MD
Maryland Senate Bill SB28

Maryland 2022 Regular Session

Maryland Senate Bill SB28 Compare Versions

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1- LAWRENCE J. HOGAN, JR., Governor Ch. 738
21
3-– 1 –
4-Chapter 738
5-(Senate Bill 28)
62
7-AN ACT concerning
3+EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4+ [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.
8+ *sb0028*
89
9-Home– and Community–Based Services Waiver – Participation and Applications
10+SENATE BILL 28
11+O3, J1 2lr1201
12+ (PRE–FILED) CF HB 80
13+By: Senators Kelley, Augustine, Beidle, and Feldman Benson, Feldman, and
14+Klausmeier
15+Requested: November 1, 2021
16+Introduced and read first time: January 12, 2022
17+Assigned to: Finance
18+Committee Report: Favorable with amendments
19+Senate action: Adopted
20+Read second time: February 17, 2022
1021
11-FOR the purpose of altering the required contents of the home– and community–based
12-services waiver submitted by the Maryland Department of Health to the Centers for
13-Medicare and Medicaid Services; requiring the Department to send an application to
14-a certain number of individuals each month, if the Department maintains a waiting
15-list or registry for the waiver; requiring the Department to apply to the Centers for
16-Medicare and Medicaid Services for an amendment to the home – and
17-community–based services waiver; and generally relating to the home– and
18-community–based services waiver.
22+CHAPTER ______
1923
20-BY repealing and reenacting, with amendments,
21- Article – Health – General
22-Section 15–132
23- Annotated Code of Maryland
24- (2019 Replacement Volume and 2021 Supplement)
24+AN ACT concerning 1
2525
26- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
27-That the Laws of Maryland read as follows:
26+Home– and Community–Based Services Waiver – Participation and Applications 2
2827
29-Article – Health – General
28+FOR the purpose of altering the required contents of the home– and community–based 3
29+services waiver submitted by the Maryland Department of Health to the Centers for 4
30+Medicare and Medicaid Services; requiring the Department to send an application to 5
31+a certain number of individuals each month, if the Department maintains a waiting 6
32+list or registry for the waiver; requiring the Department to apply to the Centers for 7
33+Medicare and Medicaid Services for an amendm ent to the home– and 8
34+community–based services waiver; and generally relating to the home– and 9
35+community–based services waiver. 10
3036
31-15–132.
37+BY repealing and reenacting, with amendments, 11
38+ Article – Health – General 12
39+Section 15–132 13
40+ Annotated Code of Maryland 14
41+ (2019 Replacement Volume and 2021 Supplement) 15
3242
33- (a) (1) In this section the following terms have the meanings indicated.
43+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
44+That the Laws of Maryland read as follows: 17
3445
35- (2) “Assisted living program” has the meaning stated in § 19–1801 of this
36-article.
46+Article – Health – General 18
3747
38- (3) “Assisted living services” means services provided by an assisted living
39-program as defined in regulations adopted by the Department.
48+15–132. 19 2 SENATE BILL 28
4049
41- (4) “Case management services” means services that assist waiver eligible
42-individuals in gaining access to needed waiver services and other needed medical, social,
43-housing, and other supportive services.
4450
45- (5) “Health related care and services” includes:
4651
47- (i) 24–hour supervision and observation by a licensed care provider;
52+ (a) (1) In this section the following terms have the meanings indicated. 1
4853
49- (ii) Medication administration; Ch. 738 2022 LAWS OF MARYLAND
54+ (2) “Assisted living program” has the meaning stated in § 19–1801 of this 2
55+article. 3
5056
51-– 2 –
57+ (3) “Assisted living services” means services provided by an assisted living 4
58+program as defined in regulations adopted by the Department. 5
5259
53- (iii) Inhalation therapy;
60+ (4) “Case management services” means services that assist waiver eligible 6
61+individuals in gaining access to needed waiver services and other needed medical, social, 7
62+housing, and other supportive services. 8
5463
55- (iv) Bladder and catheter management;
64+ (5) “Health related care and services” includes: 9
5665
57- (v) Assistance with suctioning; or
66+ (i) 24–hour supervision and observation by a licensed care provider; 10
5867
59- (vi) Assistance with treatment of skin disorders and dressings.
68+ (ii) Medication administration; 11
6069
61- (6) “Home health care services” means those services defined in § 19–401
62-of this article and in 42 C.F.R. 440.70.
