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