HOUSE . . . . . . . . No. 3929
The Commonwealth of Massachusetts
________________________________________
HOUSE OF REPRESENTATIVES, June 15, 2023.
The committee on Elder Affairs, to whom were referred the petition
(accompanied by bill, Senate, No. 364) of Julian Cyr and Angelo J.
Puppolo, Jr., for legislation relative to promoting the betterment of
resident health and safety in long term care facilities, the petition
(accompanied by bill, Senate, No. 378) of Patricia D. Jehlen for legislation
relative to regulations for small house nursing homes, the petition
(accompanied by bill, Senate, No. 379) of Patricia D. Jehlen, Thomas M.
Stanley, Joanne M. Comerford, Jack Patrick Lewis and other members of
the General Court for legislation to improve quality and oversight of long-
term care, the petition (accompanied by bill, Senate, No. 384) of Jason M.
Lewis and Andrea Joy Campbell for legislation to strengthen the Attorney
General’s tools to protect nursing home residents and other patients from
abuse and neglect, the petition (accompanied by bill, House, No. 616) of
Ruth B. Balser and Andrea Joy Campbell relative to the authority of the
Attorney General to protect nursing home residents and other patients
from abuse and neglect, the petition (accompanied by bill, House, No.
627) of Denise C. Garlick and others that the Division of Health Care
Facility Licensure and Certification be authorized to establish a program
for training and education for certain licensed providers, and the petition
(accompanied by bill, House, No. 648) of Thomas M. Stanley, Kate
Lipper-Garabedian and others for legislation to improve quality and
oversight of long-term care, reports recommending that the accompanying
bill (House, No. 3929) ought to pass.
For the committee,
THOMAS M. STANLEY. 1 of 26
FILED ON: 6/15/2023
HOUSE . . . . . . . . . . . . . . . No. 3929
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act to improve quality and oversight of long-term care.
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. Chapter 23 of the General Laws, as appearing in the 2020 Official
2Edition, is hereby amended by inserting after section 9U the following 2 sections:-
3 Section 9V. The executive office of labor and workforce development shall, in
4consultation with the commonwealth corporation, establish a grant program for nursing facility
5supervisory and leadership training. The program shall include, but not be limited to, covering
6the cost of nursing facility worker participation in evidence-based supervisory training for the
7express purpose of improving staff satisfaction, retaining staff and reducing turnover. Grants for
8supervisory and leadership training may include the cost of both in-person and online training
9programs.
10 Section 9W. The commonwealth corporation shall, subject to appropriation, establish
11extended care career ladder grant programs in long-term care facilities to upgrade skills of
12certified nurse’s aides and entry-level workers in nursing homes, to improve employee retention
13rates and to improve the quality of care provided in such facilities. Such programs shall be 2 of 26
14developed in consultation with the local workforce investment boards and the department of
15public health. Such career ladder programs shall include, but not be limited to, programs that
16establish a three-level career pathway for certified nurses’ aides or that develop employee
17competencies in specialized areas of care. The commonwealth corporation shall make grants
18available for certified nurses' aides, home health aides, homemakers and other entry-level
19workers in long-term care to improve quality of care and improve direct care worker access to
20and participation in career ladder training. Said corporation shall award such grants, subject to
21appropriation, on a competitive basis to long-term care facilities or long-term care facilities for
22the development of career ladder programs, including but not limited to curriculum development,
23instructors, instructional materials and technical assistance. Said corporation shall establish
24criteria for the selection of grant recipients to effectuate the purposes of this section. Grant
25funding may cover tuition, fees, curricular materials, staff wages, stipends for childcare and
26transportation to enable eligible workers to attend classes and secure practical nursing
27certificates. Said corporation shall require, as a condition of receipt of such grants, that each
28participating long-term care facility shall: (1) provide at least 50 per cent paid time for
29employees participating in training or instruction in connection with said career ladder program;
30(2) assist each participating employee in developing a career advancement plan; (3) increase
31employee compensation upon successful completion of each stage of the career ladder program;
32and (4) report quarterly to said corporation on the progress of the career ladder program
33implemented including, but not limited to, the number of employees served by the grant and their
34career progression within the long-term care facility and the certificates, degrees or professional
35status attained. Coursework may include English language training, training in other languages
36and adult basic education programs. The length of such grants shall not exceed a period of 3 3 of 26
37years. Said corporation shall develop partnerships with local workforce investment boards,
38community colleges and other community-based education and training providers and
39organizations to assist long-term care facilities and long-term care facility employees to fulfill
40training needs, including but not limited to, identifying sources of funding for such training, and
41to encourage and enhance access to additional and ongoing skill enhancement and career
42development in long-term care. The commonwealth corporation shall submit quarterly reports to
43the house and senate committees on ways and means on said grant program including, but not
44limited to, the number of grants awarded, the amount of each grant, a description of the career
45ladder programs, changes in care-giving and workplace practices that have occurred as a result of
46the grant program, the grant program’s impact on quality of care and worker retention and the
47certificates, degrees or professional status attained by each participating employee.