70+ (iii) Inhalation therapy; 12
6371
64- (7) “Medically and functionally impaired” means an individual who is
65-assessed by the Department to require services provided by a nursing facility as defined in
66-this section, and who, but for the receipt of these services, would require admission to a
67-nursing facility within 30 days.
72+ (iv) Bladder and catheter management; 13
6873
69- (8) “Nursing facility” means a facility that provides skilled nursing care
70-and related services, rehabilitation services, and health related care and services above the
71-level of room and board needed on a regular basis in accordance with § 1919 of the federal
72-Social Security Act.
74+ (v) Assistance with suctioning; or 14
7375
74- (9) “Waiver” means a home– and community–based services waiver under
75-§ 1915(c) of the federal Social Security Act, submitted by the Department to the Centers for
76-Medicare and Medicaid Services.
76+ (vi) Assistance with treatment of skin disorders and dressings. 15
7777
78- (10) “Waiver services” means the services covered under an approved waiver
79-that:
78+ (6) “Home health care services” means those services defined in § 19–401 16
79+of this article and in 42 C.F.R. 440.70. 17
8080
81- (i) Are needed and chosen by an eligible waiver participant as an
82-alternative to admission to or continued stay in a nursing facility;
81+ (7) “Medically and functionally impaired” means an individual who is 18
82+assessed by the Department to require services provided by a nursing facility as defined in 19
83+this section, and who, but for the receipt of these services, would require admission to a 20
84+nursing facility within 30 days. 21
8385
84- (ii) Are part of a plan of service approved by the program;
86+ (8) “Nursing facility” means a facility that provides skilled nursing care 22
87+and related services, rehabilitation services, and health related care and services above the 23
88+level of room and board needed on a regular basis in accordance with § 1919 of the federal 24
89+Social Security Act. 25
8590
86- (iii) Assure the waiver participant’s health and safety in the
87-community; and
91+ (9) “Waiver” means a home– and community–based services waiver under 26
92+§ 1915(c) of the federal Social Security Act, submitted by the Department to the Centers for 27
93+Medicare and Medicaid Services. 28
8894
89- (iv) Cost no more per capita to receive services in the community
90-than in a nursing facility.
95+ (10) “Waiver services” means the services covered under an approved waiver 29
96+that: 30
97+ SENATE BILL 28 3
9198
92- (b) (1) If authorized by the Centers for Medicare and Medicaid Services, an
93-individual shall be determined medically eligible to receive services if the individual
94-requires:
9599
96- (i) Skilled nursing care or other related services;
97- LAWRENCE J. HOGAN, JR., Governor Ch. 738
100+ (i) Are needed and chosen by an eligible waiver participant as an 1
101+alternative to admission to or continued stay in a nursing facility; 2
98102
99-– 3 –
100- (ii) Rehabilitation services; or
103+ (ii) Are part of a plan of service approved by the program; 3
101104
102- (iii) Health–related services above the level of room and board that
103-are available only through nursing facilities, including individuals who because of severe
104-cognitive impairments or other conditions:
105+ (iii) Assure the waiver participant’s health and safety in the 4
106+community; and 5
105107
106- 1. A. Are currently unable to perform at least two
107-activities of daily living without hands–on assistance or standby assistance from another
108-individual; and
108+ (iv) Cost no more per capita to receive services in the community 6
109+than in a nursing facility. 7
109110
110- B. Have been or will be unable to perform at least two
111-activities of daily living for a period of at least 90 days due to a loss of functional capacity;
112-or
111+ (b) (1) If authorized by the Centers for Medicare and Medicaid Services, an 8
112+individual shall be determined medically eligible to receive services if the individual 9
113+requires: 10
113114
114- 2. Need substantial supervision for protection against
115-threats to health and safety due to severe cognitive impairment.
115+ (i) Skilled nursing care or other related services; 11
116116
117- (2) The Department shall adopt regulations to carry out the provisions of
118-this subsection.
