Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H4178 Compare Versions

Only one version of the bill is available at this time.

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1	1
2	2	HOUSE . . . . . . . No. 4178
3	3	The Commonwealth of Massachusetts
4	4	______________________________________
5	5	HOUSE OF REPRESENTATIVES, November 14, 2023.
6	6	The committee on Ways and Means, to whom was referred the Bill to
7	7	improve quality and oversight of long-term care (House, No. 3929),
8	8	reports recommending that the same ought to pass with an amendment
9	9	substituting therefor the accompanying bill (House, No. 4178).
10	10	For the committee,
11	11	AARON MICHLEWITZ.
12	12	1 of 35
13	13	FILED ON: 11/14/2023
14	14	HOUSE . . . . . . . . . . . . . . . No. 4178
15	15	The Commonwealth of Massachusetts
16	16	_______________
17	17	In the One Hundred and Ninety-Third General Court
18	18	(2023-2024)
19	19	_______________
20	20	An Act to improve quality and oversight of long-term care.
21	21	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
22	22	of the same, as follows:
23	23	1 SECTION 1. Chapter 10 of the General Laws is hereby amended by inserting after
24	24	2section 35SSS the following section:-
25	25	3 SECTION 35TTT. (a) There shall be established and set up on the books of the
26	26	4commonwealth a separate fund known as the Long-Term Care Workforce and Capital Fund. The
27	27	5fund shall be administered by the secretary of health and human services in consultation with the
28	28	6advisory committee established pursuant to subsection (c). The secretary may use amounts
29	29	7credited to the fund to pay for: (i) the administration of the capital loan program pursuant to
30	30	8subsection (e); and (ii) the workforce training programs pursuant to subsection (d), including the:
31	31	9(A) program costs, tuition, books and fees related to the cost of education and training for
32	32	10participants in the programs; (B) costs related to obtaining an applicable license, including, but
33	33	11not limited to, examination and licensing fees; (C) stipends for program participants; and (D)
34	34	12stipends for childcare and transportation for program participants. 2 of 35
35	35	13 (b) The fund shall consist of: (i) any revenues or other financing sources directed to the
36	36	14fund by appropriation; (ii) 50 per cent of any amount recovered by the commonwealth and
37	37	15credited thereto in connection with civil actions brought pursuant to section 72K of chapter 111;
38	38	16(iii) bond revenues or other money authorized by the general court and specifically designated to
39	39	17be credited to the fund; (iv) any income derived from the investment of amounts credited to the
40	40	18fund or repayment of loans from the fund; (v) funds from public or private sources, including,
41	41	19but not limited to, gifts, federal or private grants, donations, rebates and settlements received by
42	42	20the commonwealth that are specifically designated to be credited to the fund; and (vi) all other
43	43	21amounts credited or transferred into the fund from any other source. The executive office of
44	44	22health and human services shall seek to maximize fund revenues through federal money,
45	45	23matching funds and grants. Any unexpended balances in the fund at the end of the fiscal year
46	46	24shall not revert to the General Fund and shall be available for expenditures in subsequent fiscal
47	47	25years. Any fiscal year-end balance in the fund shall be excluded from the calculation of the
48	48	26consolidated net surplus pursuant to section 5C of chapter 29. The fund shall not be subject to
49	49	27appropriation.
50	50	28 (c) There shall be an advisory committee that shall consist of the following members: the
51	51	29assistant secretary for MassHealth, or their designee, who shall serve as chair; the secretary of
52	52	30labor and workforce development, or their designee; the commissioner of public health, or their
53	53	31designee; and 2 persons to be appointed by the governor, 1 of whom shall be a representative of
54	54	32the Massachusetts Senior Care Association, Inc. and 1 of whom shall be a representative of
55	55	33Local 1199 Service Employees International Union. 3 of 35
56	56	34 (d) The secretary of health and human services, in consultation with the advisory
57	57	35committee, shall establish, and the executive office of health and human services shall
58	58	36administer, workforce training grant programs to:
59	59	37 (i) train new certified nurses’ aides to work in licensed long-term care facilities;
60	60	38 (ii) advance the skills of certified nurses’ aides, home health aides, homemakers and
61	61	39other entry-level workers in long-term care facilities to improve quality of care and improve
62	62	40worker access to and participation in a career pathway to become a licensed practical nurse; and
63	63	41 (iii) provide long-term care supervisory and leadership training, which shall consist of
64	64	42evidence-based supervisory training for the purposes of improving staff satisfaction, retaining
65	65	43staff and reducing staff turnover.
66	66	44 (e) The secretary of health and human services, in consultation with the advisory
67	67	45committee, shall establish a no interest or forgivable capital loan program for skilled nursing
68	68	46facilities to:
69	69	47 (i) support the development of specialized care units, including, but not limited to: (A)
70	70	48infectious disease isolation; (B) dementia special care; (C) degenerative neurological units; (D)
71	71	49geriatric psychiatry; (E) traumatic brain injury; (F) in-house dialysis treatment; (G) behavioral
72	72	50health and substance use disorder; and (H) bariatric patient care;
73	73	51 (ii) enable facilities to offset the costs of pay-go capital; and
74	74	52 (iii) support innovative projects, including, but not limited to: (A) converting of sections
75	75	53within skilled nursing facilities into affordable housing, veterans housing or assisted living units
76	76	54to accommodate individual needs of residents; (B) converting multi-bed rooms to single 4 of 35
77	77	55occupancy to enhance privacy and dignity; and (C) establishing voluntary skilled nursing facility
78	78	56reconfigurations, including, but not limited to, providing financial incentives to reduce capacity
79	79	57and balance supply and demand based on regional needs.
80	80	58 (f) Annually, not later than December 1, the secretary of health and human services shall
81	81	59report on the activities of the fund to the clerks of the house of representatives and the senate and
82	82	60to the house and senate committees on ways and means. The report shall include: (i) an
83	83	61accounting of expenditures made from the fund with a description of the authorized purpose of
84	84	62each expenditure; (ii) an accounting of amounts credited to the fund; and (iii) any unexpended
85	85	63balance remaining in the fund.
86	86	64 SECTION 2. Chapter 111 of the General Laws is hereby amended by striking out section
87	87	6571 and inserting in place thereof the following section:-
88	88	66 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the
89	89	67following words shall, unless the context clearly requires otherwise, have the following
90	90	68meanings:
91	91	69 “Applicant”, any person who applies to the department for a license to establish or
92	92	70maintain and operate a long-term care facility.
93	93	71 “Charitable home for the aged”, any institution, however named, conducted for charitable
94	94	72purposes and maintained for the purpose of providing a retirement home for elderly persons and
95	95	73which may provide nursing care within the home for its residents.
96	96	74 “Cohorting”, the practice of grouping patients who: (i) are colonized or infected with the
97	97	75same organism in order to confine their care to 1 area and prevent contact with other patients; or 5 of 35
98	98	76(ii) are not colonized or infected with the same organism in order to confine their care to 1 area
99	99	77and prevent contact with other patients.
100	100	78 “Convalescent or nursing home”, any institution, however named, including a skilled
101	101	79nursing facility, whether conducted for profit or not for profit, which is advertised, announced or
102	102	80maintained for the express or implied purpose of caring for 4 or more persons admitted thereto
103	103	81for the purpose of nursing or convalescent care.
