Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H4193 Compare Versions

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

Old	New	Differences
1	1	FILED ON: 11/15/2023
2	2	HOUSE . . . . . . . . . . . . . . . No. 4193
3	3	House bill No. 4178, as amended and passed to be engrossed by the House. November 15, 2023.
4	4	The Commonwealth of Massachusetts
5	5	_______________
6	6	In the One Hundred and Ninety-Third General Court
7	7	(2023-2024)
8	8	_______________
9	9	An Act to improve quality and oversight of long-term care.
10	10	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
11	11	of the same, as follows:
12	12	1 SECTION 1. Chapter 10 of the General Laws is hereby amended by inserting after
13	13	2section 35SSS the following section:-
14	14	3 SECTION 35TTT. (a) There shall be established and set up on the books of the
15	15	4commonwealth a separate fund known as the Long-Term Care Workforce and Capital Fund. The
16	16	5fund shall be administered by the secretary of health and human services in consultation with the
17	17	6advisory committee established pursuant to subsection (c). The secretary may use amounts
18	18	7credited to the fund to pay for: (i) the administration of the capital loan program pursuant to
19	19	8subsection (e); and (ii) the workforce training programs pursuant to subsection (d), including the:
20	20	9(A) program costs, tuition, books and fees related to the cost of education and training for
21	21	10participants in the programs; (B) costs related to obtaining an applicable license, including, but
22	22	11not limited to, examination and licensing fees; (C) stipends for program participants; and (D)
23	23	12stipends for childcare and transportation for program participants. 1 of 35
24	24	13 (b) The fund shall consist of: (i) any revenues or other financing sources directed to the
25	25	14fund by appropriation; (ii) 50 per cent of any amount recovered by the commonwealth and
26	26	15credited thereto in connection with civil actions brought pursuant to section 72K of chapter 111;
27	27	16(iii) bond revenues or other money authorized by the general court and specifically designated to
28	28	17be credited to the fund; (iv) any income derived from the investment of amounts credited to the
29	29	18fund or repayment of loans from the fund; (v) funds from public or private sources, including,
30	30	19but not limited to, gifts, federal or private grants, donations, rebates and settlements received by
31	31	20the commonwealth that are specifically designated to be credited to the fund; and (vi) all other
32	32	21amounts credited or transferred into the fund from any other source. The executive office of
33	33	22health and human services shall seek to maximize fund revenues through federal money,
34	34	23matching funds and grants. Any unexpended balances in the fund at the end of the fiscal year
35	35	24shall not revert to the General Fund and shall be available for expenditures in subsequent fiscal
36	36	25years. Any fiscal year-end balance in the fund shall be excluded from the calculation of the
37	37	26consolidated net surplus pursuant to section 5C of chapter 29. The fund shall not be subject to
38	38	27appropriation.
39	39	28 (c) There shall be an advisory committee that shall consist of the following members: the
40	40	29assistant secretary for MassHealth, or their designee, who shall serve as chair; the secretary of
41	41	30labor and workforce development, or their designee; the commissioner of public health, or their
42	42	31designee; and 2 persons to be appointed by the governor, 1 of whom shall be a representative of
43	43	32the Massachusetts Senior Care Association, Inc. and 1 of whom shall be a representative of
44	44	33Local 1199 Service Employees International Union. 2 of 35
45	45	34 (d) The secretary of health and human services, in consultation with the advisory
46	46	35committee, shall establish, and the executive office of health and human services shall
47	47	36administer, workforce training grant programs to:
48	48	37 (i) train new certified nurses’ aides to work in licensed long-term care facilities;
49	49	38 (ii) advance the skills of certified nurses’ aides, home health aides, homemakers and
50	50	39other entry-level workers in long-term care facilities to improve quality of care and improve
51	51	40worker access to and participation in a career pathway to become a licensed practical nurse; and
52	52	41 (iii) provide long-term care supervisory and leadership training, which shall consist of
53	53	42evidence-based supervisory training for the purposes of improving staff satisfaction, retaining
54	54	43staff and reducing staff turnover.
