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HOUSE DOCKET, NO. 213 FILED ON: 1/11/2023
HOUSE . . . . . . . . . . . . . . . No. 1195
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Carmine Lawrence Gentile
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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 clarifying rate setting processes for home health and home care services.
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PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Carmine Lawrence Gentile13th Middlesex1/11/2023Patricia D. JehlenSecond Middlesex1/20/2023Lindsay N. Sabadosa1st Hampshire1/30/2023Vanna Howard17th Middlesex1/31/2023Steven Ultrino33rd Middlesex2/3/2023Margaret R. Scarsdale1st Middlesex2/6/2023Joseph D. McKenna18th Worcester2/8/2023Joanne M. ComerfordHampshire, Franklin and Worcester2/9/2023Peter J. Durant6th Worcester2/9/2023Natalie M. Higgins4th Worcester2/9/2023Mathew J. Muratore1st Plymouth2/10/2023Patrick Joseph Kearney4th Plymouth2/10/2023Thomas M. Stanley9th Middlesex2/10/2023Todd M. Smola1st Hampden2/10/2023Colleen M. Garry36th Middlesex2/13/2023Michelle M. DuBois10th Plymouth2/13/2023Donald R. Berthiaume, Jr.5th Worcester2/15/2023Brian W. Murray10th Worcester2/16/2023 2 of 2
James B. EldridgeMiddlesex and Worcester2/18/2023Rebecca L. RauschNorfolk, Worcester and Middlesex2/23/2023Michael D. BradySecond Plymouth and Norfolk3/1/2023 1 of 3
HOUSE DOCKET, NO. 213 FILED ON: 1/11/2023
HOUSE . . . . . . . . . . . . . . . No. 1195
By Representative Gentile of Sudbury, a petition (accompanied by bill, House, No. 1195) of
Carmine Lawrence Gentile and others relative to the rate setting processes for home health and
home care services. 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 clarifying rate setting processes for home health and home care services.
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: Section 13D of Chapter 118E of the general laws is amended after the
2second paragraph by inserting the following new paragraph:
3 Such rates for home health agencies, as defined under section 51K of chapter 111, shall
4be established at least biennially. In setting such rates, the executive office shall use as base year
5costs for rate determination purposes the reported costs of the calendar year not more than 4
6years prior to the current rate year, adjusted for reasonableness and to incorporate any new
7regulatory costs imposed since said base year costs. In establishing rates of payment to home
8health agencies, the executive office shall consider all costs which must be incurred by
9efficiently and economically operated providers. The rates shall also include an allowance for
10reasonable administrative expenses and a reasonable profit factor, as determined by the executive
11office. Such cost analysis shall include, but not be limited to, the following: costs of similar
12services provided in other care settings; use of national or regional indices to measure increases 2 of 3
13or decreases in reasonable costs incurred since the base year costs; the revision of existing
14historical cost bases, where applicable, to reflect changing norms or models of efficient service
15delivery; and other means to encourage the cost-efficient delivery of services. The Secretary
16shall, concurrent with the completion of setting such rates, provide a report to the house and
17senate committees on ways and means detailing how the rates issued under this paragraph were
18analyzed and revised; provided further, that the report shall compare the inflationary
19considerations made in the adopted rate with the most recent “Home Health Agency Market
20Basket” index posted by the United States Department of Health and Human Services, Centers
21for Medicare and Medicaid Services; provided further, that if the adopted rate does not rely on
22the “Home Health Agency Market Basket” index for the purpose of determining inflationary
23adjustments, then the report will simulate what the rate would have been if such index was a
24factor in rate development. In determining the methodology for setting rates, the Secretary shall
25consult with stakeholders impacted by the rates.
26 SECTION 2: Section 4 of Chapter 19A is hereby amended by adding after Section 4D the
27following new section:
28 SECTION 4E: In establishing rates of payment pursuant to the second paragraph of
29section 13C of chapter 118E of the M.G.L., the executive office shall consider changes to the
30state minimum wage or changes to employer payroll tax obligations as governmental mandates
31that affect the costs of providing homemaker and personal care homemaker services to elderly
32clients under this section.
33 The executive office shall also consider and analyze rates of payment and wages
34associated with providing similar services in both the public and private settings. In calculating 3 of 3
35operating costs, the executive office shall consider costs of; health insurance, employee benefits
36and training, payroll taxes, technology costs, administrative allocation and staff salaries using the
37latest available national or regional indices and benchmarked to the latest available Bureau of
38Labor Statistics median wage data. Nothing in this section shall be construed as limiting
39consideration of other governmental mandates or operating costs that affect the cost of providing
40services pursuant to section 4 of chapter 19A of the General Laws. In determining the
41methodology for setting rates, the Secretary shall consult with stakeholders impacted by the
42rates.
43 The Secretary of Elder Affairs shall, concurrent with the promulgation of the final rates
44of payment for services under section 4 of chapter 19A, issue a report to the House and Senate
45committees on ways and means detailing how the rates promulgated were analyzed and
46determined in compliance with the provisions set forth in the second paragraph of section 13C of
47chapter 118E of the General Laws. The report shall detail the department’s analysis of changes in
48the costs of providing homemaker and personal care homemaker services since the immediately
49preceding rate determination; provided further, that the report shall compare the inflationary
50considerations made in the adopted rate with the most recent “Home Health Agency Market
51Basket” index posted by the United States Department of Health and Human Services, Centers
52for Medicare and Medicaid Services; provided further, that if the adopted rate does not rely on
53the “Home Health Agency Market Basket” index for the purpose of determining inflationary
54adjustments, then the report will simulate what the rate would have been if such index was a
55factor in rate development.