SB 796
Department of Legislative Services
Maryland General Assembly
2020 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 796 (Senator Guzzone)
Finance Health and Government Operations
Developmental Disabilities Administration - Program Changes and Required
Reports
This bill requires the Maryland Department of Health (MDH) to ensure that providers of
and individuals who receive Developmental Disabilities Administration (DDA) services
are not adversely impacted when using the Long Term Services and Supports (LTSS)
software system or the Electronic Visit Verification (EVV) function. DDA must ensure
that providers, including coordinators of community services, have the ability to
automatically exchange electronic data with MDH through an application program
interface with LTSS. Uncodified language requires MDH to meet specified requirements
at least 90 days before requiring providers to use LTSS, including several benchmarks by
October 31, 2020, to ensure providers are able to effectively use LTSS. MDH must delay
implementation of changes to EVV until December 1, 2020; by this date, MDH must also
submit two specified reports to the General Assembly. The bill takes effect June 1, 2020.
Fiscal Summary
State Effect: No likely effect in FY 2020. MDH expenditures increase by $2.4 million in
FY 2021 to the extent person-centered plans (PCPs) must be revised; if federal funding is
available for this purpose, general fund expenditures are offset. General fund expenditures
may increase further to prepare the required reports and alter LTSS. Federal fund revenues
may decrease if an additional extension for EVV compliance is not requested/granted.
(in dollars) FY 2021 FY 2022 FY 2023 FY 2024 FY 2025
FF Revenue (-) (-) $0 $0 $0
GF Expenditure $2,423,500 $0 $0 $0 $0
Net Effect ($2,423,500) ($-) $0 $0 $0
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: Potential meaningful.
 Analysis
Bill Summary: An individual receiving DDA services who receives notice of a loss of
Medicaid eligibility must have 90 days to appeal the determination. If an individual appeals
within 90 days, DDA services must continue uninterrupted until the appeal is complete.
MDH must ensure that providers of DDA services are notified of an individual’s loss of
eligibility.
Requirements Related to Long Term Services and Supports Software System
At least 90 days before requiring providers to use LTSS for all individuals served, MDH
must develop and distribute:
 to LTSS users, an LTSS software system operations manual for DDA services;
 to providers and individuals served by providers, written policies and procedures
for DDA waiver services;
 to individuals supported by provider services, a comprehensive guide that describes
services available through DDA, including services available under the Family
Supports, Community Supports, and Community Pathways waivers, with the
relevant funding parameters, definitions, and examples; and
 to individuals determined eligible for DDA services, a list of providers authorized
to provide services under each waiver, detailed information on self-directed services
options, and other information, as specified.
MDH must ensure that (1) all base and site Medicaid electronic Provider Revalidation and
Enrollment Portal (ePREP) numbers are approved by all parties and entered into LTSS;
(2) individuals receiving DDA services have a current, approved PCP in LTSS;
(3) individuals receiving DDA services have an accurate and current service authorization
signed by the service provider and approved by DDA; (4) rates for a provider are finalized
and a provider impact analysis is completed for each provider; and (5) all known LTSS
functionality errors are corrected systematically.
MDH must conduct an analysis of coordinator of community service job responsibilities
to identify coordinator of community services capacity needed to implement LTSS.
Requirements Related to Electronic Visit Verification
By October 31, 2020, MDH must ensure (1) all one-time password devices are distributed
as necessary to implement EVV; (2) a plan has been developed for timely distribution of
replacement one-time password devices; and (3) all providers of personal supports receive
an operations guide for the implementation of EVV that includes specified procedures.
SB 796/ Page 2
Long Term Services and Supports Software System Pilot Program
MDH must conduct an LTSS pilot program for at least six months. In conducting the pilot
program, MDH must (1) include the participation of each DDA licensed provider and
certified provider and (2) allow each provider to select the number of individuals supported
by the provider that the provider wishes to be included in the pilot program.
MDH must ensure that an individual’s choice of provider or service is not restricted by
DDA as a result of implementation of the LTSS pilot program, or any phase-in of waiver
service definitions, billing processes, or operational changes.