55	55	44 (e) The secretary of health and human services, in consultation with the advisory
56	56	45committee, shall establish a no interest or forgivable capital loan program for skilled nursing
57	57	46facilities to:
58	58	47 (i) support the development of specialized care units, including, but not limited to: (A)
59	59	48infectious disease isolation; (B) dementia special care; (C) degenerative neurological units; (D)
60	60	49geriatric psychiatry; (E) traumatic brain injury; (F) in-house dialysis treatment; (G) behavioral
61	61	50health and substance use disorder; and (H) bariatric patient care;
62	62	51 (ii) enable facilities to offset the costs of pay-go capital; and
63	63	52 (iii) support innovative projects, including, but not limited to: (A) converting of sections
64	64	53within skilled nursing facilities into affordable housing, veterans housing or assisted living units
65	65	54to accommodate individual needs of residents; (B) converting multi-bed rooms to single 3 of 35
66	66	55occupancy to enhance privacy and dignity; and (C) establishing voluntary skilled nursing facility
67	67	56reconfigurations, including, but not limited to, providing financial incentives to reduce capacity
68	68	57and balance supply and demand based on regional needs.
69	69	58 (f) Annually, not later than December 1, the secretary of health and human services shall
70	70	59report on the activities of the fund to the clerks of the house of representatives and the senate and
71	71	60to the house and senate committees on ways and means. The report shall include: (i) an
72	72	61accounting of expenditures made from the fund with a description of the authorized purpose of
73	73	62each expenditure; (ii) an accounting of amounts credited to the fund; and (iii) any unexpended
74	74	63balance remaining in the fund.
75	75	64 SECTION 2. Chapter 111 of the General Laws is hereby amended by striking out section
76	76	6571 and inserting in place thereof the following section:-
77	77	66 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the
78	78	67following words shall, unless the context clearly requires otherwise, have the following
79	79	68meanings:
80	80	69 “Applicant”, any person who applies to the department for a license to establish or
81	81	70maintain and operate a long-term care facility.
82	82	71 “Charitable home for the aged”, any institution, however named, conducted for charitable
83	83	72purposes and maintained for the purpose of providing a retirement home for elderly persons and
84	84	73which may provide nursing care within the home for its residents.
85	85	74 “Cohorting”, the practice of grouping patients who: (i) are colonized or infected with the
86	86	75same organism in order to confine their care to 1 area and prevent contact with other patients; or 4 of 35
87	87	76(ii) are not colonized or infected with the same organism in order to confine their care to 1 area
88	88	77and prevent contact with other patients.
89	89	78 “Convalescent or nursing home”, any institution, however named, including a skilled
90	90	79nursing facility, whether conducted for profit or not for profit, which is advertised, announced or
91	91	80maintained for the express or implied purpose of caring for 4 or more persons admitted thereto
92	92	81for the purpose of nursing or convalescent care.
93	93	82 “Correct by date”, the date by which a licensee shall remedy or correct any violation
94	94	83discovered after an inspection by the department pursuant to section 72E.
95	95	84 “Endemic level”, the usual level of a given disease in a geographic area.
96	96	85 “Intermediate care facility for persons with an intellectual disability”, any institution,
97	97	86however named, that: (i) is conducted for charity or not for profit; (ii) is advertised, announced or
98	98	87maintained for the purpose of providing rehabilitative services and active treatment to persons
99	99	88with an intellectual disability or persons with related conditions, as defined in regulations
100	100	89promulgated pursuant to Title XIX of the federal Social Security Act, Public Law 89-97; (iii) is
101	101	90not both owned and operated by a state agency; and (iv) makes application to the department for
102	102	91a license for the purpose of participating in the federal program established by said Title XIX.
103	103	92 “Isolating”, the process of separating persons colonized or infected with a communicable
104	104	93disease from those who are not colonized or infected with a communicable disease.
105	105	94 “License”, an initial or renewal license issued by the department and which permits the
106	106	95licensee to establish or maintain and operate a long-term care facility. 5 of 35
107	107	96 “Licensee”, a person permitted to establish or maintain and operate a long-term care
108	108	97facility through a license.
109	109	98 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home,
110	110	99skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest
111	111	100home.
112	112	101 “Long-term care services”, include: (i) long-term resident, nursing, convalescent or
113	113	102rehabilitative care; (ii) supervision and care incident to old age for ambulatory persons; or (iii)
114	114	103retirement home care for elderly persons.