104	104	82 “Correct by date”, the date by which a licensee shall remedy or correct any violation
105	105	83discovered after an inspection by the department pursuant to section 72E.
106	106	84 “Endemic level”, the usual level of a given disease in a geographic area.
107	107	85 “Intermediate care facility for persons with an intellectual disability”, any institution,
108	108	86however named, that: (i) is conducted for charity or not for profit; (ii) is advertised, announced or
109	109	87maintained for the purpose of providing rehabilitative services and active treatment to persons
110	110	88with an intellectual disability or persons with related conditions, as defined in regulations
111	111	89promulgated pursuant to Title XIX of the federal Social Security Act, Public Law 89-97; (iii) is
112	112	90not both owned and operated by a state agency; and (iv) makes application to the department for
113	113	91a license for the purpose of participating in the federal program established by said Title XIX.
114	114	92 “Isolating”, the process of separating persons colonized or infected with a communicable
115	115	93disease from those who are not colonized or infected with a communicable disease.
116	116	94 “License”, an initial or renewal license issued by the department and which permits the
117	117	95licensee to establish or maintain and operate a long-term care facility. 6 of 35
118	118	96 “Licensee”, a person permitted to establish or maintain and operate a long-term care
119	119	97facility through a license.
120	120	98 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home,
121	121	99skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest
122	122	100home.
123	123	101 “Long-term care services”, include: (i) long-term resident, nursing, convalescent or
124	124	102rehabilitative care; (ii) supervision and care incident to old age for ambulatory persons; or (iii)
125	125	103retirement home care for elderly persons.
126	126	104 “Management company”, an organization engaged by a licensee to manage the operations
127	127	105at a long-term care facility.
128	128	106 “Outbreak”, any unusual occurrence of disease or any disease above endemic levels.
129	129	107 “Owner”, any person with an ownership interest of not less than 5 per cent, or with a
130	130	108controlling interest in an applicant, licensee, potential transferee or the real property on which a
131	131	109long-term care facility is located.
132	132	110 “Person”, an individual, trust, partnership, association, corporation or other form of
133	133	111business association.
134	134	112 “Potential transferee”, a person who submits to the department a notice of intent to
135	135	113acquire the facility operations of a currently operating long-term care facility.
136	136	114 “Religious and recreational activities”, any religious, social or recreational activity that is
137	137	115consistent with the resident’s preferences and choosing, regardless of whether the activity is
138	138	116coordinated, offered, provided or sponsored by facility staff or by an outside activities provider. 7 of 35
139	139	117 “Resident”, an individual who resides in a long-term care facility.
140	140	118 “Rest home”, any institution, however named, which is advertised, announced or
141	141	119maintained for the express or implied purpose of providing care incident to old age to 4 or more
142	142	120persons who are ambulatory and who do not require a specific level of nursing care or other
143	143	121medically related services on a routine basis.
144	144	122 “Skilled nursing facility”, any institution, however named, whether conducted for profit
145	145	123or not for profit, which is certified by the federal Centers for Medicare and Medicaid Services for
146	146	124the purpose of providing continuous skilled nursing care and rehabilitative services for 4 or more
147	147	125persons.
148	148	126 “Small house nursing home”, 1 or more units of a convalescent or nursing home designed
149	149	127and modeled as a residential home including a central living space, kitchen, dining area, living
150	150	128area and outdoor space.
151	151	129 “Transfer of facility operations”, a transfer of the operations of a long-term care facility
152	152	130from a licensee to a potential transferee.
153	153	131 (b)(1) The department shall issue for a term of 2 years, and shall renew for like terms, a
154	154	132license, subject to the restrictions in this section, to each applicant the department deems
155	155	133responsible and suitable to establish or maintain and operate a long-term care facility and which
156	156	134meets all other requirements for long-term care facility licensure pursuant to this chapter. A
157	157	135license issued pursuant to this section shall not be transferable or assignable and shall be issued
158	158	136only for the premises named in the application. 8 of 35
159	159	137 (2) Each long-term care facility shall be subject to not less than 1 periodic, resident-
160	160	138centered inspection per year for the purpose of gathering information about the quality of
161	161	139services furnished in the long-term care facility to determine compliance with applicable state
162	162	140and federal requirements.
163	163	141 (3) The department may, when public necessity and convenience require, or to prevent
164	164	142undue hardship to an applicant or licensee, pursuant to such rules and regulations as it may
165	165	143adopt, grant a temporary provisional or probationary license pursuant to this section; provided,
166	166	144however, that no such license shall be for a term exceeding 1 year.
167	167	145 (4) The fee for a license to establish or maintain and operate a long-term care facility
168	168	146shall be determined annually by the secretary of administration and finance pursuant to section
169	169	1473B of chapter 7.
170	170	148 (c) The department shall not issue a license to establish or maintain an intermediate care
171	171	149facility for persons with an intellectual disability unless the department determines that there is a
172	172	150need for such a facility at the designated location; provided, however, that in the case of a facility
173	173	151previously licensed as an intermediate care facility for persons with an intellectual disability in
174	174	152which there is a change in ownership or transfer of operations, no such determination shall be
175	175	153required; and provided further, that in the case of a facility previously licensed as an intermediate
176	176	154care facility for persons with an intellectual disability in which there is a change in location, such
177	177	155determination shall be limited to consideration of the suitability of the new location.
178	178	156 (d)(1) In the case of the transfer of facility operations of a long-term care facility, a
179	179	157potential transferee shall submit a notice of intent to acquire to the department not less than 90
180	180	158days prior to the proposed transfer date. The notice of intent to acquire shall be on a form 9 of 35
181	181	159supplied by the department and shall be deemed complete upon submission of all information the
182	182	160department requires on said form. The potential transferee shall be deemed responsible and
183	183	161suitable upon the expiration of the 90-day period, or upon the expiration of said period as
184	184	162extended, if the department fails to notify said potential transferee in writing of its decision
185	185	163within the 90-day period or within the expiration of the extension period, whichever is
186	186	164applicable.
187	187	165 (2) A potential transferee shall, concurrently with the submission of an intent to acquire,
188	188	166provide notice to the current staff of the facility, and to any labor organization that represents the
189	189	167facility’s staff at the time the notice of intent to acquire is submitted, of the potential transferee’s
190	190	168plans to retain or not retain the facility staff and to recognize and bargain with any labor
191	191	169organizations currently representing the facility staff.
192	192	170 (3) Upon determination by the department that a potential transferee is responsible and
193	193	171suitable for licensure, the potential transferee may file an application for a license. In the case of
194	194	172a potential transfer of facility operations, the filing of an application for a license shall have the
195	195	173effect of a temporary provisional or probationary license until the department takes final action
196	196	174on such application.
197	197	175 (4) Upon an approved transfer of facility operations, the department shall not reduce the
198	198	176number of beds it originally approved in granting a license, unless a reduction in the number of
199	199	177beds is in the interest of public health, welfare or safety.
200	200	178 (e) Every applicant for a license shall provide on or with its application, and every
201	201	179potential transferee shall provide on or with its notice of intent to acquire, a sworn statement of
202	202	180the names and addresses of any owner of the applicant or the potential transferee. 10 of 35
203	203	181 (f) No license shall be issued to an applicant or potential transferee prior to a
204	204	182determination by the department that the applicant or potential transferee is responsible and
205	205	183suitable pursuant to subsection (g).