117+ (ii) Rehabilitation services; or 12
119118
120- (c) The Department’s waiver shall include the following:
119+ (iii) Health–related services above the level of room and board that 13
120+are available only through nursing facilities, including individuals who because of severe 14
121+cognitive impairments or other conditions: 15
121122
122- (1) [An initial] A cap on waiver participation [at] OF NOT FEWER THAN
123-7,500 individuals;
123+ 1. A. Are currently unable to perform at least two 16
124+activities of daily living without hands–on assistance or standby assistance from another 17
125+individual; and 18
124126
125- (2) [A limit on annual waiver participation based on State General Fund
126-support as provided in the budget bill] A PLAN FOR WAIVER PART ICIPATION OF NOT
127-FEWER THAN 7,500 INDIVIDUALS;
127+ B. Have been or will be unable to perform at least two 19
128+activities of daily living for a period of at least 90 days due to a loss of functional capacity; 20
129+or 21
128130
129- (3) Financial eligibility criteria which include:
131+ 2. Need substantial supervision for protection against 22
132+threats to health and safety due to severe cognitive impairment. 23
130133
131- (i) The current federal and State medical assistance long–term care
132-rules for using services provided by a nursing facility, per §§ 1902, 1919, and 1924 of the
133-federal Social Security Act, and applicable regulations adopted by the Department;
134+ (2) The Department shall adopt regulations to carry out the provisions of 24
135+this subsection. 25
134136
135- (ii) Medically needy individuals using services provided by a nursing
136-facility under the current federal and State medical assistance eligibility criteria governed
137-by regulations adopted by the Department and § 1919 of the federal Social Security Act;
138-and
137+ (c) The Department’s waiver shall include the following: 26
139138
140- (iii) Categorically needy individuals with income up to 300% of the
141-applicable payment rate for supplemental security income;
139+ (1) [An initial] A cap on waiver participation [at] OF NOT FEWER THAN 27
140+7,500 individuals; 28
142141
143- (4) Waiver services that include at least the following:
142+ (2) [A limit on annual waiver participation based on State General Fund 29
143+support as provided in the budget bill] A PLAN FOR WAIVER PART ICIPATION OF NOT 30
144+FEWER THAN 7,500 INDIVIDUALS; 31
144145
145- (i) Assisted living services; Ch. 738 2022 LAWS OF MARYLAND
146+ (3) Financial eligibility criteria which include: 32 4 SENATE BILL 28
146147
147-– 4 –
148148
149- (ii) Case management services;
150149
151- (iii) Family training;
150+ (i) The current federal and State medical assistance long–term care 1
151+rules for using services provided by a nursing facility, per §§ 1902, 1919, and 1924 of the 2
152+federal Social Security Act, and applicable regulations adopted by the Department; 3
152153
153- (iv) Dietitian and nutritionist services;
154+ (ii) Medically needy individuals using services provided by a nursing 4
155+facility under the current federal and State medical assistance eligibility criteria governed 5
156+by regulations adopted by the Department and § 1919 of the federal Social Security Act; 6
157+and 7
154158
155- (v) Medical day care services; and
159+ (iii) Categorically needy individuals with income up to 300% of the 8
160+applicable payment rate for supplemental security income; 9
156161
157- (vi) Senior center plus services;
162+ (4) Waiver services that include at least the following: 10
158163
159- (5) The opportunity to provide eligible individuals with waiver services
160-under this section as soon as they are available without waiting for placement slots to open
161-in the next fiscal year;
164+ (i) Assisted living services; 11
162165
163- (6) An increase in participant satisfaction;
166+ (ii) Case management services; 12
164167
165- (7) The forestalling of functional decline;
168+ (iii) Family training; 13
166169
167- (8) A reduction in Medicaid expenditures by reducing utilization of
168-services; and
170+ (iv) Dietitian and nutritionist services; 14
169171
170- (9) The enhancement of compliance with the decision of the United States
171-Supreme Court in the case of Olmstead v. L.C. (1999) by offering cost–effective
172-community–based services in the most appropriate setting.
172+ (v) Medical day care services; and 15
173173
174- (d) This section may not be construed to affect, interfere with, or interrupt any
175-services reimbursed through the Program under this title.
174+ (vi) Senior center plus services; 16
176175
177- (e) (1) (I) IF THE DEPARTMENT MAINTAINS A WAITING LIST OR
178-REGISTRY, EACH MONTH THE DEPARTMENT SHALL SEND A WAIVER APPLICATION :
176+ (5) The opportunity to provide eligible individuals with waiver services 17
177+under this section as soon as they are available without waiting for placement slots to open 18
178+in the next fiscal year; 19
179179
180- 1. IF THERE ARE FEWER TH AN 600 INDIVIDUALS ON THE
181-WAITING LIST OR REGI STRY, TO ALL INDIVIDUALS O N THE WAITING LIST OR
182-REGISTRY; AND
180+ (6) An increase in participant satisfaction; 20
183181
184- 2. IF THERE ARE 600 OR MORE INDIVIDUALS ON THE
185-WAITING LIST OR REGI STRY, TO AT LEAST 600 INDIVIDUALS ON THE W AITING LIST
186-OR REGISTRY.
