Senator Ingwersen, Representative Meyer, and distinguished members of the Joint Standing Committee on Health and Human Services:

Good afternoon. My name is Sara Ratcliffe and I am here today on behalf of the Maine Alliance for Care at Home, representing home health, hospice, and home-based care providers across our state. We respectfully urge you to oppose LD 2196.

Our members care for thousands of Mainers every day - older adults, individuals with disabilities, patients recovering from surgery, and those with complex chronic conditions - allowing them to remain safely at home. Homebased care is one of the most cost-effective and patient-centered parts of our healthcare system. But we do not operate independently. We are deeply connected to Maine’s hospitals.

LD 2196 would impose an arbitrary cap on privately negotiated hospital reimbursement rates, equivalent to more than $1 billion in annual cuts. From a home health perspective, reductions of this magnitude would destabilize hospitals across the state, including rural and Critical Access Hospitals. When hospitals are destabilized, the ripple effects directly impact patients receiving care at home.

Safe and timely hospital discharge is critical to successful home-based care. Our clinicians coordinate closely with hospital teams to ensure patients have the medications, equipment, and follow-up services they need before returning home. If hospitals are forced to reduce services, cut staff, or close facilities, discharge planning becomes delayed and fragmented. Patients stay longer in acute care settings. Others may be transferred out of state if higher level services such as trauma or specialty care are reduced.

We are already operating in a strained environment. The committee has received testimony from hospitals that hundreds of patients remain hospitalized due to a lack of nursing home beds. Home health agencies are helping relieve that pressure by providing care in lower-cost, community settings whenever possible. But we cannot absorb the impact of widespread hospital closures or workforce reductions.

More than 60 percent of hospital care is paid for by Medicare and Medicaid - programs that often reimburse below the cost of care. If commercial reimbursement is further restricted under this bill, hospitals will have fewer resources to sustain essential services, particularly in rural communities. Reduced access to hospital care, behavioral health, cardiovascular services, and oncology will ultimately shift more complexity into the home - without the necessary infrastructure to support it.

We agree that affordability is a serious concern for Maine families. But according to publicly available data 90 percent of premium increases are driven by inflation and healthcare utilization. LD 2196 does not address those root causes. Instead, it risks weakening the full continuum of care.

Home-based care providers are committed to being part of meaningful, thoughtful reform. We support collaborative solutions that strengthen care coordination, expand access to preventive services, and invest in lower-cost care settings - including the home. What we cannot support is a policy that introduces significant financial instability into an already fragile system.

When hospitals struggle, patients suffer. Discharges are delayed. Access narrows. Rural communities are hit hardest. And the very goal we all share - keeping people healthy at home - becomes more difficult to achieve.

For these reasons, the Maine Alliance for Care at Home respectfully urges the Joint Standing Committee on Health and Human Services to oppose LD 2196 and instead pursue balanced reforms that protect Maine’s healthcare infrastructure and the patients we all serve.

Thank you for your time and consideration.

Sara Ratcliffe

Executive Director, Maine Alliance for Care at Home

Senator Ingwersen, Representative Meyer, and members of the Health & Human Services

Committee:

My name is Sara Ratcliffe, and I serve as Executive Director of the Maine Alliance for Care at Home. The Alliance is submitting testimony in opposition to LD 2177, An Act to Update and Improve the MaineCare Reimbursement System.

The Maine Alliance for Care at Home is a network of home care, hospice, and personal care providers across our State delivering in-home care to older adults and disabled individuals of all ages, allowing them to stay in their homes and communities.

The Alliance primary objection comes from one portion of this bill – Sec. 3 subsection 4, Funding. This language would make future rate adjustments subject to available appropriations and would give the department the authority to reduce rates, including cost of living adjustments, in proportion to “available funding,” including the ability to cancel COLAs altogether.

This language is extremely worrisome for home care and hospice providers across the state. It is similar to language included in last year’s budget proposal in part UU, which the Legislature rejected.

Healthcare providers across Maine need to know they can rely on stable funding, so they can budget and maintain staffing levels. COLAs and timely rate increases should be a cornerstone of our state’s healthcare workforce strategy. Unfortunately, the language proposed in LD 2177 undermines recent work done by the Legislature to provide COLAs for healthcare professionals. It also undermines the department’s statutory rate setting process, which they, the Legislature, and stakeholders worked hard to put into place.