48Administrative and program-management costs for the grant program shall not exceed 4 per cent
49of the amount of the grant program. Each grant may include funding for technical assistance and
50evaluation.
51 SECTION 2. Chapter 111 of the General Laws, as so appearing, is hereby amended by
52inserting after section 4O the following section:-
53 Section 4P. The department shall, subject to appropriation, establish a tuition
54reimbursement program for certified nursing assistant training. The department shall reimburse
55for the costs of certified nursing assistant training or competency, provided that: (i) the costs
56have been incurred for enrollment in an approved certified nursing assistant training program;
57(ii) the costs have been actually paid by the certified nursing assistant from their own personal
58funds; and (iii) the individual has begun employment as a certified nursing assistant in a licensed 4 of 26
59nursing facility within 12 months of completing the training program, including passing the
60competency testing.
61 SECTION 3. Said chapter 111 of the General Laws is hereby further amended by striking
62out section 71 and inserting in place thereof the following section:-
63 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the
64following terms shall have the following meanings unless the context or subject matter clearly
65requires otherwise:
66 “Applicant”, any person who applies to the department for a license to establish or
67maintain and operate a long-term care facility.
68 “Charitable home for the aged”, any institution, however named, conducted for charitable
69purposes and maintained for the purpose of providing a retirement home for elderly persons and
70which may provide nursing care within the home for its residents.
71 “Convalescent or nursing home or skilled nursing facility”, any institution, however
72named, whether conducted for charity or profit, which is advertised, announced or maintained for
73the express or implied purpose of caring for four or more persons admitted thereto for the
74purpose of nursing or convalescent care.
75 “Intermediate care facility for persons with an intellectual disability”, any institution,
76however named, that: (i) is conducted for charity; (ii) is advertised, announced or maintained for
77the purpose of providing rehabilitative services and active treatment to persons with an
78intellectual disability or persons with related conditions, as defined in regulations promulgated
79pursuant to Title XIX of the federal Social Security Act (P.L. 89–97); (iii) is not both owned and 5 of 26
80operated by a state agency; and (iv) makes application to the department for a license for the
81purpose of participating in the federal program established by said Title XIX.
82 “License”, an initial or renewal license to establish or maintain and operate a long-term
83care facility issued by the department.
84 “Licensee”, a person to whom a license to establish or maintain and operate a long-term
85care facility has been issued by the department.
86 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home,
87skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest
88home.
89 “Management Company”, an organization engaged by a licensee to manage all or a
90subset of the operations at a long-term care facility.
91 “Owner”, any person with an ownership interest of 5 per cent or more, or with a
92controlling interest in an applicant, potential transferee or the real property on which a long-term
93care facility is located.
94 “Person”, an individual, trust, estate, partnership, association, company or corporation.
95 “Potential transferee”, a person who submits to the department a notice of intent to
96acquire the facility operations of a currently operating long-term care facility.
97 “Rest home”, any institution, however named, which is advertised, announced or
98maintained for the express or implied purpose of providing care incident to old age to four or
99more persons who are ambulatory and who need supervision. 6 of 26
100 “Transfer of facility operations”, a transfer of the operations of a currently operating
101long-term care facility from the current licensee of the long-term care facility to a potential
102transferee, pending licensure, pursuant to a written “transfer of operations” agreement.
103 (b)(1) To each applicant it deems suitable and responsible to establish or maintain and
104operate a long-term care facility and which meets all other requirements for long-term care
105facility licensure, the department shall issue for a term of 2 years, and shall renew for like terms,
106a license, subject to the restrictions set forth in this section or revocation by it for cause;
107provided, however, that each long-term care facility shall be inspected at least once a year. The
108license shall not be transferable or assignable and shall be issued only for the premises named in
109the application.
110 (2) The department shall not issue a license to establish or maintain an intermediate care
111facility for persons with an intellectual disability unless the department determines that there is a
112need for such a facility at the designated location; provided, however, that in the case of a facility
113previously licensed as an intermediate care facility for persons with an intellectual disability in
114which there is a change in ownership, no such determination shall be required; and provided
115further, that in the case of a facility previously licensed as an intermediate care facility for
116persons with an intellectual disability in which there is a change in location, such determination
117shall be limited to consideration of the suitability of the new location.