206	206	184 (g) For the purposes of this section, the department’s determination of responsibility and
207	207	185suitability shall include, but shall not be limited to, the following factors:
208	208	186 (1) the criminal history of the applicant or the potential transferee, including its respective
209	209	187owners and management companies, and, to the extent possible, the civil litigation history of the
210	210	188applicant or potential transferee, including its respective owners and contracted management
211	211	189companies, including litigation related to the operation of a long-term care facility, such as
212	212	190quality of care, safety of residents or staff, employment and labor issues, fraud, unfair or
213	213	191deceptive business practices and landlord-tenant issues; provided, that such criminal and civil
214	214	192litigation history may include pending or other court proceedings in the commonwealth and in
215	215	193any other state or federal jurisdiction. Any information related to criminal or civil litigation
216	216	194obtained by the department pursuant to this section shall be confidential and exempt from
217	217	195disclosure under clause Twenty-sixth of section 7 of chapter 4 and chapter 66;
218	218	196 (2) the financial capacity of the applicant or potential transferee, including its respective
219	219	197owners and management companies, to establish or maintain and operate a long-term care
220	220	198facility; provided, that financial capacity may include, but shall not be limited to, recorded liens
221	221	199or unpaid fees or taxes in the commonwealth or in other states;
222	222	200 (3) the history of the applicant or potential transferee, including its respective owners and
223	223	201management companies, in providing quality long-term care in the commonwealth as measured 11 of 35
224	224	202by compliance with applicable quality measures, statutes and regulations governing the operation
225	225	203of long-term care facilities; and
226	226	204 (4) the history of the applicant or potential transferee, including its respective owners and
227	227	205management companies, in providing quality long-term care in states other than the
228	228	206commonwealth, if any, as measured by compliance with the applicable quality measures, statutes
229	229	207and regulations governing the operation of long-term care facilities in said states.
230	230	208 (h)(1) If the department determines that an applicant or potential transferee is not
231	231	209responsible and suitable, the department’s determination shall take effect on the date of the
232	232	210department’s notice to the applicant or potential transferee. In such cases and upon the filing of a
233	233	211written request, the department shall afford the applicant or potential transferee an adjudicatory
234	234	212hearing pursuant to chapter 30A.
235	235	213 (2) During the pendency of an adjudicatory hearing, the applicant or potential transferee
236	236	214shall not operate the facility as a licensee, nor, without prior approval of the department, manage
237	237	215such facility.
238	238	216 (i) Each applicant, potential transferee and licensee shall maintain current records of all
239	239	217information provided to the department. After the applicant, potential transferee or licensee
240	240	218becomes aware of any change related to information it has provided or is required to provide to
241	241	219the department, such person shall submit to the department written notice of the change as soon
242	242	220as practicable and without unreasonable delay; provided, that any change in financial status shall
243	243	221be provided to the department and shall include, but shall not be limited to, filing for bankruptcy,
244	244	222any default under a lending agreement or under a lease, the appointment of a receiver or the 12 of 35
245	245	223recording of any lien. Failure to provide timely notice of such change shall be subject to the
246	246	224remedies or sanctions available to the department pursuant to this chapter.
247	247	225 (j) An applicant, potential transferee or licensee and its respective owners and
248	248	226management companies shall comply with all applicable federal, state and local laws, rules and
249	249	227regulations.
250	250	228 (k)(1) Prior to entering into a contract with a management company, an applicant,
251	251	229potential transferee or licensee shall notify and receive a determination from the department that
252	252	230the management company is responsible and suitable to manage a long-term care facility.
253	253	231 (2) In its notification to the department and to inform the department’s review, the
254	254	232applicant, potential transferee or licensee shall provide the proposed management company’s
255	255	233name, contact information and any other information on the proposed management company and
256	256	234its personnel that may be reasonably requested by the department, including, but not limited to,
257	257	235information required pursuant to subsection (g). Upon a determination by the department that the
258	258	236proposed management company is responsible and suitable to manage a long-term care facility,
259	259	237the applicant, potential transferee or licensee may engage said company to manage the long-term
260	260	238care facility.
261	261	239 (3) The applicant, potential transferee or licensee shall memorialize any such engagement
262	262	240in a written agreement with the management company. Such written agreement shall include a
263	263	241requirement that the management company and its personnel comply with all applicable federal,
264	264	242state and local laws, regulations and rules. Promptly after the effective date of any such
265	265	243agreement, the applicant, potential transferee or licensee shall provide to the department a copy
266	266	244of the valid, fully executed agreement. Any payment terms included in the agreement shall be 13 of 35
267	267	245confidential and exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 and
268	268	246chapter 66.
269	269	247 (4) If the department determines that a management company is not responsible and
270	270	248suitable, the department’s determination shall take effect on the date of the department’s notice
271	271	249to the applicant, potential transferee or licensee. In such cases and upon the filing of a written
272	272	250request, the department shall afford the applicant, potential transferee, licensee or management
273	273	251company an adjudicatory hearing pursuant to chapter 30A.
274	274	252 (l) The department shall not reduce the number of beds it originally approved in granting
275	275	253a license for a convalescent or nursing home or rest home upon the transfer of facility operations
276	276	254of said convalescent or nursing home or rest home from 1 licensee to another, unless a reduction
277	277	255in the number of beds is in the interest of public health, welfare or safety.
278	278	256 (m)(1) The department shall not issue a license unless the applicant first submits to the
279	279	257department, with respect to each building occupied by residents: (i) a certificate of inspection of
280	280	258the egresses, the means of preventing the spread of fire and apparatus for extinguishing fire,
281	281	259issued by an inspector of the office of public safety and inspections within the division of
282	282	260professional licensure; and (ii) a certificate of inspection issued by the head of the local fire
283	283	261department certifying compliance with local ordinances; provided, however, that for
284	284	262convalescent or nursing homes, the division of health care quality within the department shall
285	285	263have sole authority to inspect and issue a certificate required pursuant to clause (i) of this
286	286	264paragraph.
287	287	265 (2) Any applicant who is aggrieved, on the basis of a written disapproval of a certificate
288	288	266of inspection by the head of the local fire department or by the office of public safety and 14 of 35
289	289	267inspections of the division of professional licensure, may, within 30 days from such disapproval,
290	290	268appeal in writing to the division of professional licensure. Failure to either approve or disapprove
291	291	269within 30 days after a written request by an applicant shall be deemed a disapproval. With
292	292	270respect to certificates of inspection issued to convalescent or nursing homes by the division of
293	293	271health care quality within the department, an applicant may, within 30 days from disapproval of
294	294	272a certificate of inspection, appeal in writing to the department. Failure to either approve or
295	295	273disapprove within 30 days after a written request by an applicant shall be deemed a disapproval.
296	296	274 (3) If the division of professional licensure or, where applicable, the department approves
297	297	275the issuance of a certificate of inspection after an appeal, the certificate shall be issued by the
298	298	276issuing agency. If the division of professional licensure or, where applicable, the department
299	299	277does not approve the issuance of a certificate of inspection, the applicant may appeal to the
300	300	278superior court. Failure of said division or said department to either approve or disapprove the
301	301	279issuance of a certificate of inspection within 30 days after receipt of an appeal shall be deemed a
302	302	280disapproval. The department shall not issue a license until issuance of an approved certificate of
303	303	281inspection, as required pursuant to paragraph (1).