115	115	104 “Management company”, an organization engaged by a licensee to manage the operations
116	116	105at a long-term care facility.
117	117	106 “Outbreak”, any unusual occurrence of disease or any disease above endemic levels.
118	118	107 “Owner”, any person with an ownership interest of not less than 5 per cent, or with a
119	119	108controlling interest in an applicant, licensee, potential transferee or the real property on which a
120	120	109long-term care facility is located.
121	121	110 “Person”, an individual, trust, partnership, association, corporation or other form of
122	122	111business association.
123	123	112 “Potential transferee”, a person who submits to the department a notice of intent to
124	124	113acquire the facility operations of a currently operating long-term care facility.
125	125	114 “Religious and recreational activities”, any religious, social or recreational activity that is
126	126	115consistent with the resident’s preferences and choosing, regardless of whether the activity is
127	127	116coordinated, offered, provided or sponsored by facility staff or by an outside activities provider. 6 of 35
128	128	117 “Resident”, an individual who resides in a long-term care facility.
129	129	118 “Rest home”, any institution, however named, which is advertised, announced or
130	130	119maintained for the express or implied purpose of providing care incident to old age to 4 or more
131	131	120persons who are ambulatory and who do not require a specific level of nursing care or other
132	132	121medically related services on a routine basis.
133	133	122 “Skilled nursing facility”, any institution, however named, whether conducted for profit
134	134	123or not for profit, which is certified by the federal Centers for Medicare and Medicaid Services for
135	135	124the purpose of providing continuous skilled nursing care and rehabilitative services for 4 or more
136	136	125persons.
137	137	126 “Small house nursing home”, 1 or more units of a convalescent or nursing home designed
138	138	127and modeled as a residential home including a central living space, kitchen, dining area, living
139	139	128area and outdoor space.
140	140	129 “Transfer of facility operations”, a transfer of the operations of a long-term care facility
141	141	130from a licensee to a potential transferee.
142	142	131 (b)(1) The department shall issue for a term of 2 years, and shall renew for like terms, a
143	143	132license, subject to the restrictions in this section, to each applicant the department deems
144	144	133responsible and suitable to establish or maintain and operate a long-term care facility and which
145	145	134meets all other requirements for long-term care facility licensure pursuant to this chapter. A
146	146	135license issued pursuant to this section shall not be transferable or assignable and shall be issued
147	147	136only for the premises named in the application. 7 of 35
148	148	137 (2) Each long-term care facility shall be subject to not less than 1 periodic, resident-
149	149	138centered inspection per year for the purpose of gathering information about the quality of
150	150	139services furnished in the long-term care facility to determine compliance with applicable state
151	151	140and federal requirements.
152	152	141 (3) The department may, when public necessity and convenience require, or to prevent
153	153	142undue hardship to an applicant or licensee, pursuant to such rules and regulations as it may
154	154	143adopt, grant a temporary provisional or probationary license pursuant to this section; provided,
155	155	144however, that no such license shall be for a term exceeding 1 year.
156	156	145 (4) The fee for a license to establish or maintain and operate a long-term care facility
157	157	146shall be determined annually by the secretary of administration and finance pursuant to section
158	158	1473B of chapter 7.
159	159	148 (c) The department shall not issue a license to establish or maintain an intermediate care
160	160	149facility for persons with an intellectual disability unless the department determines that there is a
161	161	150need for such a facility at the designated location; provided, however, that in the case of a facility
162	162	151previously licensed as an intermediate care facility for persons with an intellectual disability in
163	163	152which there is a change in ownership or transfer of operations, no such determination shall be
164	164	153required; and provided further, that in the case of a facility previously licensed as an intermediate
165	165	154care facility for persons with an intellectual disability in which there is a change in location, such
166	166	155determination shall be limited to consideration of the suitability of the new location.
167	167	156 (d)(1) In the case of the transfer of facility operations of a long-term care facility, a
168	168	157potential transferee shall submit a notice of intent to acquire to the department not less than 90
169	169	158days prior to the proposed transfer date. The notice of intent to acquire shall be on a form 8 of 35
170	170	159supplied by the department and shall be deemed complete upon submission of all information the
171	171	160department requires on said form. The potential transferee shall be deemed responsible and
172	172	161suitable upon the expiration of the 90-day period, or upon the expiration of said period as
173	173	162extended, if the department fails to notify said potential transferee in writing of its decision
174	174	163within the 90-day period or within the expiration of the extension period, whichever is
175	175	164applicable.
