Home care providers are now required to be licensed by the Maine Department of Health and Human Services (DHHS). These new regulations took effect on Aug. 20, 2024.

By licensing these agencies, the state establishes standards that they must follow, as well as mechanisms for oversight and enforcement actions in cases of non-compliance. Additionally, there is now an appeals process available if an agency disagrees with an enforcement decision made by the Maine DHHS.

As part of this new licensing requirement, home care agencies will pay an initial application fee of $500, rather than the previous $25 registration fee. Additionally, agencies will be required to renew their licenses every two years, starting at a fee of $200, which will vary based on the number of employees.

“The licensure process establishes minimum standards for quality, safety and client rights that apply to all agencies providing these services equally regardless of payment source,” a Maine DHHS spokesperson told Home Health Care News. “It also allows the department to address deficiencies through the licensing process, whereas the previous registration process did not include authority for direct enforcement by the department.”

The regulations require that all direct care employees either be certified nursing assistants or have completed or be enrolled in department-approved training to become a personal support specialist, which is a type of non-medical direct care worker. Training to become a personal support specialist is optional when the services provided are limited to meals, money management, shopping, light housework and communication.

The personal support specialist training program consists of 50 hours. New hires are expected to complete their training within 60 days of starting their position while existing staff have one year to fulfill this requirement.

Additionally, any new hire must receive on-site supervision at least once every 30 days during their first three months of employment. This standard applies to all new hires as of the date the rule was adopted.

“Requiring all personal care assistants (PCAs) in Maine to be licensed is a significant advantage for older adults and their families,” Renate Scholz, Home Instead franchise owner and chair of the board for the newly formed Maine Association of Personal Care Agencies, told HHCN. “This requirement ensures that any agency they hire meets the same standards. Licensed agencies will be insured, and care professionals will receive proper training. There will also be a service plan detailing the care provided, along with documentation of that care. Additionally, a process will be in place for reporting complaints to the state. This licensing provides a layer of security for a vulnerable population.”

It also legitimizes the industry, she said.

“Many agencies have been operating highly professional businesses, yet they are often perceived as merely offering babysitting services,” she explained. “From an external perspective, a license elevates us to the same level as home health and other essential care services. If we partner with or refer a client to another agency, we can be confident that they adhere to the same standards we do.”

Ensuring quality care is a top priority for everyone in the industry; however, there are concerns about the rising costs associated with providing that care.

“The two biggest drawbacks of licensing are the increased expenses and the fact that the regulations were crafted by individuals who do not fully understand the home care industry,” Scholz explained. “When the initial draft of the rule was released, it was clear that it was modeled after medical licensing rules, which assume that all personal care agencies accept MaineCare. This is not the case.”

Scholz noted that the state took feedback into account and made updates to the rule before finalizing it. Some elements still need adjustments, and those are currently being addressed.

“A group of personal care agencies has come together to form the Maine Association of Personal Care Agencies,” Scholz said. “Our goal is to address the ongoing concerns we have regarding the rule and ensure that we have a voice in any legislation that may impact us.”

The Home Care & Hospice Alliance of Maine also supports the proposed licensing rule, emphasizing the importance of balancing regulations and costs to ensure agencies can remain open and continue providing quality care to patients.

“The Home Care & Hospice Alliance of Maine supports state licensure because it establishes essential standards of care, ensuring that Mainers receive high-quality services at home,” Sara Ratcliffe, executive director, told HHCN. “However, licensure also incurs costs. Rising fees and regulatory burdens could potentially prevent smaller providers from participating. Finding the right balance is crucial. We all agree that our most vulnerable populations deserve the best care, but it is equally important to ensure that providers are available and capable of delivering that care.”

According to Scholz, home care businesses are significantly affected by the new rule in terms of both time and costs. She noted that understanding the rules and ensuring compliance requires considerable time investment. The licensing fee and the new training requirements for care professionals were highlighted as particularly burdensome.

“This training takes approximately 40 to 50 hours to complete,” she explained. “We plan to conduct our training in-house, and we compensate care professionals for their training time, which amounts to $720 to $900 per individual. With around 90 caregivers, this is a significant expense.”

Home Instead is currently awaiting the rollout of a new training program that the state has indicated is coming. Scholz hopes this training will be subsidized by either the state or federal government and advocates for the option for experienced care professionals to test out of training.

“My goal is to continue providing high-quality in-home personal care for as many older adults in Maine as possible,” she said. “It is an ongoing challenge to balance the costs we charge for home care with the rising expenses of operating a personal care agency. We aim to keep prices as low as possible while ensuring that our care professionals receive the wages they deserve. Unfortunately, the licensing rule complicates this situation, and I fear that people who genuinely need care may be priced out.”