304	304	282 (4) Nothing in this section or in sections 72 or 73 shall be construed to supersede or
305	305	283otherwise affect any laws, ordinances, by-laws, rules or regulations relating to building, zoning,
306	306	284registration or maintenance of a long-term care facility.
307	307	285 (n)(1) For cause, the department may limit, restrict, suspend or revoke a license.
308	308	286 (2) Grounds for cause on which the department may take action pursuant to paragraph (1)
309	309	287shall include: (i) substantial or sustained failure or inability to provide adequate care to residents;
310	310	288(ii) substantial or sustained failure to maintain compliance with applicable statutes, rules and 15 of 35
311	311	289regulations; or (iii) the lack of financial capacity to maintain and operate a long-term care
312	312	290facility.
313	313	291 (3) The limits or restrictions the department may impose on a licensee include requiring a
314	314	292facility to limit new admissions.
315	315	293 (4) Suspension of a license may include suspending the license during a pending license
316	316	294revocation action or suspending the license to permit the licensee a period of time, not less than
317	317	29560 days, to terminate operations, and discharge and transfer all residents, if applicable.
318	318	296 (5) With respect to an order by the department to limit, restrict or suspend a license,
319	319	297within 7 days of receipt of the written order, the licensee may file a written request with the
320	320	298department for an adjudicatory proceeding pursuant to chapter 30A.
321	321	299 (6) Upon a written request by a licensee who is aggrieved by the revocation or limitation
322	322	300of a license or by an applicant who is aggrieved by the refusal of the department to renew a
323	323	301license, the licensee or applicant so aggrieved shall have all the rights provided in chapter 30A
324	324	302with respect to adjudicatory proceedings. In no case shall the revocation of such a license take
325	325	303effect in less than 30 days after written notification by the department to the licensee.
326	326	304 (o) In the case of the new construction of, or major addition, alteration or repair to, any
327	327	305long-term care facility, preliminary and final architectural plans and specifications shall be
328	328	306submitted to a qualified person designated by the commissioner. Written approval of the final
329	329	307architectural plans and specifications shall be obtained from said person prior to said new
330	330	308construction or major addition, alteration or repair. 16 of 35
331	331	309 (p) Notwithstanding any of the other provisions of this section, the department shall not
332	332	310issue a license to establish or maintain and operate a long-term care facility to an applicant who
333	333	311applies to the department for said license to establish or maintain and operate a convalescent or
334	334	312nursing home unless the applicant for such license submits to the department a certificate that
335	335	313each building to be occupied by residents of such convalescent or nursing home meets the
336	336	314construction standards of the state building code, and is of at least type 1–B fireproof
337	337	315construction; provided, however, that this subsection shall not apply in the instance of a transfer
338	338	316of facility operations of a convalescent or nursing home whose license has not been revoked as
339	339	317of the time of such transfer; and provided, further, that a public medical institution as defined in
340	340	318section 8 of chapter 118E, which meets the construction standards as defined herein, shall not be
341	341	319denied a license as a long-term care facility pursuant to this section because it was not of new
342	342	320construction and designed for the purpose of operating a long-term care facility at the time of
343	343	321application for a license to operate a long-term care facility. An intermediate care facility for
344	344	322persons with an intellectual disability shall be required to meet the construction standards
345	345	323established for such facilities by Title XIX of the Social Security Act, Public Law 89-97 and any
346	346	324regulations promulgated pursuant thereto, and by regulations promulgated by the department.
347	347	325 (q) The department shall notify the secretary of elder affairs of the pendency of any
348	348	326proceeding, public hearing or action to be taken pursuant to this section relating to any
349	349	327convalescent or nursing home, rest home or charitable home for the aged. The department shall
350	350	328notify the commissioner of the department of developmental services of the pendency of any
351	351	329proceeding, public hearing or action to be taken pursuant to this section relating to any
352	352	330intermediate care facility for persons with an intellectual disability. 17 of 35
353	353	331 SECTION 3. Said chapter 111 is hereby further amended by striking out section 72 and
354	354	332inserting in place thereof the following section:-
355	355	333 Section 72. (a)(1) The department shall classify long-term care facilities and shall, after a
356	356	334public hearing, promulgate rules and regulations for the conduct of such facilities. Rules and
357	357	335regulations for long-term care facilities shall include, but not be limited to, minimum
358	358	336requirements for medical and nursing care, the keeping of proper medical and nursing records,
359	359	337uniform requirements for the handling of patient funds, minimum requirements relative to the
360	360	338prevention and reparation of lost or damaged patient possessions, including personal clothing
361	361	339and minimum requirements relative to facility sanitation.
362	362	340 (2) Regulations for intermediate care facilities for persons with an intellectual disability
363	363	341shall, in addition to the requirements pursuant to paragraph (1), include minimum requirements
364	364	342for social services, psychological services and other services appropriate for the care of persons
365	365	343with an intellectual disability and shall limit the size of such facilities to not more than 15 beds.
366	366	344 (3) The department in promulgating rules and regulations for long-term care facilities
367	367	345shall consider the ability of long-term care facilities to provide service under rates set pursuant to
368	368	346section 13C of chapter 118E. No such rule or regulation shall apply to a long-term care facility
369	369	347licensed at the time of promulgation of such rule or regulation, or a long-term care facility being
370	370	348constructed at the time of such promulgation under plans approved by the department, unless
371	371	349such rule or regulation has a direct and material relation to patient diet, cleanliness, nursing care
372	372	350or health, or to habilitative services and active treatment for persons with an intellectual
373	373	351disability or persons with related conditions; provided, however, that nothing herein contained 18 of 35
374	374	352shall be interpreted to prevent the department from adopting or interpreting rules and regulations
375	375	353more favorable toward existing long-term care facilities.
376	376	354 (b)(1) The department or its agents and the board of health or its agents of the city or
377	377	355town wherein any portion of such long-term care facility is located may visit and inspect such
378	378	356institution at any time; provided, that a board of health or its agents conducting an inspection of a
379	379	357long-term care facility located within its city or town shall notify the department of the results of
380	380	358any inspection conducted pursuant to this paragraph.
381	381	359 (2) Any person making an inspection pursuant to paragraph (1) shall record in writing
382	382	360every violation of the applicable rules and regulations of the department that they discover
383	383	361during the course of their inspection. Every record of inspection shall be treated as a public
384	384	362record except to such extent the record or a portion thereof is expressly exempt from such
385	385	363treatment pursuant to clause Twenty-sixth of section 7 of chapter 4. A record of inspection
386	386	364containing violations shall be made public by the department at the same time that a written plan
387	387	365of correction is submitted. If a written plan of correction is not submitted within the allowable
388	388	366time, said violations shall be made public at the expiration of the allowable time. Inspections
389	389	367hereunder shall be unannounced and made at such intervals as the department shall specify in its
390	390	368rules and regulations; provided, that, each long-term care facility shall be subject to not less than
391	391	3691 periodic, resident-centered inspection per year pursuant to subsection (b) of section 71. A visit
392	392	370made to a facility for the purpose of providing consultation shall not be considered to be an
393	393	371inspection.