Required Reports
By December 1, 2020, MDH must report to the General Assembly on the status of the
LTSS pilot program, including (1) the status of all functions of the software system used
to provide support for individuals using DDA services, as specified, and (2) the average
amount of time required to process and complete payments for services rendered.
MDH must also report to the General Assembly, by December 1, 2020, on:
 the time, deadlines, and resources required for a provider to use LTSS;
 specified actions taken by DDA and MDH;
 a description of the reporting and audit standards required of providers;
 written policies, procedures, and guidelines for the transition to, and implementation
of, LTSS and all facets of service system change, including use of EVV;
 a comprehensive guide that describes the services available through DDA, including
the Family Supports, Community Supports, and Community Pathways waivers, as
specified;
 the status of delays on PCP approvals or service authorizations and actions needed
to eliminate the backlog of delayed plans;
 an impact analysis of the effect of a new rate system, service definitions, and
eligibility guidelines for individuals who access DDA services;
 an analysis of the impact of the implementation of new rates by individual provider
and by service;
 how DDA will ensure that providers have sufficient working capital to transition
successfully from a prospective payment system to a fee-for-service (FFS) system;
and
 funding needed to enable community providers to successfully transition to LTSS
and any new rate and billing systems.
SB 796/ Page 3
Current Law/Background: DDA provides direct services to intellectually and
developmentally disabled individuals in two State residential centers and through the
funding of a coordinated community-based service delivery system. The State receives
federal matching funds for services provided through three Medicaid waivers: Community
Pathways; Community Supports; and Family Supports. Waiver-eligible individuals make
up the vast majority of individuals served by the agency.
Within the Community Services Program, DDA funds a variety of services broadly
categorized as residential, day, and supportive services and targeted case management. The
Community Supports waiver provides up to $25,000 per individual per year for
nonresidential services in the community. Individuals who choose self-directed services
can receive the full range of DDA services, but they select their services and support and
manage their own budget from DDA.
Person-centered Plans
For an individual to receive authorization for DDA-funded services, the individual must
first complete a process referred to as person-centered planning to determine the
appropriate and preferred services and supports needed. The development and approval
process for PCPs includes the individual, their families, providers, coordination of
community services agencies, and regional offices. The plans must be approved annually
and can be updated as service needs change. DDA is transitioning this process as it relates
to service authorization to new functionalities on LTSS.
Fee-for-service Pilot Program
Chapter 390 of 2019 established the FFS pilot program. The pilot program intended to
authorize DDA to establish a small-scale FFS pilot to test the LTSS network transition to
FFS rates with a limited group so that any issues with the system could be addressed and
managed without significant impact to providers or service recipients. A provider that
delivers waiver program services to individuals with a developmental disability eligible for
specified services may participate in the pilot program. MDH must determine and establish
rates for waiver program services and publish such rates in regulation.
Transition to Long Term Services and Supports
DDA is undergoing a transformation that simultaneously launches community service
functionalities on the department’s care management tracking system, new provider
reimbursement rates, a FFS model, and new service options on LTSS. Many of these
changes are set to begin wider implementation in July 2020. DDA received approval for
an amendment to its Community Pathways waiver and plans to implement a new service
structure as a part of the larger contribution plan.
SB 796/ Page 4
In August 2018, MDH launched the initial LTSS release of DDA functions, such as client
profiles, waiver applications and determinations, and PCP development. Transitioning to
LTSS is intended to help DDA better identify the services that an individual connecting
with MDH is eligible for or already receiving across programs.
Electronic Visit Verification Requirement
The federal 21st Century Cures Act requires states to implement EVV for all Medicaid
personal care services that require an in-home visit by a provider. The deadline for
compliance was January 2020. MDH has used the In-home Supports Assurance System
(ISAS) housed on LTSS to meet the requirement for other Medicaid programs and will
transition DDA to using this system when it begins using LTSS. ISAS is not configured
for DDA’s current system, which is why LTSS is needed. MDH was granted a good-faith
effort exception to meet the EVV requirement until January 2021.