118 (3) In the case of the transfer of facility operations of a long-term care facility, a potential
119transferee shall submit a notice of intent to acquire to the department at least 90 days prior to the
120proposed transfer date. The notice of intent to acquire shall be on a form supplied by the
121department and shall be deemed complete upon submission of all information which the 7 of 26
122department requires on said form and is reasonably necessary to carry out the purposes of this
123section. In the case of the transfer of facility operations, a potential transferee shall provide
124notice to the current staff of the facility and shall provide notice of the potential transferee’s
125plans regarding retaining the facility workforce and recognizing any current collective
126bargaining agreements to the labor organizations that represents the facility’s workforce at the
127time the potential transferee submits a notice of intent to acquire.
128 Upon determination by the department that a potential transferee is responsible and
129suitable for licensure, the potential transferee may file an application for a license. In the case of
130a potential transfer of facility operations, the filing of an application for a license shall have the
131effect of a license until the department takes final action on such application.
132 Upon an approved transfer of facility operations of long-term care facility from one
133licensee to another, the department shall not reduce the number of beds originally approved by it
134in granting a license , unless in the interest of public health, welfare or safety.
135 (4) Every applicant for a license and potential transferee shall provide on or with its
136application or notice of intent to acquire a sworn statement of the names and addresses of any
137owner as defined in this section.
138 (5) No license shall be issued to an applicant or potential transferee unless the department
139makes a determination that the applicant or potential transferee is responsible and suitable for
140licensure.
141 (6) Every applicant for a license and every potential transferee shall provide on or with its
142application or notice of intent to acquire a sworn statement of the names and addresses of any
143owner as defined in this section. 8 of 26
144 (c) For purposes of this section, the department’s determination of responsibility and
145suitability shall include but not be limited to the following factors:
146 (1) the criminal history of the applicant or the potential transferee, including their
147respective owners, or the management company and, to the extent possible, the civil litigation
148history of the applicant or potential transferee, including their respective owners, or the
149management company, including litigation related to the operation of a long-term care facility,
150such as quality of care, safety of residents or staff, employment and labor issues, fraud, unfair or
151deceptive business practices and landlord/tenant issues; provided that, such criminal and civil
152litigation history may include pending or other court proceedings in the commonwealth and in
153other states including federal jurisdiction. Any information related to criminal or civil litigation
154obtained by the department pursuant to this section shall be confidential and exempt from
155disclosure under clause Twenty-sixth of section 7 of chapter 4 and chapter 66;
156 (2) the financial capacity of the applicant or potential transferee, including their
157respective owners, or the management company to establish or maintain and operate a long-term
158care facility, which may include any recorded liens and unpaid fees or taxes in the
159commonwealth and in other states;
160 (3) the history of the applicant or potential transferee, including their respective owners,
161or the management company in providing long-term care in the commonwealth, measured by
162compliance with applicable statutes and regulations governing the operation of long-term care
163facilities; and
164 (4) the history of the applicant or potential transferee, including their respective owners,
165or the management company in providing long-term care in states other than the commonwealth, 9 of 26
166if any, measured by compliance with the applicable statutes and regulations governing the
167operation of long-term care facilities in said states.
168 (d)(1) If the department determines that an applicant or potential transferee is not suitable
169and responsible, the department’s determination shall take effect on the date of the department’s
170notice. In such cases and upon the filing of a written request, the department shall afford the
171applicant or potential transferee an adjudicatory hearing pursuant to chapter 30A.
172 (2) During the pendency of an adjudicatory hearing, the applicant or potential transferee
173shall not operate the facility as a licensee.
174 (e) Each applicant, potential transferee and licensee shall maintain current records of all
175information provided to the department current. After the applicant, potential transferee or
176licensee becomes aware of any change related to information it has provided or is required to
177provide to the department, such person shall submit to the department written notice of the
178changes as soon as practicable and without unreasonable delay. Changes include, but are not
179limited to, changes in financial status, such as filing for bankruptcy, any default under a lending
180agreement or under a lease, the appointment of a receiver or the recording of any lien. Failure to
181provide timely notice of such change may be subject to the remedies or sanctions available to the
182department under sections 71 to 73, inclusive.
183 An applicant, potential transferee or licensee and their respective owners shall be in
184compliance with all applicable federal, state and local laws, rules and regulations.