394	394	372 (c) The superior court shall have jurisdiction in equity to enforce the rules and regulations
395	395	373promulgated pursuant to this section. 19 of 35
396	396	374 (d)(1) The department shall promulgate regulations for the operation of small house
397	397	375nursing homes. Newly constructed small house nursing homes shall house no more than 14
398	398	376individuals per unit, in resident rooms that accommodate not more than 1 resident per room;
399	399	377provided, however, that if a resident requests to share a room with another resident to
400	400	378accommodate a spouse, partner, family member or friend, such resident room shall have
401	401	379sufficient space and equipment, as established by the department, for 2 residents; provided,
402	402	380further, that determinations to grant such requests shall be determined based on space and
403	403	381availability of rooms. All resident rooms shall contain a full private and accessible bathroom.
404	404	382 (2) The department shall promulgate regulations for construction and physical plant
405	405	383standards for small house nursing homes that shall consider environmental standards and
406	406	384sustainability.
407	407	385 (3) The department may promulgate regulations for small house nursing homes for a
408	408	386staffing model that: (i) allows for a universal worker approach to resident care that is organized
409	409	387to support and empower all staff to respond to the needs and desires of residents, including, but
410	410	388not limited to, cooking and meal preparation, without exceeding the lawful scope of practice of
411	411	389said employee; and (ii) provides for consistent staff in each small house nursing home.
412	412	390 (4) The regulations promulgated pursuant to this subsection shall ensure the convalescent
413	413	391or nursing home meets the requirements necessary to be eligible to participate in both the
414	414	392Medicare and Medicaid programs.
415	415	393 SECTION 4. Said chapter 111 is hereby further amended by striking out section 72E and
416	416	394inserting in place thereof the following section:- 20 of 35
417	417	395 Section 72E. (a) The department shall, after every inspection by its agent pursuant to
418	418	396section 72, provide the licensee of the inspected long-term care facility notice in writing of every
419	419	397violation of the applicable statutes, rules and regulations found during said inspection. With
420	420	398respect to the date by which the licensee shall remedy or correct each violation, the department
421	421	399in such notice shall specify a reasonable time, not more than 60 days after receipt, by which time
422	422	400the licensee shall remedy or correct each violation cited or, in the case of any violation which in
423	423	401the opinion of the department is not reasonably capable of correction within 60 days, the
424	424	402department shall require only that the licensee submit a written plan for the timely correction of
425	425	403the violation in a reasonable manner. The department may modify any nonconforming plan upon
426	426	404notice, in writing, to the licensee.
427	427	405 (b) Failure to remedy or correct a cited violation by the correct by date shall be cause to
428	428	406pursue or impose the remedies or sanctions available to the department pursuant to this chapter,
429	429	407unless the licensee demonstrates to the satisfaction of the department or a court, where
430	430	408applicable, that such failure was not due to any neglect of its duty and occurred despite an
431	431	409attempt in good faith to make correction by the correct by date. An aggrieved licensee may
432	432	410pursue the remedies available to it pursuant to chapter 30A.
433	433	411 (c) If the department determines the licensee failed to maintain substantial or sustained
434	434	412compliance with applicable state and federal laws, rules and regulations, in addition to imposing
435	435	413any of the other remedies or sanctions available to it, the department may require the licensee to
436	436	414engage, at the licensee’s own expense, a temporary manager to assist the licensee with bringing
437	437	415the facility into substantial compliance and with sustaining such compliance. Such temporary
438	438	416manager shall be subject to the department’s approval; provided, that such approval shall not be
439	439	417unreasonably withheld. Any such engagement of a temporary manager shall be for a period of 21 of 35
440	440	418not less than 3 months and shall be pursuant to a written agreement between the licensee and the
441	441	419management company. A copy of said agreement shall be provided by the licensee to the
442	442	420department promptly after execution. Any payment terms included in the agreement shall be
443	443	421confidential and exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter
444	444	4224 and chapter 66.
445	445	423 (d) Nothing in this section shall be construed to prohibit the department from enforcing a
446	446	424statute, rule or regulation, administratively or in court, without first affording formal opportunity
447	447	425to make correction pursuant to this section, where, in the opinion of the department, the violation
448	448	426of such statute, rule or regulation jeopardizes the health or safety of residents or the public or
449	449	427seriously limits the capacity of a licensee to provide adequate care, or where the violation of such
450	450	428statute, rule or regulation is the second such violation occurring during a period of 12 full
451	451	429months.
452	452	430 SECTION 5. Section 72K of said chapter 111, as appearing in the 2022 Official Edition,
453	453	431is hereby amended by striking out subsection (b) and inserting in place thereof the following 2
454	454	432subsections:-
455	455	433 (b) The attorney general may file a civil action against a person who: (i) commits abuse,
456	456	434mistreatment or neglect of a patient or resident; (ii) misappropriates patient or resident property;
457	457	435or (iii) wantonly or recklessly permits or causes another to commit abuse, mistreatment or
458	458	436neglect of a patient or resident or misappropriate patient or resident property. The civil penalty
459	459	437for such abuse, mistreatment, neglect or misappropriation shall not exceed: $25,000 if no bodily
460	460	438injury results; $50,000 if bodily injury results; $100,000 if sexual assault or serious bodily injury
461	461	439results; and $250,000 if death results. Section 60B of chapter 231 shall not apply to an action 22 of 35
462	462	440brought by the attorney general pursuant to this section. Nothing in this section shall preclude the
463	463	441filing of any action brought by the attorney general or a private party pursuant to chapter 93A or
464	464	442any action by the department pursuant to this chapter. The comptroller shall deposit not less than
465	465	44350 per cent of any amount secured by the attorney general as a result of a civil action brought
466	466	444pursuant to this section into the Long-Term Care Workforce and Capital Fund established in
467	467	445section 35TTT of chapter 10.
468	468	446 (c) Notwithstanding section 5 of chapter 260, the attorney general may file a civil action
469	469	447within 4 years next after an offense is committed.
470	470	448 SECTION 6. Said chapter 111 is hereby further amended by inserting after section 72BB
471	471	449the following 4 sections:-
472	472	450 Section 72CC. (a) The department shall require long-term care facilities to develop an
473	473	451outbreak response plan which shall be customized to the long-term care facility. Each long-term
474	474	452care facility’s plan shall include, but shall not be limited to:
475	475	453 (1) a protocol for isolating and cohorting infected and at-risk patients in the event of an
476	476	454outbreak of a contagious disease until the cessation of the outbreak;
477	477	455 (2) clear policies for the notification of residents, residents’ families, visitors and staff in
478	478	456the event of an outbreak of a contagious disease at a long-term care facility;
479	479	457 (3) information on the availability of laboratory testing, protocols for screening visitors
480	480	458and staff for the presence of a communicable disease, protocols to require infected staff to not
481	481	459present at the long-term care facility for work duties and processes for implementing evidence-
482	482	460based outbreak response measures; 23 of 35
483	483	461 (4) policies to conduct routine monitoring of residents and staff to quickly identify signs
484	484	462of a communicable disease that could develop into an outbreak;
485	485	463 (5) policies for reporting outbreaks to public health officials in accordance with
486	486	464applicable laws and regulations; and
487	487	465 (6) policies to meet staffing, training and long-term care facility demands during an
488	488	466infectious disease outbreak and to successfully implement the outbreak response plan.
