
5050
51+ (4) “Case management services” means services that assist waiver eligible 1
52+individuals in gaining access to needed waiver services and other needed medical, social, 2
53+housing, and other supportive services. 3
5154
52-15–132. 1
55+ (5) “Health related care and services” includes: 4
5356
54- (a) (1) In this section the following terms have the meanings indicated. 2
57+ (i) 24–hour supervision and observation by a licensed care provider; 5
5558
56- (2) “Assisted living program” has the meaning stated in § 19–1801 of this 3
57-article. 4
59+ (ii) Medication administration; 6
5860
59- (3) “Assisted living services” means services provided by an assisted living 5
60-program as defined in regulations adopted by the Department. 6
61+ (iii) Inhalation therapy; 7
6162
62- (4) “Case management services” means services that assist waiver eligible 7
63-individuals in gaining access to needed waiver services and other needed medical, social, 8
64-housing, and other supportive services. 9
63+ (iv) Bladder and catheter management; 8
6564
66- (5) “Health related care and services” includes: 10
65+ (v) Assistance with suctioning; or 9
6766
68- (i) 24–hour supervision and observation by a licensed care provider; 11
67+ (vi) Assistance with treatment of skin disorders and dressings. 10
6968
70- (ii) Medication administration; 12
69+ (6) “Home health care services” means those services defined in § 19–401 11
70+of this article and in 42 C.F.R. 440.70. 12
7171
72- (iii) Inhalation therapy; 13
72+ (7) “Medically and functionally impaired” means an individual who is 13
73+assessed by the Department to require services provided by a nursing facility as defined in 14
74+this section, and who, but for the receipt of these services, would require admission to a 15
75+nursing facility within 30 days. 16
7376
74- (iv) Bladder and catheter management; 14
77+ (8) “Nursing facility” means a facility that provides skilled nursing care 17
78+and related services, rehabilitation services, and health related care and services above the 18
79+level of room and board needed on a regular basis in accordance with § 1919 of the federal 19
80+Social Security Act. 20
7581
76- (v) Assistance with suctioning; or 15
82+ (9) “Waiver” means a home– and community–based services waiver under 21
83+§ 1915(c) of the federal Social Security Act, submitted by the Department to the Centers for 22
84+Medicare and Medicaid Services. 23
7785
78- (vi) Assistance with treatment of skin disorders and dressings. 16
86+ (10) “Waiver services” means the services covered under an approved waiver 24
87+that: 25
7988
80- (6) “Home health care services” means those services defined in § 19–401 17
81-of this article and in 42 C.F.R. 440.70. 18
89+ (i) Are needed and chosen by an eligible waiver participant as an 26
90+alternative to admission to or continued stay in a nursing facility; 27
8291
83- (7) “Medically and functionally impaired” means an individual who is 19
84-assessed by the Department to require services provided by a nursing facility as defined in 20
85-this section, and who, but for the receipt of these services, would require admission to a 21
86-nursing facility within 30 days. 22
92+ (ii) Are part of a plan of service approved by the program; 28
8793
88- (8) “Nursing facility” means a facility that provides skilled nursing care 23
89-and related services, rehabilitation services, and health related care and services above the 24
90-level of room and board needed on a regular basis in accordance with § 1919 of the federal 25
91-Social Security Act. 26
92-
93- (9) “Waiver” means a home– and community–based services waiver under 27
94-§ 1915(c) of the federal Social Security Act, submitted by the Department to the Centers for 28
95-Medicare and Medicaid Services. 29
94+ (iii) Assure the waiver participant’s health and safety in the 29
95+community; and 30
9696 HOUSE BILL 80 3
9797
9898
99- (10) “Waiver services” means the services covered under an approved waiver 1
100-that: 2
99+ (iv) Cost no more per capita to receive services in the community 1
100+than in a nursing facility. 2
101101
102- (i) Are needed and chosen by an eligible waiver participant as an 3
103-alternative to admission to or continued stay in a nursing facility; 4
102+ (b) (1) If authorized by the Centers for Medicare and Medicaid Services, an 3
103+individual shall be determined medically eligible to receive services if the individual 4
104+requires: 5
104105
105- (ii) Are part of a plan of service approved by the program; 5
106+ (i) Skilled nursing care or other related services; 6
106107
107- (iii) Assure the waiver participant’s health and safety in the 6
108-community; and 7
108+ (ii) Rehabilitation services; or 7
109109
110- (iv) Cost no more per capita to receive services in the community 8
111-than in a nursing facility. 9
110+ (iii) Health–related services above the level of room and board that 8