185 (f) Prior to entering into an engagement with a management company, as defined in
186subsection (a), an applicant, potential transferee, or a licensee shall notify and receive a
187determination from the department that the management company is responsible and suitable for 10 of 26
188managing the long-term care facility. In its notification to the department and to inform the
189department’s review, the applicant, potential transferee, or licensee shall provide the proposed
190management company’s name, contact information and any other information on the proposed
191management company and its personnel that may be reasonably requested by the department
192including but not limited to information required in section (c). Upon a determination by the
193department that the proposed management company is responsible and suitable for managing a
194long-term care facility, the applicant, potential transferee, or licensee may engage said company
195to manage the long-term care facility. The applicant, potential transferee, or licensee shall
196memorialize any such engagement in a written agreement with the management company. Such
197written agreement shall include a requirement that the management company and its personnel
198comply with all applicable federal, state and local laws, regulations and rules. Promptly after the
199effective date of any such agreement, the applicant, potential transferee, or licensee shall provide
200to the department a copy of the valid, fully executed agreement. Any payment terms included in
201the agreement shall be confidential and exempt from disclosure under clause Twenty-sixth of
202section 7 of chapter 4 and chapter 66. If the department determines that a management company
203is not suitable and responsible, the department’s determination shall take effect on the date of the
204department’s notice. In such cases and upon the filing of a written request, the department shall
205afford the applicant or licensee an adjudicatory hearing pursuant to chapter 30A.
206 (g) The department shall not reduce the number of beds originally approved by it in
207granting a license for a convalescent or nursing home or rest home upon the transfer of facility
208operations of said convalescent or nursing home or rest home from one licensee to another,
209unless in the interest of public health, welfare, or safety. 11 of 26
210 (h) The department shall not issue a license unless the authorities in charge of the long-
211term care facility first submit to the department, with respect to each building occupied by
212residents: (1) a certificate of inspection of the egresses, the means of preventing the spread of fire
213and apparatus for extinguishing fire, issued by an inspector of the office of public safety and
214inspections of the division of professional licensure; provided, however, that with respect to
215convalescent or nursing homes only, the division of health care quality of the department of
216public health shall have sole authority to inspect for and issue such certificate and (2) a
217certificate of inspection issued by the head of the local fire department certifying compliance
218with the local ordinances.
219 Any applicant who is aggrieved, on the basis of a written disapproval of a certificate of
220inspection by the head of the local fire department or by the office of public safety and
221inspections of the division of professional licensure, may, within 30 days from such disapproval,
222appeal in writing to the division of professional licensure. With respect to certificates of
223inspection that the division of health care quality of the department of public health has the sole
224authority to issue, an applicant may, within 30 days from disapproval of a certificate of
225inspection, appeal in writing to the department of public health only. Failure to either approve or
226disapprove within 30 days after a written request by an applicant shall be deemed a disapproval.
227 If the division of professional licensure or, where applicable, the department of public
228health approves the issuance of a certificate of inspection where initially disapproved, it shall
229forthwith be issued by the agency that failed to approve. If the relevant agency further
230disapproves the issuance of a certificate of inspection, the applicant may appeal to the superior
231court. Failure of said department to either approve or disapprove the issuance of a certificate of
232inspection within 30 days after receipt of an appeal shall be deemed a disapproval. The 12 of 26
233department shall not issue a license until issuance of an approved certificate of inspection, as
234required in this section.
235 Nothing in this section or in sections 72 or 73 shall be construed to revoke, supersede or
236otherwise affect any laws, ordinances, by-laws, rules or regulations relating to building, zoning,
237registration or maintenance of a long-term care facility.
238 (i)(1) For cause, the department may limit, restrict, suspend or revoke a license. Grounds
239for cause on which the department may take such action shall include: (i) substantial or sustained
240failure or inability to provide adequate care to residents; (ii) substantial or sustained failure to
241maintain compliance with applicable statutes, rules and regulations; (iii) or the lack of financial
242capacity to maintain and operate a long-term care facility. Limits or restrictions include requiring
243a facility to limit new admissions. Suspension of a license may include suspending the license
244during a pending license revocation action or suspending the license to permit the licensee a
245period of time, not shorter than 60 days, to terminate operations, and discharge and transfer, if
246applicable, all residents.
247 (2) The department may, when public necessity and convenience require, or to prevent
248undue hardship to an applicant or licensee, under such rules and regulations as it may adopt,
249grant a temporary provisional or probationary license under this section; provided, however, that
250no such license shall be for a term exceeding 1 year.
251 (3) With respect to an order to limit, restrict or suspend a license, within 7 days of receipt
252of the written order, the licensee may file a written request with the department for an
253adjudicatory proceeding pursuant to chapter 30A. 13 of 26
254 (4)(i) Upon a written request by a licensee who is aggrieved by the revocation of a license
255or by an applicant who is aggrieved by the refusal of the department to renew a license, the
256applicant so aggrieved shall have all the rights provided in chapter 30A with respect to
257adjudicatory proceedings.
258 (ii) In no case shall the revocation of such a license take effect in less than 30 days after
259written notification by the department to the licensee.
260 (j) The fee for a license to establish or maintain and operate a long-term care facility shall
261be determined annually by the secretary of administration and finance pursuant to section 3B of
262chapter 7.