489	489	467 (b) The department shall verify that the outbreak response plans submitted by long-term
490	490	468care facilities are in compliance with the requirements of subsection (a).
491	491	469 (c)(1) Every long-term care facility shall review the outbreak response plan it submitted
492	492	470to the department pursuant to subsection (a) on an annual basis.
493	493	471 (2) If a long-term care facility makes any material changes to its outbreak response plan,
494	494	472the facility shall submit to the department an updated outbreak response plan within 30 days. The
495	495	473department shall, upon receiving an updated outbreak response plan, verify that the plan is in
496	496	474compliance with the requirements of subsection (a).
497	497	475 (d) The department shall promulgate regulations necessary to implement this section.
498	498	476 Section 72DD. (a) The division of health care facility licensure and certification shall
499	499	477establish and implement a process and program for providing training and education to staff of
500	500	478long-term care facilities licensed by the department pursuant to section 71. The training and
501	501	479education program may include, but shall not be limited to: (i) infection prevention and control;
502	502	480(ii) development, implementation, adherence and review of comprehensive resident care plans;
503	503	481(iii) falls prevention; (iv) procedures to ensure timely notification of changes in a resident’s 24 of 35
504	504	482condition to the resident’s primary care physician; (v) prevention of abuse and neglect; (vi)
505	505	483development and implementation of a program to ensure staff safety; and (vii) review of the
506	506	484inspection process established in section 72.
507	507	485 (b) The training and education program shall be interactive and shall include, but shall
508	508	486not be limited to: (i) an annual training for long-term care facility supervisory and leadership
509	509	487staff on the licensure and certification process, including, but not limited to, the department’s
510	510	488interpretation of the general laws and relevant changes or additions to applicable rules,
511	511	489regulations, procedures and policies concerning the licensure and certification process for long-
512	512	490term care facilities; and a (ii) biannual training of staff of long-term care facilities on the most
513	513	491frequently cited deficiencies, identified deficiency trends, both state and federal, and best
514	514	492practices to ensure resident quality of care.
515	515	493 (c) The department may consult with industry trade associations before issuing or
516	516	494promulgating guidance, regulations, interpretations, program letters, memoranda or any other
517	517	495materials used in inspector training for the inspection of long-term care facilities pursuant to
518	518	496section 72.
519	519	497 Section 72EE. (a) The department shall promulgate regulations to encourage and enable
520	520	498residents of a long-term care facility to engage in in-person, face-to-face, verbal or auditory-
521	521	499based contact, communications and religious and recreational activities with others to the extent
522	522	500that in-person contact, communication or activities are not prohibited, restricted or limited by
523	523	501federal or state statute, rule or regulation. Said regulations shall include specific protocols and
524	524	502procedures to provide for residents of the facility who have disabilities that impede their ability 25 of 35
525	525	503to communicate, including, but not limited to, residents who are blind, deaf, have Alzheimer’s
526	526	504disease or other dementias and developmental disabilities.
527	527	505 (b) The department may distribute federal civil monetary penalty funds, subject to
528	528	506approval by the federal Centers for Medicare and Medicaid Services, and any other available
529	529	507federal and state funds, upon request, to facilities for communicative technologies and
530	530	508accessories pursuant to this section.
531	531	509 Section 72FF. (a) The department, in consultation with the center for health information
532	532	510and analysis, the division of medical assistance, the executive office of elder affairs and the
533	533	511health policy commission, shall annually conduct an examination and report on cost trends and
534	534	512financial performance among skilled nursing facilities. The information shall be analyzed on an
535	535	513institution-specific and industry-wide basis. The examination shall aggregate information
536	536	514collected on multiple skilled nursing facilities that are owned and operated by a single owner.
537	537	515 (b) The examination and report shall include, but shall not be limited to collection and
538	538	516analysis of: (i) gross and net patient service revenues; (ii) other sources of operating and non-
539	539	517operating revenue; (iii) trends in relative price, payer mix, case mix, utilization and length of
540	540	518stay; (iv) affiliations with other health care providers, including, but not limited to, preferred
541	541	519clinical relationships and partnerships; (v) categories of costs, including, but not limited to,
542	542	520general and administrative costs, nursing and other labor costs and salaries, building costs,
543	543	521capital costs and other operating costs; (vi) total spending on direct patient care as a percent of
544	544	522total operating expenses; (vii) operating and total margin; (viii) occupancy rates and total
545	545	523resident population; and (ix) any other relevant measures of financial performance and service 26 of 35
546	546	524delivery the department deems necessary; provided, that these measures shall distinguish long-
547	547	525term residents from short-stay residents where possible.
548	548	526 (c) Annually, not later than December 1, the report and any policy recommendations shall
549	549	527be filed with the clerks of the house of representatives and the senate, the house and senate
550	550	528committees on ways and means and the joint committee on elder affairs.
551	551	529 (d) The department shall utilize ownership information submitted as part of the long-term
552	552	530care facility licensure determination process pursuant to section 71 to determine affiliations
553	553	531between skilled nursing facilities and other health care providers as required.
554	554	532 SECTION 7. Said chapter 111 is hereby further amended by striking out section 73 and
555	555	533inserting in place thereof the following section:-
556	556	534 Section 73. (a) Whoever advertises, announces, establishes or maintains, or is concerned
557	557	535in establishing or maintaining, a long-term care facility, or otherwise is engaged in any such
558	558	536business without a license granted pursuant to section 71, or whoever being licensed pursuant to
559	559	537said section 71 violates any provision of sections 71 to 73, inclusive, shall for a first offense be
560	560	538punished by a fine of not more than $1,000, and for a subsequent offense by a fine of not more
561	561	539than $2,000 or by imprisonment for not more than 2 years.
562	562	540 (b) Whoever violates any rule or regulation promulgated pursuant to sections 71, 72 and
563	563	54172C shall be punished by a fine, not to exceed $500. If any person violates any such rule or
564	564	542regulation by allowing a condition to exist which may be corrected or remedied, the department
565	565	543shall order such person, in writing, to correct or remedy such condition. If such person fails or
566	566	544refuses to comply with such order by the correct by date, each day after the correct by date 27 of 35
567	567	545during which such failure or refusal to comply continues shall constitute a separate offense. A
568	568	546failure to pay the fine imposed by this section shall be a violation of this subsection.
569	569	547 SECTION 8. Section 25 of chapter 118E of the General Laws, as appearing in the 2022
570	570	548Official Edition, is hereby amended by inserting after the word “provided.”, in line 61, the
571	571	549following 2 sentences:- In the case of an incompetent applicant or member that requires long-
572	572	550term care services, the division shall authorize a deduction from the applicant or member’s
573	573	551income for guardianship fees and related expenses when the appointment of a guardian is
574	574	552essential to enable an incompetent applicant or member to gain access or consent to medical
575	575	553treatment. The division shall authorize a deduction for the reasonable costs, as approved by the
576	576	554probate and family court, associated with: (i) the appointment of a guardian; (ii) the guardian’s
577	577	555services during the application process; and (iii) the guardian’s services during the
578	578	556redetermination process; provided, however, that said deduction shall not exceed, in any case,
579	579	557$1,500.