182+ (7) The forestalling of functional decline; 21
187183
188- (II) A WAIVER APPLICATION S ENT UNDER SUBPARAGRA PH (I)
189-OF THIS PARAGRAPH SH ALL STATE CLEARLY AND CONSPICU OUSLY THAT:
184+ (8) A reduction in Medicaid expenditures by reducing utilization of 22
185+services; and 23
190186
191- 1. THE APPLICANT MUST SU BMIT THE APPLICATION
192-WITHIN 6 WEEKS AFTER RECEIVIN G THE APPLICATION ; AND LAWRENCE J. HOGAN, JR., Governor Ch. 738
187+ (9) The enhancement of compliance with the decision of the United States 24
188+Supreme Court in the case of Olmstead v. L.C. (1999) by offering cost –effective 25
189+community–based services in the most appropriate setting. 26
193190
194-– 5 –
191+ (d) This section may not be construed to affect, interfere with, or interrupt any 27
192+services reimbursed through the Program under this title. 28
195193
196- 2. THE APPLICANT IS REQU IRED TO MEET ALL OF THE
197-ELIGIBILITY CRITERIA FOR PARTICIPATION IN THE WAIVER WITHIN 6 MONTHS
198-AFTER SUBMITTING THE APPLICATION.
194+ (e) (1) (I) IF THE DEPARTMENT MAINTAINS A WAITING LIST OR 29
195+REGISTRY, EACH MONTH THE DEPARTMENT SHALL SEND A WAIVER APPLICATION : 30 SENATE BILL 28 5
199196
200- (2) If a person determined to be eligible to receive waiver services under
201-this section desires to receive waiver services and an appropriate placement is available,
202-the Department shall authorize the placement.
203197
204- (f) The Department, in consultation with representatives of the affected industry
205-and advocates for waiver candidates, and with the approval of the Department of Aging,
206-shall adopt regulations to implement this section.
207198
208- SECTION 2. AND BE IT FURTHER ENACTED, That on or before October 31, 2022,
209-and thereafter as necessary, the Maryland Department of Health shall apply to the Centers
210-for Medicare and Medicaid Services for an amendment to the home– and community–based
211-waiver under § 1915(c) of the federal Social Security Act to increase the waiver cap size to
212-be consistent with Section 1 of this Act.
199+ 1. IF THERE ARE FEWER TH AN 600 INDIVIDUALS ON THE 1
200+WAITING LIST OR REGI STRY, TO ALL INDIVIDUALS O N THE WAITING LIST O R 2
201+REGISTRY; AND 3
213202
214- SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect
215-October 1, 2022.
203+ 2. IF THERE ARE 600 OR MORE INDIVIDUALS ON THE 4
204+WAITING LIST OR REGI STRY, TO AT LEAST 600 INDIVIDUALS ON THE W AITING LIST 5
205+OR REGISTRY. 6
216206
217-Enacted under Article II, § 17(c) of the Maryland Constitution, May 29, 2022.
207+ (II) A WAIVER APPLICATION SENT U NDER SUBPARAGRAPH (I) 7
208+OF THIS PARAGRAPH SH ALL STATE CLEARLY AN D CONSPICUOUSLY THAT : 8
209+
210+ 1. THE APPLICANT MUST SU BMIT THE APPLICATION 9
211+WITHIN 6 WEEKS AFTER RECEIVIN G THE APPLICATION ; AND 10
212+
213+ 2. THE APPLICANT IS REQU IRED TO MEET ALL OF THE 11
214+ELIGIBILITY CRITERIA FOR PARTICIPATION IN THE WAIVER WITHIN 6 MONTHS 12
215+AFTER SUBMITTING THE APPLICATION. 13
216+
217+ (2) If a person determined to be eligible to receive waiver services under 14
218+this section desires to receive waiver services and an appropriate placement is available, 15
219+the Department shall authorize the placement. 16
220+
221+ (f) The Department, in consultation with representatives of the affected industry 17
222+and advocates for waiver candidates, and with the approval of the Department of Aging, 18
223+shall adopt regulations to implement this section. 19
224+
225+ SECTION 2. AND BE IT FURTHER ENACTED, That on or before October 31, 2022, 20
226+and thereafter as necessary, the Maryland Department of Health shall apply to the Centers 21
227+for Medicare and Medicaid Services for an amendment to the home– and community–based 22
228+waiver under § 1915(c) of the federal Social Security Act to increase the waiver cap size to 23
229+be consistent with Section 1 of this Act. 24
230+
231+ SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 25
232+October 1, 2022. 26
233+
234+