263 (k) Nursing institutions licensed by the department of mental health, or the department of
264developmental services for persons with intellectual disabilities shall not be licensed or inspected
265by the department of public health. The inspections herein provided shall be in addition to any
266other inspections required by law.
267 (l) In the case of the new construction of, or major addition, alteration or repair to, any
268facility subject to this section, preliminary and final architectural plans and specifications shall
269be submitted to a qualified person designated by the commissioner. Written approval of the final
270architectural plans and specifications shall be obtained from said person prior to said new
271construction or major addition, alteration or repair.
272 (m) Notwithstanding any of the foregoing provisions of this section, the department shall
273not issue a license to establish or maintain and operate a long-term care facility to an applicant
274who applies to the department for said license to establish or maintain and operate a convalescent
275or nursing home or skilled nursing facility unless the applicant for such license submits to the 14 of 26
276department a certificate that each building to be occupied by residents of such convalescent or
277nursing home or skilled nursing facility meets the construction standards of the state building
278code, and is of at least type 1–B fireproof construction; provided, however, that this paragraph
279shall not apply in the instance of a transfer of facility operations of a convalescent or nursing
280home or skilled nursing facility whose license had not been revoked as of the time of such
281transfer; and provided, further, that a public medical institution as defined under section 8 of
282chapter 118E, which meets the construction standards as defined herein, shall not be denied a
283license as a long-term care facility under this section because it was not of new construction and
284designed for the purpose of operating a long-term care facility at the time of application for a
285license to operate a long-term care facility . An intermediate care facility for persons with an
286intellectual disability shall be required to meet the construction standards established for such
287facilities by Title XIX of the Social Security Act (P.L. 89–97) and any regulations promulgated
288pursuant thereto, and by regulations promulgated by the department.
289 (n) The department shall notify the secretary of elder affairs forthwith of the pendency of
290any proceeding, public hearing or action to be taken under this section relating to any
291convalescent or nursing home, rest home, or charitable home for the aged. The department shall
292notify the commissioner of the department of developmental services forthwith of the pendency
293of any proceeding, public hearing or action to be taken under this section relating to any
294intermediate care facility for persons with an intellectual disability.
295 SECTION 4. Section 72 of said chapter 111 of the General Laws is amended by striking
296out section 72 and inserting in place thereof the following section:- 15 of 26
297 Section 72. (a) The department shall classify long-term care facilities and shall, after a
298public hearing, promulgate rules and regulations for the conduct of the same. Such rules and
299regulations for long-term care facilities shall include minimum requirements for medical and
300nursing care, the keeping of proper medical and nursing records, uniform requirements for the
301handling of patient funds, minimum requirements relative to the prevention and reparation of
302loss of or damage to patient's possessions including personal clothing, and minimum
303requirements relative to facility sanitation. Regulations for intermediate care facilities for persons
304with an intellectual disability shall also include minimum requirements for social services,
305psychological services and other services appropriate for the care of developmentally disabled
306persons and shall limit the size of intermediate care facilities for persons with an intellectual
307disability to not more than fifteen beds. The department in promulgating such rules and
308regulations for long-term care facilities shall consider the ability of such facilities to provide
309service under rates set under the provisions of section thirty-two of chapter six A. No such rule
310or regulation shall apply to a long-term care facility licensed at the time of promulgation of such
311rule or regulation, or a long-term care facility being constructed at the time of such promulgation
312under plans approved by the department, unless such rule or regulation has a direct and material
313relation to patient diet, cleanliness, nursing care or health of the patient, or to habilitative services
314and active treatment for persons with an intellectual disability or persons with related conditions;
315provided, however, that nothing herein contained shall be interpreted to prevent the department
316from adopting or interpreting rules and regulations more favorable toward existing long-term
317care facilities. 16 of 26
318 (b) The department or its agents and the board of health or its agents of the city or town
319wherein any portion of such long-term care facility is located may visit and inspect such
320institution at any time.
321 Any person making an inspection under authority of this section shall record in writing
322every violation which he finds of the applicable rules and regulations of the department. Every
323record of inspection so made shall be treated as a public record except to such extent as the
324record or a portion thereof is expressly exempt from such treatment under section seven of
325chapter four, said violations shall be made public at the same time that a written plan of
326correction is submitted. If a written plan of correction is not submitted within the allowable time,
327said violations shall be made public at the expiration of the allowable time. Inspections
328hereunder shall be unannounced and made at such intervals as the department shall specify in its
329rules and regulations, but at least twice per annum. A visit made to a facility for the purpose of
330providing consultation shall not be considered to be an inspection.
331 The superior court shall have jurisdiction in equity to enforce the rules and regulations
332promulgated under this section.