580	580	558 SECTION 9. Said chapter 118E is hereby further amended by adding the following 2
581	581	559sections:-
582	582	560 Section 83. To establish Medicaid rates for skilled nursing facilities licensed pursuant to
583	583	561section 71 of chapter 111, the division of medical assistance shall use as base year costs for rate
584	584	562determination purposes the reported costs of the calendar year not more than 2 years prior to the
585	585	563current rate year.
586	586	564 Section 84. (a) The division of medical assistance shall establish a skilled nursing facility
587	587	565rate add-on program for bariatric patient care and a rate add-on program for 1-on-1 staffing of at-
588	588	566risk residents requiring 24-hour monitoring and supervision for their safety and the safety of 28 of 35
589	589	567other residents and staff. The division of medical assistance shall identify at-risk resident
590	590	568populations to include in the rate add-on program for 1-on-1 staffing which shall include, but not
591	591	569be limited to, residents that: (i) have demonstrated suicidal ideation; (ii) have demonstrated
592	592	570aggressive behavior toward other residents or staff; (iii) have demonstrated exit-seeking
593	593	571behavior; or (vi) are registered sex offenders. The rate add-ons for said program shall be
594	594	572sufficient to defray the cost of employing the required staff to conduct the 24-hour monitoring
595	595	573and supervision of the at-risk residents.
596	596	574 (b) The division of medical assistance may develop an add-on to rate of payment for
597	597	575skilled nursing facilities that develop small house nursing homes and meet criteria established by
598	598	576the executive office.
599	599	577 SECTION 10. Subsection (c) of section 25 of chapter 176O of the General Laws, as
600	600	578appearing in the 2022 Official Edition, is hereby amended by inserting after the second sentence
601	601	579the following sentence:- The division shall develop and implement a uniform prior authorization
602	602	580form for the admission of patients from an acute care hospital to a post-acute care facility or
603	603	581transitioned to a home health agency certified by the federal Centers for Medicare and Medicaid
604	604	582Services for covered post-acute care services.
605	605	583 SECTION 11. (a) For the purposes of this section, the following words shall have the
606	606	584following meanings unless the context clearly requires otherwise:
607	607	585 “Enrollee”, as defined in section 8A of chapter 118E of the General Laws; provided, that
608	608	586“enrollee” shall include “insured” as defined in section 1 of chapter 176O of the General Laws.
609	609	587 “Payer”, the group insurance commission under chapter 32A of the General Laws, the
610	610	588division of medical assistance under chapter 118E of the General Laws, insurance companies 29 of 35
611	611	589organized under chapter 175 of the General Laws, non-profit hospital service corporations
612	612	590organized under chapter 176A of the General Laws, medical service corporations organized
613	613	591under chapter 176B of the General Laws, health maintenance organizations organized under
614	614	592chapter 176G of the General Laws and preferred provider organizations organized under chapter
615	615	593176I of the General Laws, or a utilization review organization acting under contract with the
616	616	594aforementioned entities.
617	617	595 “Post-acute care facility or agency”, any: (i) facility licensed under chapter 111 of the
618	618	596General Laws to provide inpatient post-acute care services, including, but not limited to skilled
619	619	597nursing facilities, long-term care hospitals, intermediate care facilities, or rehabilitation facilities;
620	620	598or (ii) a home health agency certified by the federal Centers for Medicare and Medicaid Services.
621	621	599 (b) Notwithstanding any general or special law to the contrary, all payers shall approve or
622	622	600deny a request for prior authorization for admission to a post-acute care facility or transition to a
623	623	601post-acute care agency for any inpatient of an acute care hospital requiring covered post-acute
624	624	602care services by the next business day following receipt by the payer of all necessary information
625	625	603to establish medical necessity of the requested service. If the calendar day immediately following
626	626	604the date of submission of the completed request is not a payer’s business day, and the payer
627	627	605cannot otherwise make a determination by the next calendar day, and the receiving post-acute
628	628	606care facility or agency is both open to new admissions and has indicated that said facility or
629	629	607agency will accept the enrollee, then prior authorization shall be waived; provided, that the payer
630	630	608shall provide coverage and may begin its concurrent review of the admission on the next
631	631	609business day; provided further, that the payer shall not retrospectively deny coverage for services
632	632	610to an enrollee admitted to a post-acute care facility or transitioned to a post-acute care agency
633	633	611after a waiver of prior authorization pursuant to this section unless the claim was a result of 30 of 35
634	634	612fraud, waste or abuse. An adverse determination of a prior authorization request pursuant to this
635	635	613section may be appealed by an enrollee or the enrollee’s provider and such appeal, in the case of
636	636	614an enrollee of a commercial payer, shall be subject to the expedited grievance process pursuant
637	637	615to clause (iv) of subsection (b) of section 13 of chapter 176O of the General Laws. An enrollee
638	638	616of an insurance program of the division of medical assistance or the enrollee’s provider may
639	639	617request an expedited appeal of an adverse determination of a prior authorization request. Nothing
640	640	618in this section shall be construed to require a payer to reimburse for services that are not a
641	641	619covered benefit.
642	642	620 (c) In the case of non-emergency transportation between an acute care hospital and a
643	643	621post-acute care facility, payers shall approve or deny a request for prior authorization according
644	644	622to the same process provided pursuant to subsection (b); provided, that once authorization has
645	645	623been granted, said authorization shall be valid for not less than 7 calendar days following
646	646	624approval.
647	647	625 (d) The division of insurance and the division of medical assistance shall issue sub-
648	648	626regulatory guidance to effectuate the purposes of this subsection.
649	649	627 SECTION 12. (a) There shall be a task force to study and propose recommendations to
650	650	628address acute care hospital throughput challenges and the impact of persistent delays in
651	651	629discharging patients from acute to post-acute care settings. The task force shall examine: (i)
652	652	630hospital discharge planning and case management practices; (ii) payer administrative barriers to
653	653	631discharge; (iii) legal and regulatory barriers to discharge; (iv) efforts to increase public
654	654	632awareness of health care proxies and the importance of designating a health care agent; (v) post-
655	655	633acute care capacity constraints and additional opportunities to provide financial incentives to 31 of 35
656	656	634increase capacity; (vi) administrative day rates and the cost to hospitals of discharge delays; (vii)
657	657	635enhanced hospital case management practices and reimbursement for wraparound services; (viii)
658	658	636the adequacy of post-acute care facility insurance networks and the establishment of an out-of-
659	659	637network rate for post-acute care facilities; (ix) expanding MassHealth Limited coverage to
660	660	638include post-acute and long-term care services; (x) the effectiveness of interagency coordination
661	661	639to resolve complex case discharges; (xi) the adequacy of reimbursement rates of MassHealth and
662	662	640commercial carriers for nonemergency medical transportation; and (xii) the adequacy of state
663	663	641resources and infrastructure to place complex case discharges in appropriate post-acute care
664	664	642settings.