Beginning in January 2021, if DDA has not met the EVV requirement by transitioning to
LTSS, the federal fund participation for all MDH programs providing personal care
services will be reduced by 0.25%, with the penalty increasing each subsequent year. DDA
advises that, to meet the EVV requirement before the January 2021 deadline, it would need
to transition all individuals and providers receiving or providing personal support services
to LTSS. To completely transition the personal support services in time, the majority of
DDA providers would need to begin using LTSS before January 2021. All individuals
receiving personal support services would also have to make the transition to LTSS, which
would mean that, if any other providers bill for services for that individual, they would also
have to transition or operate both billing systems at the same time.
MDH estimates that federal fund attainment in fiscal 2021 could decrease by up to
$1.0 million resulting from a 0.25% federal fund participation penalty for all personal care
services, including those provided through Medicaid, Community First Choice, and the
Community Pathways waiver program.
State Fiscal Effect:
Person-centered Plans and Long Term Services and Supports Software System
DDA advised that, as of March 2020, approximately 7,600 PCPs had been completed to
prepare for LTSS deployment in July 2020, including detailed authorization of services
beginning after July 1, 2020. Under the bill, implementation of LTSS must be delayed until
December 2020, after the completion of the LTSS pilot program. DDA advises that PCPs
would need to be revised to revert to current services provided. To do so, the coordinators
of community services need to meet with the individual requiring DDA services and update
the plan as necessary. MDH estimates that updating 7,600 PCPs that have already been
SB 796/ Page 5
completed increases general fund expenditures by $2,423,488 in fiscal 2021. To the extent
federal support is available for this purpose, general fund expenditures are offset. This
analysis does not account for any impact on (1) rates being maintained for an additional
year and (2) expenditures due to Medicaid eligibility being maintained during an appeal
after implementation.
MDH advises that substantial software system design and development will be required to
create an application program interface to allow for bidirectional exchange of data between
MDH and coordinators of community services. Since these software changes are in
addition to already planned LTSS adaptations, general fund expenditures may increase,
potentially significantly, to modify LTSS to meet the requirements of the bill.
Completion of Required Reports
MDH must submit two reports by December 1, 2020; this analysis assumes that all of the
items required to be reported must be known prior to the roll out. Even so, the Department
of Legislative Services (DLS) advises that contractual support may be needed in
fiscal 2021 for this purpose.
Noncompliance Penalties
MDH must have a fully functioning EVV system in place for all Medicaid-funded personal
care services by January 1, 2021, to be compliant with the federal 21st Century Cures Act.
If the State is not fully compliant by that date, federal Medicaid matching fund reductions
for personal care services may be applied. The bill delays implementation of changes to
EVV until December 1, 2020, which is one month prior to the federal deadline. However,
DLS advises that, according to MDH, LTSS must be operational in order to roll out EVV;
thus, the deadline for EVV compliance may not be met under the bill. The extent to which
federal fund revenues decrease is dependent upon on how long it takes for MDH to comply
with the EVV requirement and if and when the federal government imposes penalties. If
MDH is unable to implement EVV by January 1, 2021, MDH might have to request another
extension. If granted, related penalties are not incurred.
Small Business Effect: An implementation delay of LTSS affects approximately 30 small
business DDA service providers in the State. Small business providers receive current
DDA service rates for a year longer than anticipated; these rates may be less than those that
become effective after LTSS implementation.
Additional Information
Prior Introductions: None.
SB 796/ Page 6
Designated Cross File: HB 984 (Delegate Cullison) - Health and Government Operations.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History: First Reader - March 3, 2020
rh/jc Third Reader - April 7, 2020
Revised - Amendment(s) - April 7, 2020
Analysis by: Amberly Holcomb Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 796/ Page 7


Statutes affected:
Text - First - Developmental Disabilities Administration - Program Changes and Required Reports: 7-309 Health General
Text - Third - Developmental Disabilities Administration - Program Changes and Required Reports: 7-309 Health General