176	176	165 (2) A potential transferee shall, concurrently with the submission of an intent to acquire,
177	177	166provide notice to the current staff of the facility, and to any labor organization that represents the
178	178	167facility’s staff at the time the notice of intent to acquire is submitted, of the potential transferee’s
179	179	168plans to retain or not retain the facility staff and to recognize and bargain with any labor
180	180	169organizations currently representing the facility staff.
181	181	170 (3) Upon determination by the department that a potential transferee is responsible and
182	182	171suitable for licensure, the potential transferee may file an application for a license. In the case of
183	183	172a potential transfer of facility operations, the filing of an application for a license shall have the
184	184	173effect of a temporary provisional or probationary license until the department takes final action
185	185	174on such application.
186	186	175 (4) Upon an approved transfer of facility operations, the department shall not reduce the
187	187	176number of beds it originally approved in granting a license, unless a reduction in the number of
188	188	177beds is in the interest of public health, welfare or safety.
189	189	178 (e) Every applicant for a license shall provide on or with its application, and every
190	190	179potential transferee shall provide on or with its notice of intent to acquire, a sworn statement of
191	191	180the names and addresses of any owner of the applicant or the potential transferee. 9 of 35
192	192	181 (f) No license shall be issued to an applicant or potential transferee prior to a
193	193	182determination by the department that the applicant or potential transferee is responsible and
194	194	183suitable pursuant to subsection (g).
195	195	184 (g) For the purposes of this section, the department’s determination of responsibility and
196	196	185suitability shall include, but shall not be limited to, the following factors:
197	197	186 (1) the criminal history of the applicant or the potential transferee, including its respective
198	198	187owners and management companies, and, to the extent possible, the civil litigation history of the
199	199	188applicant or potential transferee, including its respective owners and contracted management
200	200	189companies, including litigation related to the operation of a long-term care facility, such as
201	201	190quality of care, safety of residents or staff, employment and labor issues, fraud, unfair or
202	202	191deceptive business practices and landlord-tenant issues; provided, that such criminal and civil
203	203	192litigation history may include pending or other court proceedings in the commonwealth and in
204	204	193any other state or federal jurisdiction. Any information related to criminal or civil litigation
205	205	194obtained by the department pursuant to this section shall be confidential and exempt from
206	206	195disclosure under clause Twenty-sixth of section 7 of chapter 4 and chapter 66;
207	207	196 (2) the financial capacity of the applicant or potential transferee, including its respective
208	208	197owners and management companies, to establish or maintain and operate a long-term care
209	209	198facility; provided, that financial capacity may include, but shall not be limited to, recorded liens
210	210	199or unpaid fees or taxes in the commonwealth or in other states;
211	211	200 (3) the history of the applicant or potential transferee, including its respective owners and
212	212	201management companies, in providing quality long-term care in the commonwealth as measured 10 of 35
213	213	202by compliance with applicable quality measures, statutes and regulations governing the operation
214	214	203of long-term care facilities; and
215	215	204 (4) the history of the applicant or potential transferee, including its respective owners and
216	216	205management companies, in providing quality long-term care in states other than the
217	217	206commonwealth, if any, as measured by compliance with the applicable quality measures, statutes
218	218	207and regulations governing the operation of long-term care facilities in said states.
219	219	208 (h)(1) If the department determines that an applicant or potential transferee is not
220	220	209responsible and suitable, the department’s determination shall take effect on the date of the
221	221	210department’s notice to the applicant or potential transferee. In such cases and upon the filing of a
222	222	211written request, the department shall afford the applicant or potential transferee an adjudicatory
223	223	212hearing pursuant to chapter 30A.
224	224	213 (2) During the pendency of an adjudicatory hearing, the applicant or potential transferee
225	225	214shall not operate the facility as a licensee, nor, without prior approval of the department, manage
226	226	215such facility.