665	665	643 (b) The task force shall consist of: the secretary of health and human services, or a
666	666	644designee, who shall serve as chair; the assistant secretary for MassHealth, or a designee; the
667	667	645commissioner of mental health, or a designee; the attorney general, or a designee; the
668	668	646commissioner of correction, or a designee; 1 sheriff appointed by the Massachusetts Sheriffs’
669	669	647Association, Inc.; 1 member representing the division of the probate and family court department
670	670	648of the trial court to be appointed by the chief justice of said division; and 10 members to be
671	671	649appointed by the chair, 1 of whom shall be a representative of the Massachusetts Hospital
672	672	650Association, Inc., 1 of whom shall be a representative of the Massachusetts Senior Care
673	673	651Association, Inc., 1 of whom shall be a representative of the Home Care Alliance of
674	674	652Massachusetts, Inc., 1 of whom shall be a representative of the Massachusetts Academy of Elder
675	675	653Law Attorneys, 1 of whom shall be a representative from the Massachusetts Ambulance
676	676	654Association, Incorporated, 1 of whom shall be a representative from the Massachusetts
677	677	655Association of Health Plans, Inc., 1 of whom shall be a representative from Blue Cross and Blue
678	678	656Shield of Massachusetts, Inc., 1 of whom shall be a representative from an academic medical 32 of 35
679	679	657center located in Worcester county, 1 of whom shall be a representative of an acute care hospital
680	680	658located in Suffolk county and 1 of whom shall be a representative from an acute care hospital
681	681	659designated by the health policy commission as an independent community hospital for the
682	682	660purposes of 105 CMR 100.715(B)(2)(b).
683	683	661 (c) Not later than July 31, 2024, the task force shall submit its report, including its
684	684	662recommendations or any proposed legislation necessary to carry out its recommendations, to the
685	685	663clerks of the house of representatives and the senate, the house and senate committees on ways
686	686	664and means and the joint committee on health care financing.
687	687	665 SECTION 13. The division of medical assistance shall study the cost and feasibility of
688	688	666changes to the eligibility requirements for Medicaid long-term care services with the goal of
689	689	667reducing the time applicants spend at acute care hospitals awaiting long-term care eligibility
690	690	668determinations. The study shall consider: (i) improvements to the eligibility determination
691	691	669process; (ii) establishing a rebuttable presumption of eligibility; (iii) guaranteeing payment for
692	692	670long-term care services for up to 1 year regardless of eligibility status; and (iv) expanding the
693	693	671undue hardship waiver criteria. The division of medical assistance shall seek input from the
694	694	672Massachusetts Senior Care Association, Inc., the Massachusetts Academy of Elder Law
695	695	673Attorneys and other interested stakeholders. The division of medical assistance shall submit a
696	696	674report with the results of its study and policy recommendations to the clerks of the house of
697	697	675representatives and the senate and the house and senate committees on ways and means, not later
698	698	676than 180 days after the effective date of this act.
699	699	677 SECTION 14. (a) The health policy commission shall conduct an analysis and issue a
700	700	678report on the impact of the Medicare shared savings program and participating Medicare 33 of 35
701	701	679accountable care organizations, hereinafter referred to as Medicare ACOs, on the financial
702	702	680viability of long-term care facilities in the commonwealth and continued access to long-term care
703	703	681facility services for Medicare patients. The analysis shall include, but not be limited to, an
704	704	682examination of the following:
705	705	683 (i) the impact of Medicare ACOs on clinical eligibility decisions related to initial long-
706	706	684term care facility placement and patient length of stay for Medicare ACO beneficiaries compared
707	707	685to Medicare fee-for-service beneficiaries, including an analysis of the impact of length of stay on
708	708	686quality outcomes including readmissions, functional status and patient experience;
709	709	687 (ii) the amount of payments Medicare ACOs have received from the federal government
710	710	688from capitated, shared savings or other related initiatives and how those payments have been
711	711	689utilized, or not, to enhance patient care and outcomes in long-term care facilities;
712	712	690 (iii) Medicare ACO practices related to patient care utilization controls and the financial
713	713	691and quality care impact of these controls on beneficiaries in the acute and post-acute care system;
714	714	692and
715	715	693 (iv) Medicare ACOs long-term care network adequacy.
716	716	694 (b) The health policy commission shall submit the report to the clerks of the house of
717	717	695representatives and the senate, the house and senate committees on ways and means, the joint
718	718	696committee on health care financing and the joint committee on elder affairs not later than
719	719	697December 31, 2024.
720	720	698 SECTION 15. Notwithstanding any general or special law to the contrary, the division of
721	721	699insurance shall develop the uniform prior authorization form for admission to a post-acute care 34 of 35
722	722	700facility or transition to a home health agency for any inpatient of an acute care hospital requiring
723	723	701covered post-acute care services pursuant to section 25 of chapter 176O of the General Laws, as
724	724	702amended by section 10, not later than 90 days after the effective date of this act. The division of
725	725	703insurance shall develop said uniform prior authorization form in consultation with the division of
726	726	704medical assistance. The division of medical assistance, or any entity acting for the division of
727	727	705medical assistance under contract, shall accept the uniform prior authorization form as sufficient
728	728	706to request prior authorization for the requested service. All acute care hospitals shall use the
729	729	707uniform prior authorization form to request prior authorization for coverage of post-acute care
730	730	708services at a post-acute care facility or home health agency, and all payers, as defined in section
731	731	70911, or entities acting for a payer under contract shall accept such form as sufficient to request
732	732	710prior authorization for the requested service, not later than 30 days after the form has been
733	733	711developed by the division of insurance.
734	734	712 SECTION 16. (a) For the purposes of this section, the terms “licensee” and “management
735	735	713company” shall have the meanings as defined in section 71 of chapter 111 of the General Laws,
736	736	714as amended by section 2.
737	737	715 (b) Pursuant to section 71 of chapter 111 of the General Laws, as amended by section 2, a
738	738	716licensee who has entered into a contract with a management company prior to the effective date
739	739	717of this act shall provide the department of public health with the necessary documentation and
740	740	718materials for a determination by the department of the responsibility and suitability as described
741	741	719in subsection (g) of said section 71 of said chapter 111 of the management company, prior to any
742	742	720issuance of a renewed license; provided, however, that the department shall give a licensee
743	743	721reasonable time to provide the department with the necessary documents and materials if the
744	744	722licensee’s renewal date is within 90 days of the effective date of this act. A licensee’s failure to 35 of 35
745	745	723comply with this section shall subject the licensee to the penalties established in section 73 of
746	746	724said chapter 111, as amended by section 7.
747	747	725 SECTION 17. Pursuant to section 72CC of chapter 111 of the General Laws, as inserted
748	748	726by section 6, each long-term care facility shall submit its outbreak response plan to the
749	749	727department of public health not later than 180 days after the effective date of this act.
750	750	728 SECTION 18. The initial report required by section 72FF of chapter 111 of the General
751	751	729Laws, as inserted by section 6, shall be filed with the clerks of the house of representatives and
752	752	730the senate, the house and senate committees on ways and means and the joint committee on elder
753	753	731affairs not later than 6 months after the effective date of this act.
754	754	732 SECTION 19. Section 11 is hereby repealed.
755	755	733 SECTION 20. Section 19 shall take effect 2 years after the effective date of this act.
756	756	734 SECTION 21. Section 83 of chapter 118E of the General Laws, as inserted by section 9,
757	757	735shall take effect on October 1, 2025.