111+are available only through nursing facilities, including individuals who because of severe 9
112+cognitive impairments or other conditions: 10
112113
113- (b) (1) If authorized by the Centers for Medicare and Medicaid Services, an 10
114-individual shall be determined medically eligible to receive services if the individual 11
115-requires: 12
114+ 1. A. Are currently unable to perform at least two 11
115+activities of daily living without hands–on assistance or standby assistance from another 12
116+individual; and 13
116117
117- (i) Skilled nursing care or other related services; 13
118+ B. Have been or will be unable to perform at least two 14
119+activities of daily living for a period of at least 90 days due to a loss of functional capacity; 15
120+or 16
118121
119- (ii) Rehabilitation services; or 14
122+ 2. Need substantial supervision for protection against 17
123+threats to health and safety due to severe cognitive impairment. 18
120124
121- (iii) Health–related services above the level of room and board that 15
122-are available only through nursing facilities, including individuals who because of severe 16
123-cognitive impairments or other conditions: 17
125+ (2) The Department shall adopt regulations to carry out the provisions of 19
126+this subsection. 20
124127
125- 1. A. Are currently unable to perform at least two 18
126-activities of daily living without hands–on assistance or standby assistance from another 19
127-individual; and 20
128+ (c) The Department’s waiver shall include the following: 21
128129
129- B. Have been or will be unable to perform at least two 21
130-activities of daily living for a period of at least 90 days due to a loss of functional capacity; 22
131-or 23
130+ (1) [An initial] A cap on waiver participation [at] OF NOT FEWER THAN 22
131+7,500 individuals; 23
132132
133- 2. Need substantial supervision for protection against 24
134-threats to health and safety due to severe cognitive impairment. 25
133+ (2) [A limit on annual waiver participation based on State General Fund 24
134+support as provided in the budget bill] A PLAN FOR WAIVER PART ICIPATION OF NO T 25
135+FEWER THAN 7,500 INDIVIDUALS; 26
135136
136- (2) The Department shall adopt regulations to carry out the provisions of 26
137-this subsection. 27
137+ (3) Financial eligibility criteria which include: 27
138138
139- (c) The Department’s waiver shall include the following: 28
139+ (i) The current federal and State medical assistance long–term care 28
140+rules for using services provided by a nursing facility, per §§ 1902, 1919, and 1924 of the 29
141+federal Social Security Act, and applicable regulations adopted by the Department; 30
140142
141- (1) [An initial] A cap on waiver participation [at] OF NOT FEWER THAN 29
142-7,500 individuals; 30
143- 4 HOUSE BILL 80
143+ (ii) Medically needy individuals using services provided by a nursing 31
144+facility under the current federal and State medical assistance eligibility criteria governed 32 4 HOUSE BILL 80
144145
145146
146- (2) [A limit on annual waiver participation based on State General Fund 1
147-support as provided in the budget bill] A PLAN FOR WAIVER PART ICIPATION OF NOT 2
148-FEWER THAN 7,500 INDIVIDUALS; 3
147+by regulations adopted by the Department and § 1919 of the federal Social Security Act; 1
148+and 2
149149
150- (3) Financial eligibility criteria which include: 4
150+ (iii) Categorically needy individuals with income up to 300% of the 3
151+applicable payment rate for supplemental security income; 4
151152
152- (i) The current federal and State medical assistance long–term care 5
153-rules for using services provided by a nursing facility, per §§ 1902, 1919, and 1924 of the 6
154-federal Social Security Act, and applicable regulations adopted by the Department; 7
153+ (4) Waiver services that include at least the following: 5
155154
156- (ii) Medically needy individuals using services provided by a nursing 8
157-facility under the current federal and State medical assistance eligibility criteria governed 9
158-by regulations adopted by the Department and § 1919 of the federal Social Security Act; 10
159-and 11
155+ (i) Assisted living services; 6
160156
161- (iii) Categorically needy individuals with income up to 300% of the 12
162-applicable payment rate for supplemental security income; 13
157+ (ii) Case management services; 7
163158
164- (4) Waiver services that include at least the following: 14
159+ (iii) Family training; 8
165160
166- (i) Assisted living services; 15
161+ (iv) Dietitian and nutritionist services; 9
167162
168- (ii) Case management services; 16
163+ (v) Medical day care services; and 10
169164
170- (iii) Family training; 17
165+ (vi) Senior center plus services; 11
171166
172- (iv) Dietitian and nutritionist services; 18
167+ (5) The opportunity to provide eligible individuals with waiver services 12
168+under this section as soon as they are available without waiting for placement slots to open 13