333 (c) The department shall establish regulations for the operation of small house nursing
334homes, herein defined as 1 or more units of a convalescent or nursing home or skilled nursing
335facility designed and modeled as a residential home including a central living space with a
336kitchen, dining and living area and outdoor space. Newly constructed small house nursing homes
337shall house no more than 14 individuals per unit, in resident rooms that accommodate not more
338than 1 resident per room. Should a resident request to share a room with another resident to
339accommodate a spouse, partner, family member or friend, such resident room shall have 17 of 26
340sufficient space and equipment, as established by the department, for two residents. All resident
341rooms shall contain a full private and accessible bathroom.
342 Regulations for construction and physical plant standards should consider environmental
343standards and sustainability. Regulations may further provide for a staffing model that allows
344for a universal worker approach to resident care that is organized to support and empower all
345staff to respond to the needs and desires of residents including but not limited to cooking and
346meal preparation without exceeding the lawful scope of practice of said employee, and provides
347for consistent staff in each small house.
348 The executive office of health and human services may develop an add-on to rates of
349payment for convalescent or nursing home or skilled nursing facilities that develop small house
350nursing homes and meet criteria established by the executive office.
351 The regulations promulgated pursuant to this subsection shall ensure the convalescent or
352nursing home or skilled nursing facilities subject to this section meet the requirements necessary
353to be eligible to participate in both the Medicare and Medicaid programs.
354 SECTION 5. Said chapter 111 is hereby further amended by striking out section 72E and
355inserting in place thereof the following section:-
356 Section 72E. The department shall, after every inspection by its agent made under
357authority of section 72, give the licensee of the inspected long-term care facility notice in writing
358of every violation of the applicable statutes, rules and regulations of the department found upon
359said inspection. With respect to the date by which the licensee shall remedy or correct each
360violation, hereinafter the “correct by date”, the department in such notice shall specify a
361reasonable time, not more than 60 days after receipt thereof, by which time the licensee shall 18 of 26
362remedy or correct each violation cited therein or, in the case of any violation which in the
363opinion of the department is not reasonably capable of correction within 60 days, the department
364shall require only that the licensee submit a written plan for the timely correction of the violation
365in a reasonable manner. The department may modify any nonconforming plan upon notice in
366writing to the licensee.
367 Failure to remedy or correct a cited violation by the correct by date shall be cause to
368pursue or impose the remedies or sanctions available to the department under sections 71 to 73,
369inclusive, unless the licensee shall demonstrate to the satisfaction of the department or a court,
370where applicable, that such failure was not due to any neglect of its duty and occurred despite an
371attempt in good faith to make correction by the correct by date. The department may pursue or
372impose any remedy or sanction or combination of remedies or sanctions available to it under said
373sections 71 to 73, inclusive. An aggrieved licensee may pursue the remedies available to it under
374said sections 71 to 73, inclusive.
375 In addition, if the licensee fails to maintain substantial or sustained compliance with
376applicable statutes, rules and regulations, in addition to imposing any of the other remedies or
377sanctions available to it, the department may require the licensee to engage, at the licensee’s own
378expense, a temporary manager to assist the licensee with bringing the facility into substantial
379compliance and with sustaining such compliance. Such manager shall be subject to the
380department’s approval, provided that such approval not be unreasonably withheld. Any such
381engagement of a temporary manager shall be for a period of not less than 3 months and shall be
382pursuant to a written agreement between the licensee and the management company. A copy of
383said agreement shall be provided by the licensee to the department promptly after execution. Any 19 of 26
384payment terms included in the agreement shall be confidential and exempt from disclosure under
385clause twenty-sixth of section 7 of chapter 4 and chapter 66.
386 Nothing in this section shall be construed to prohibit the department from enforcing a
387statute, rule or regulation, administratively or in court, without first affording formal opportunity
388to make correction under this section, where, in the opinion of the department, the violation of
389such statute, rule or regulation jeopardizes the health or safety of residents or the public or
390seriously limits the capacity of a licensee to provide adequate care, or where the violation of such
391statute, rule or regulation is the second such violation occurring during a period of 12 full
392months.
393 SECTION 6. Section 72K of said chapter 111 of the General Laws, as so appearing, is
394hereby amended by striking out subsection (b) and inserting in place thereof the following 2
395subsections:-
396 (b) The attorney general may file a civil action against a person who commits abuse,
397mistreatment or neglect of a patient or resident or who misappropriates patient or resident
398property or against a person who wantonly or recklessly permits or causes another to commit
399abuse, mistreatment or neglect of a patient or resident or who misappropriates patient or resident
400property. The civil penalty for such abuse, mistreatment, neglect or misappropriation shall not
401exceed: $25,000 if no bodily injury results; $50,000 if bodily injury results; $100,000 if sexual
402assault or serious bodily injury results; and $250,000 if death results. Section 60B of chapter 231
403shall not apply to an action brought by the attorney general pursuant to this section. Nothing in
404this section shall preclude the filing of any action brought by the attorney general or a private
405party pursuant to chapter 93A or any action by the department pursuant to this chapter. 20 of 26
406 (c) Notwithstanding section 5 of chapter 260, the attorney general may file a civil action
407only within four years next after an offense is committed.
