Attention Providers of Section 21 Home Support Agency Per Diem: Enforcement Discretion Related to Reimbursement for Asleep Staff 

Jun 23, 2022

The Department recently adopted amendments to Section 21 rules (10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 21). The rules clarified longstanding policy related to overnight staff in group homes. The following language was adopted at §21.05-11 (Home Support-Agency Per Diem): “…The department reimburses for the delivery of a service to a member and that assumes that the provider is awake.” 

It has come to the Department’s attention that compliance with this provision would require a change in practice at several group homes across the state, with the potential of home closures and significant disruption for MaineCare members. The Department is collecting additional data from providers about this issue to better understand current practice and any potential negative impacts on members, and to determine whether to make changes to the rule language as now adopted.   

As it gathers more information on this issue and determines how it will proceed, the Department will exercise enforcement discretion with respect to specific staffing situations and the services specific members may require during the night.  In all circumstances, provider agencies continue to be responsible for the health and safety of the residents in their group homes, and for ensuring that the services provided, including during overnight hours, are consistent with each member’s person-centered service plan.  

You may send questions on this topic to OADS@maine.gov.