169+in the next fiscal year; 14
173170
174- (v) Medical day care services; and 19
171+ (6) An increase in participant satisfaction; 15
175172
176- (vi) Senior center plus services; 20
173+ (7) The forestalling of functional decline; 16
177174
178- (5) The opportunity to provide eligible individuals with waiver services 21
179-under this section as soon as they are available without waiting for placement slots to open 22
180-in the next fiscal year; 23
175+ (8) A reduction in Medicaid expenditures by reducing utilization of 17
176+services; and 18
181177
182- (6) An increase in participant satisfaction; 24
178+ (9) The enhancement of compliance with the decision of the United States 19
179+Supreme Court in the case of Olmstead v. L.C. (1999) by offering cost –effective 20
180+community–based services in the most appropriate setting. 21
183181
184- (7) The forestalling of functional decline; 25
182+ (d) This section may not be construed to affect, interfere with, or interrupt any 22
183+services reimbursed through the Program under this title. 23
185184
186- (8) A reduction in Medicaid expenditures by reducing utilization of 26
187-services; and 27
185+ (e) (1) (I) IF THE DEPARTMENT MAINTAINS A WAITING LIST OR 24
186+REGISTRY, EACH MONTH THE DEPARTMENT SHALL SEND A WAIVER APPLICATION : 25
188187
189- (9) The enhancement of compliance with the decision of the United States 28
190-Supreme Court in the case of Olmstead v. L.C. (1999) by offering cost –effective 29
191-community–based services in the most appropriate setting. 30
188+ 1. IF THERE ARE FEWER TH AN 600 INDIVIDUALS ON THE 26
189+WAITING LIST OR REGI STRY, TO ALL INDIVIDUALS O N THE WAITING LIST O R 27
190+REGISTRY; AND 28
192191 HOUSE BILL 80 5
193192
194193
195- (d) This section may not be construed to affect, interfere with, or interrupt any 1
196-services reimbursed through the Program under this title. 2
194+ 2. IF THERE ARE 600 OR MORE INDIVIDUALS ON THE 1
195+WAITING LIST OR REGI STRY, TO AT LEAST 600 INDIVIDUALS ON THE W AITING LIST 2
196+OR REGISTRY. 3
197197
198- (e) (1) (I) IF THE DEPARTMENT MAINTAINS A WAITING LIST OR 3
199-REGISTRY, EACH MONTH THE DEPARTMENT SHALL SEND A WA IVER APPLICATION : 4
198+ (II) A WAIVER APPLICATION SE NT UNDER SUBPARAGRAPH (I) 4
199+OF THIS PARAGRAPH SHALL STATE CLEARLY AND CONSPICUOUSLY THAT: 5
200200
201- 1. IF THERE ARE FEWER TH AN 600 INDIVIDUALS ON THE 5
202-WAITING LIST OR REGI STRY, TO ALL INDIVIDUALS O N THE WAITING LIST O R 6
203-REGISTRY; AND 7
201+ 1. THE APPLICANT MUST SUBMIT THE APPL ICATION 6
202+WITHIN 6 WEEKS AFTER RECEIVING THE APPLICATION ; AND 7
204203
205- 2. IF THERE ARE 600 OR MORE INDIVIDUALS ON THE 8
206-WAITING LIST OR REGI STRY, TO AT LEAST 600 INDIVIDUALS ON THE W AITING LIST 9
207-OR REGISTRY. 10
204+ 2. THE APPLICANT IS REQUIRED TO MEET ALL OF THE 8
205+ELIGIBILITY CRITERIA FOR PARTICIPATION IN THE WAIVER WITHIN 6 MONTHS 9
206+AFTER SUBMITTING THE APPLICATION. 10
208207
209- (II) A WAIVER APPLICATION S ENT UNDER SUBPARAGRA PH (I) 11
210-OF THIS PARAGRAPH SH ALL STATE CLEARLY AN D CONSPICUOUSLY THAT : 12
208+ (2) If a person determined to be eligible to receive waiver services under 11
209+this section desires to receive waiver services and an appropriate placement is available, 12
210+the Department shall authorize the placement. 13
211211
212- 1. THE APPLICANT MUST SU BMIT THE APPLICATION 13
213-WITHIN 6 WEEKS AFTER RECEIVI NG THE APPLICATION ; AND 14
212+ (f) The Department, in consultation with representatives of the affected industry 14
213+and advocates for waiver candidates, and with the approval of the Department of Aging, 15
214+shall adopt regulations to implement this section. 16
214215
215- 2. THE APPLICANT IS REQU IRED TO MEET ALL OF THE 15
216-ELIGIBILITY CRITERIA FOR PARTICIPATION IN THE WAIVER WITHIN 6 MONTHS 16
217-AFTER SUBMITTING THE APPLICATION. 17
218-
219- (2) If a person determined to be eligible to receive waiver services under 18
220-this section desires to receive waiver services and an appropriate placement is available, 19
221-the Department shall authorize the placement. 20
222-
223- (f) The Department, in consultation with representatives of the affected industry 21
224-and advocates for waiver candidates, and with the approval of the Department of Aging, 22
225-shall adopt regulations to implement this section. 23
226-
227- SECTION 2. AND BE IT FURTHER ENACTED, That on or before October 31, 2022, 24
228-and thereafter as necessary, the Maryland Department of Health shall apply to the Centers 25
229-for Medicare and Medicaid Services for an amendment to the home– and community–based 26
230-waiver under § 1915(c) of the federal Social Security Act to increase the waiver cap size to 27
231-be consistent with Section 1 of this Act. 28
232-
233- SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 29
234-October 1, 2022. 30
235-
216+ SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 17
217+October 1, 2022. 18