408 SECTION 7. Said chapter 111 of the General Laws is hereby further amended by
409inserting after section 72BB the following 5 sections:-
410 Section 72CC. As used in section 72CC to 72FF, inclusive, the following words shall,
411unless the context clearly requires otherwise, have the following meanings:
412 “Cohorting”, the practice of grouping patients who are or are not colonized or infected
413with the same organism in order to confine their care to one area and prevent contact with other
414patients.
415 “Endemic level”, the usual level of given disease in a geographic area.
416 “Isolating”, the process of separating persons colonized or infected with a communicable
417disease from those who are not colonized or infected with a communicable disease.
418 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home
419or skilled nursing facility, an intermediate care facility for persons with an intellectual disability
420or a rest home.
421 “Outbreak”, any unusual occurrence of disease or any disease above background or
422endemic levels.
423 “Religious and recreational activities”, any religious, social or recreational activity that is
424consistent with the resident’s preferences and choosing, regardless of whether the activity is
425coordinated, offered, provided or sponsored by facility staff or by an outside activities provider. 21 of 26
426 “Resident”, a person who resides in a long-term care facility.
427 Section 72DD. (a) Notwithstanding any general or special law to the contrary, the
428department shall require long-term care facilities to develop an outbreak response plan which
429shall be customized to the facility. Each facility’s plan shall include, but not be limited to:
430 (1) a protocol for isolating and cohorting infected and at-risk patients in the event of an
431outbreak of a contagious disease until the cessation of the outbreak;
432 (2) clear policies for the notification of residents, residents’ families, visitors and staff in
433the event of an outbreak of a contagious disease at a facility;
434 (3) information on the availability of laboratory testing, protocols for screening visitors
435and staff for the presence of a communicable disease, protocols to require those staff who are
436infected with a communicable disease to not present at the facility for work duties and processes
437for implementing evidence-based outbreak response measures;
438 (4) policies to conduct routine monitoring of residents and staff to quickly identify signs
439of a communicable disease that could develop into an outbreak;
440 (5) policies for reporting outbreaks to public health officials in accordance with
441applicable laws and regulations; and
442 (6) policies to meet staffing, training and facility demands during an infectious disease
443outbreak and to successfully implement the outbreak response plan.
444 (b) The department shall verify that the outbreak response plans submitted by long-term
445care facilities are in compliance with the requirements of subsection (a). 22 of 26
446 (c) (1) Each long-term care facility that submits an outbreak response plan to the
447department pursuant to subsection (b) shall review the plan on an annual basis.
448 (2) If a long-term care facility makes any material changes to its outbreak response plan,
449the facility shall submit to the department an updated outbreak response plan within 30 days. The
450department shall, upon receiving an updated outbreak response plan, verify that the plan is
451compliant with the requirements of subsection (a).
452 (e) The department shall promulgate regulations necessary to implement this section.
453 Section 72EE. The department, through its division of health care facility licensure and
454certification, shall establish and implement a prescribed process and program for providing
455training and education to long-term care providers licensed by the department under section 72.
456Content covered in the training and education program may include infection prevention and
457control; development, implementation, adherence and review of comprehensive resident care
458plans; falls prevention; procedures to ensure timely notification of changes in a resident’s
459condition to the resident’s primary care physician; the prevention of abuse and neglect;
460development and implementation of a program to ensure staff safety and review of the survey
461and inspection process as permitted by section 72.
462 The training and education program shall be interactive and include, but not be limited to,
463the following:
464 (1) annual training for long-term care facilities on the licensure and certification process,
465including but not be limited to the department’s interpretation of the general laws and relevant
466changes or additions to applicable rules, regulations, procedures and policies concerning the
467licensure and certification process for long-term care facilities; 23 of 26
468 (2) biannual training of long-term care providers on the most frequently cited
469deficiencies, identified deficiency trends, both state and federal and best practices to ensure
470resident quality of care
471 The department may consult with industry trade associations before issuing or
472promulgating guidance, regulation, interpretation, program letter, memorandum or any other
473materials used in surveyor training to survey licensed providers as permitted by section 72.
