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HOUSE DOCKET, NO. 3451 FILED ON: 1/20/2023
HOUSE . . . . . . . . . . . . . . . No. 1166
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Ruth B. Balser
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act to address the overuse of temporary nursing service agencies at Massachusetts skilled
nursing facilities.
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PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Ruth B. Balser12th Middlesex1/20/2023Steven Ultrino33rd Middlesex1/26/2023David Henry Argosky LeBoeuf17th Worcester1/27/2023Christopher J. Worrell5th Suffolk1/27/2023Joanne M. ComerfordHampshire, Franklin and Worcester1/27/2023Brian W. Murray10th Worcester1/31/2023Jack Patrick Lewis7th Middlesex1/31/2023James C. Arena-DeRosa8th Middlesex1/31/2023Gerard J. Cassidy9th Plymouth1/31/2023Michelle M. DuBois10th Plymouth2/2/2023Michael P. Kushmerek3rd Worcester2/2/2023Patricia A. Duffy5th Hampden2/2/2023James K. Hawkins2nd Bristol2/8/2023Frank A. Moran17th Essex2/8/2023Paul McMurtry11th Norfolk2/8/2023Kay Khan11th Middlesex2/8/2023Vanna Howard17th Middlesex2/10/2023 2 of 2
Russell E. Holmes6th Suffolk2/10/2023William C. Galvin6th Norfolk2/13/2023Rodney M. Elliott16th Middlesex2/17/2023Samantha Montaño15th Suffolk2/17/2023Peter Capano11th Essex2/21/2023Michael D. BradySecond Plymouth and Norfolk2/21/2023James B. EldridgeMiddlesex and Worcester2/21/2023Adrianne Pusateri Ramos14th Essex3/2/2023Lindsay N. Sabadosa1st Hampshire3/6/2023 1 of 5
HOUSE DOCKET, NO. 3451 FILED ON: 1/20/2023
HOUSE . . . . . . . . . . . . . . . No. 1166
By Representative Balser of Newton, a petition (accompanied by bill, House, No. 1166) of Ruth
B. Balser and others for legislation to address the overuse of temporary nursing service agencies
at Massachusetts skilled nursing facilities. Health Care Financing.
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act to address the overuse of temporary nursing service agencies at Massachusetts skilled
nursing facilities.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. (a) Notwithstanding any special or general law to the contrary, the
2department of public health is directed to amend the state regulations governing the reporting by
3and rates paid by health-care providers to temporary nursing agencies registered with the
4department (101 CMR 345).
5 (b) Such amendment shall include reductions in the maximum prices set forth in 101
6CMR 345.03(2) that an agency may charge for registered nurse, licensed practical nurse, or
7certified nurse aide services provided to a skilled nursing facility. In setting such reduced
8maximum rates, the department shall establish hourly rate caps through a process that establishes
9and considers a weighted average wage for regular skilled nursing facility employees, plus a
10factor to incorporate payroll taxes, for each applicable employee classification, shift, and region.
11The department shall establish such weighted average service rates annually utilizing
12information provided by facilities. In no case shall the established maximum prices of temporary 2 of 5
13nursing agencies be permitted to exceed one hundred and fifty percent of the established average
14wages for regular employees at each applicable classification.
15 (c) Such amendment shall require reporting any individual or business entity with an
16ownership interest of 5 percent or more of a temporary nursing agency is also the holder of an
17operating license issued to establish or maintain a Massachusetts skilled nursing facility. Further,
18a temporary nursing agency so owned by any such individual or entity shall be prohibited from
19procuring or providing temporary employment at a skilled nursing facility so owned by the same
20individual or entity.