According to the department, the goal of its rate setting statute is “to provide a clear and transparent process for MaineCare rate determinations, with opportunities for robust participation from all interested stakeholders.” We fully support that goal and have participated in the new process in good faith. But what is the point of a transparent process if providers have no assurance that the department will actually implement outcome of the process?

As an example, we can look at the ongoing rate determination process for Home & Community Based Services. This wide-ranging process includes rates for many MaineCare sections and services, including clinical services (primarily RNs and LPNs) provided by home care agencies. These nursing services are critical to allowing Mainers to remain at home, where they are most comfortable. By offering nursing care at home, we keep medically-complex children, older Mainers, and others out of more costly hospital and long-term care settings. Currently there are thousands of hours of unmet nursing care in the home care sector each month, and this is directly tied to inadequate reimbursement rates.

Current wages for nurses in home care have fallen drastically behind market rates due to low MaineCare reimbursement rates. Current reimbursement rates for these services are based off a 2016 rate study, which utilized data from 2012-2014. Utilizing data from 2012 to reimburse for services in 2026 is completely inadequate and has led to severe workforce shortages and care deserts across the state.

The Maine Alliance for Care at Home worked on legislation to raise rates during the 129th and 130th legislative sessions, but funding was not appropriated. During the 130th session, the Legislature worked with DHHS to enact a standard statutory process for rate setting. After that, providers of home care services awaited their turn in the queue for a rate determination process. We were heartened when DHHS launched the process to examine rates for home and community based services in June 2024. Public engagement took place during the fall of 2024 and we were told to expect the process to wrap up in spring of 2025. The department initially scheduled webinars to discuss the outcome of the process in April 2025, but they later cancelled those and have not posted anything publicly about the process since that time.

We are deeply troubled that the supplemental budget proposal released last week does not contain any funding for MaineCare rate increases for home and community based services.

We think it’s important for the committee to know that the statutory rate setting process is perhaps not working entirely as intended. The most critical part of the process for ensuring healthcare access across our state is implementation of new rates. To that end, the Alliance would like to offer alternative language for this section of LD 2177. We recommend language that requires the department to request funding in the next budget to implement new rates upon completion of a rate determination process and also requires the department to finalize each process and move forward with implementation in a timely manner. Instead of opening a loophole and undermining the rate setting process, such language would instead ensure that the department proposes a budget to the Legislature that accounts for necessary rate changes. From that point, of course that budget would be subject to the appropriations process. That is the case with every dollar of spending in state government, and not something we feel needs to be specified in statutory language.

We would be happy to work with the committee and other stakeholders on amendment language along these lines.

Dear Members of the Board, 

The Home Care & Hospice Alliance of Maine appreciates the opportunity to provide feedback on the proposed rule regarding the delegation of nursing activities and tasks to Unlicensed Assistive Personnel (UAP) by Registered Professional Nurses (RNs). 

We are strongly supportive of this proposed rule. Allowing RNs the option to delegate appropriate tasks to UAPs is a critical step toward strengthening Maine’s care delivery system, particularly in the home care and hospice settings, where workforce challenges and rising patient needs continue to intensify. 

Importantly, this rule does not mandate delegation. Rather, it provides RNs with a flexible, clinically sound tool they may use at their discretion. Delegation remains firmly grounded in the nurse’s professional judgment. The RN retains full authority to determine whether a task is appropriate to delegate, to oversee the delegated activity, and to modify or revoke that delegation at any time based on the patient’s condition, the competence of the UAP, or other relevant factors. 

By creating this option, not an obligation, the rule empowers nurses to practice at the top of their license. This supports more efficient care delivery, improves patient access, and helps ensure that nurses can focus their expertise where it is most needed. 

For home care in particular, the ability to safely delegate tasks to trained UAPs is essential. Maine continues to face a significant nursing shortage, especially in rural and underserved areas. Many patients who wish to remain at home struggle to receive timely services simply because a registered nurse is not available to complete every task personally. Delegation, when appropriate, can expand capacity, support continuity of care, and allow more Mainers to receive high-quality services in the setting they prefer, their home. 

The Alliance strongly supports moving forward with this rule as written. It offers an evidence-based, patient-centered approach that maintains safety, preserves RN oversight, and addresses real workforce pressures in our state’s home health and hospice communities. 

Thank you for your consideration and for your ongoing commitment to advancing safe, high-quality nursing care in Maine. We appreciate the opportunity to comment and stand ready to support the successful implementation of this important rule. 

Sincerely, 

Sara Ratcliffe 

Executive Director 
Home Care & Hospice Alliance of Maine (now Maine Alliance for Care at Home)