474 Section 72FF. (a) The department shall promulgate regulations necessary to encourage
475and enable residents of a long-term care facility to engage in in-person, face-to-face, verbal or
476auditory-based contact, communications and religious and recreational activities with others
477except when such in-person contact, communication or activities are prohibited, restricted or
478limited by federal or state statute, rule or regulation. Said regulations shall include specific
479protocols and procedures to provide for residents of the facility who have disabilities that impede
480their ability to communicate, including, but not limited to, residents who are blind, deaf, have
481Alzheimer’s disease or other related dementias and residents who have developmental
482disabilities.
483 (b) The department may distribute civil monetary penalty funds, as approved by the
484federal Centers for Medicare and Medicaid Services, and any other available federal and state
485funds, upon request, to facilities for communicative technologies and accessories needed for the
486purposes of this section.
487 Section 72GG (a) The department, in consultation with the center for health information
488and analysis, MassHealth, the executive office of elder affairs and the health policy commission
489shall annually conduct an examination of cost trends and financial performance among nursing 24 of 26
490facilities, as defined by section 71 of chapter 111 of the general laws. The information shall be
491analyzed on an institution-specific and industry-wide basis. The examination shall aggregate
492information collected on multiple nursing facilities that are owned and operated by a single
493individual, trust, estate, partnership, association, company or corporation with an ownership
494interest of 5 per cent or more in the facilities’ operating license, management company or
495associated real estate. The examination and report shall include but not be limited to the
496collection and analysis of the following: (1) gross and net patient service revenues; (2) other
497sources of operating and non-operating revenue; (3) trends in relative price, payer mix, case mix,
498utilization and length of stay; (4) affiliations with other health care providers including but not
499limited to preferred clinical relationships and partnerships; (5) categories of costs including but
500not limited to general and administrative costs, nursing and other labor costs and salaries,
501building costs, capital costs and other operating costs; (6) total spending on direct patient care as
502a percent of total operating expenses; (7) operating and total margin; (8) occupancy rates and
503total resident population and (9) other relevant measures of financial performance and service
504delivery. These measures shall distinguish long-term residents from short-stay residents where
505possible. The initial report and any policy recommendations shall be filed with the clerks of the
506house of representatives and the senate, the house of representatives and senate committees on
507ways and means and the joint committee on elder affairs no later than 6 months after the passage
508of this act.
509 (b) To determine affiliations between nursing facilities and other health care providers as
510required, the department shall utilize ownership information submitted as part of the long-term
511care facility licensure determination process set forth in section 71 of chapter 111. 25 of 26
512 SECTION 8. Said chapter 111 is hereby further amended by striking out section 73 and
513inserting in place thereof the following section:-
514 Section 73. Whoever advertises, announces, establishes or maintains, or is concerned in
515establishing or maintaining, a long-term care facility, or otherwise is engaged in any such
516business without a license granted under section 71, or whoever being licensed under said
517section 71 violates any provision of sections 71 to 73, inclusive, shall for a first offense be
518punished by a fine of not more than $1,000, and for a subsequent offense by a fine of not more
519than $2,000 or by imprisonment for not more than two years.
520 Whoever violates any rule or regulation promulgated pursuant to sections 71, 72 and 72C
521shall be punished by a fine, not to exceed $500. If any person violates any such rule or regulation
522by allowing a condition to exist which may be corrected or remedied, the department shall order
523such person, in writing, to correct or remedy such condition, and if such person fails or refuses to
524comply with such order by the correct by date, as defined in section 72E, each day after the
525correct by date during which such failure or refusal to comply continues shall constitute a
526separate offense. A failure to pay the fine imposed by this section shall be a violation of this
527section.
528 SECTION 9. Chapter 118E of the General Laws, as so appearing, is hereby amended by
529inserting after section 82 the following section:-
530 Section 83. To establish Medicaid rates for nursing homes licensed pursuant to section
53171 of chapter 111, the executive office of health and human services shall use as base year costs
532for rate determination purposes the reported costs of the calendar year not more than 2 years
533prior to the current rate year. 26 of 26
534 SECTION 10. Pursuant to section 71 of chapter 111, as amended by this act, a licensee
535who has entered into an engagement with a management company prior to the effective date of
536this act shall provide the department of public health with the necessary documentation and
537materials for a determination by the department of the responsibility and suitability of said
538management company, as required by section (f) of said section 72, prior to any issuance of a
539renewed license; provided however, that the department shall give a licensee reasonable time to
540provide the department with the necessary documents and materials if the licensee’s renewal is
541within 90 days of the effective date of this act. A licensee’s failure to comply with this provision
542shall subject the licensee to the penalties established in section 73 of said chapter 111.
543 SECTION 11. Pursuant to section 72DD of chapter 111 of the General Laws, each long-
544term care facility shall submit its outbreak response plan to the department within 180 days of
545the effective date of this act.
546 SECTION 12. Section 9 shall take effect on October 1, 2025.