21 (d) The process for establishing the amendments as outlined in the subsections above
22shall also include an examination and analysis of the Temporary Nursing Service Cost Report
23and Reporting Requirements established in 101 CMR 345.05. As it so determines in such
24analysis, the department may amend the Reporting Requirements regulatory provision to
25strengthen the transparency of, increase the mandated disclosures required in or to otherwise
26strengthen the state accountability standards now included in the mandated Temporary Nursing
27Service Cost Report. Such analysis shall include and such amendments to the regulatory
28reporting requirements may include improved standards for temporary nursing agency reporting
29on compensation, benefits and worker supports for temporary nursing agency workers; licensing,
30training, and continuing education requirements for assigned workers; reporting on the
31operations, cost trends and financial performance of temporary nursing agencies; processes
32utilized to assure prompt arrival of assigned workers; procedures for reporting on, the
33investigation of and the resolution of complaints about the performance of temporary nursing
34agency workers; and procedures for the notice of and for resolving actual or suspected abuse,
35theft, tampering or other diversion of controlled substances by temporary nursing agency staff 3 of 5
36workers. Such amendments may also include the establishment of or increases to corresponding
37registration and reporting fees.
38 (e) The process for determining maximum rates as outlined in subsection (b) above shall
39also include an examination and analysis of Travel Nurse Factor established in 101 CMR 345(e).
40The department may amend the Travel Nurse Factor provision to reduce the established
41percentage amount above which an agency’s price for travel nurses’ services provided to a
42nursing facility may exceed the base rate limits established in 101 CMR 345.03.
43 (f) Prior to and during the process of making the regulatory amendments outlined in the
44subsections above, the department shall consult with the Massachusetts Senior Care Association,
45Inc. and 1199 SEIU United Healthcare Workers East.
46 (g) The department of public health shall complete the processes above and file for
47Emergency Adoption of such amended regulations no later than 180 days after passage of this
48Act.
49 SECTION 2. (a) Notwithstanding any special or general law to the contrary, the
50executive office of health and human services is directed to amend the state standard payment
51regulations establishing Quality Adjustment Payments (101 CMR 206.06).
52 (b) Such amendment shall require each nursing facility to report to EOHHS on the
53amount and percentage of the facility’s federally reported nursing care hours per patient day that
54was provided by temporary nursing agency staff.
55 (c) Such amendment shall include establish a new Quality Adjustment Payment
56subsection and a Nursing Care Staffing Levels Achievement rate adjustment that implements 4 of 5
57such new rate adjustment and that is based upon a facility’s compliance with the Massachusetts
58hours per resident day standard. For purposes of determining such a rate adjustment, a facility’s
59reported nursing care hours per resident day standard shall be adjusted downward to reduce the
60facility’s credit for reported hours of care provided by temporary nursing agency staff by a
61percentage to be determined by EOHHS but that shall adjust credited hours downward by least
62twenty-five percent.
63 (d) Prior to and in making the regulatory amendments as outlined in the subsections
64above, the executive office of health and human services shall consult with the Massachusetts
65Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.
66 (e) The executive office of health and human services shall complete the process above
67and file for Emergency Adoption of such amended regulations no later than 180 days after
68passage of this Act.
69 SECTION 3. (a) Notwithstanding any special or general law to the contrary, the
70department of public health is directed to amend the Massachusetts long term care facility
71operating regulations provisions relative to Staff Qualifications and Training (105 CMR
72150.024) and Educational Programs (105 CMR 150.7(I)).
73 (b) Such amendments shall require that any temporary nursing agency staff that works in
74a skilled nursing facility is compliant with all applicable requirements and qualifications, as
75determined by the department, that are required of nursing care staff regularly employed in their
76position. Such amendments shall require temporary nursing agency staff working for more than
77one hundred hours in a facility participate in any job orientation and other continuing in-service 5 of 5
78educational programs appropriate to the care provided in the facility by regularly employed
79nursing personnel.
80 (c) Prior to and in making the regulatory amendments as outlined in the subsections
81above, the executive office of health and human services shall consult with the Massachusetts
82Senior Care Association, Inc. and 1199 SEIU United Healthcare Workers East.
83 (d) The department of public health shall complete the process above and file for
84Emergency Adoption of such amended regulations no later than 180 days after passage of this
85Act.