227	227	216 (i) Each applicant, potential transferee and licensee shall maintain current records of all
228	228	217information provided to the department. After the applicant, potential transferee or licensee
229	229	218becomes aware of any change related to information it has provided or is required to provide to
230	230	219the department, such person shall submit to the department written notice of the change as soon
231	231	220as practicable and without unreasonable delay; provided, that any change in financial status shall
232	232	221be provided to the department and shall include, but shall not be limited to, filing for bankruptcy,
233	233	222any default under a lending agreement or under a lease, the appointment of a receiver or the 11 of 35
234	234	223recording of any lien. Failure to provide timely notice of such change shall be subject to the
235	235	224remedies or sanctions available to the department pursuant to this chapter.
236	236	225 (j) An applicant, potential transferee or licensee and its respective owners and
237	237	226management companies shall comply with all applicable federal, state and local laws, rules and
238	238	227regulations.
239	239	228 (k)(1) Prior to entering into a contract with a management company, an applicant,
240	240	229potential transferee or licensee shall notify and receive a determination from the department that
241	241	230the management company is responsible and suitable to manage a long-term care facility.
242	242	231 (2) In its notification to the department and to inform the department’s review, the
243	243	232applicant, potential transferee or licensee shall provide the proposed management company’s
244	244	233name, contact information and any other information on the proposed management company and
245	245	234its personnel that may be reasonably requested by the department, including, but not limited to,
246	246	235information required pursuant to subsection (g). Upon a determination by the department that the
247	247	236proposed management company is responsible and suitable to manage a long-term care facility,
248	248	237the applicant, potential transferee or licensee may engage said company to manage the long-term
249	249	238care facility.
250	250	239 (3) The applicant, potential transferee or licensee shall memorialize any such engagement
251	251	240in a written agreement with the management company. Such written agreement shall include a
252	252	241requirement that the management company and its personnel comply with all applicable federal,
253	253	242state and local laws, regulations and rules. Promptly after the effective date of any such
254	254	243agreement, the applicant, potential transferee or licensee shall provide to the department a copy
255	255	244of the valid, fully executed agreement. Any payment terms included in the agreement shall be 12 of 35
256	256	245confidential and exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 and
257	257	246chapter 66.
258	258	247 (4) If the department determines that a management company is not responsible and
259	259	248suitable, the department’s determination shall take effect on the date of the department’s notice
260	260	249to the applicant, potential transferee or licensee. In such cases and upon the filing of a written
261	261	250request, the department shall afford the applicant, potential transferee, licensee or management
262	262	251company an adjudicatory hearing pursuant to chapter 30A.
263	263	252 (l) The department shall not reduce the number of beds it originally approved in granting
264	264	253a license for a convalescent or nursing home or rest home upon the transfer of facility operations
265	265	254of said convalescent or nursing home or rest home from 1 licensee to another, unless a reduction
266	266	255in the number of beds is in the interest of public health, welfare or safety.
267	267	256 (m)(1) The department shall not issue a license unless the applicant first submits to the
268	268	257department, with respect to each building occupied by residents: (i) a certificate of inspection of
269	269	258the egresses, the means of preventing the spread of fire and apparatus for extinguishing fire,
270	270	259issued by an inspector of the office of public safety and inspections within the division of
271	271	260professional licensure; and (ii) a certificate of inspection issued by the head of the local fire
272	272	261department certifying compliance with local ordinances; provided, however, that for
273	273	262convalescent or nursing homes, the division of health care quality within the department shall
274	274	263have sole authority to inspect and issue a certificate required pursuant to clause (i) of this
275	275	264paragraph.
276	276	265 (2) Any applicant who is aggrieved, on the basis of a written disapproval of a certificate
277	277	266of inspection by the head of the local fire department or by the office of public safety and 13 of 35
278	278	267inspections of the division of professional licensure, may, within 30 days from such disapproval,
279	279	268appeal in writing to the division of professional licensure. Failure to either approve or disapprove
280	280	269within 30 days after a written request by an applicant shall be deemed a disapproval. With
281	281	270respect to certificates of inspection issued to convalescent or nursing homes by the division of
282	282	271health care quality within the department, an applicant may, within 30 days from disapproval of
283	283	272a certificate of inspection, appeal in writing to the department. Failure to either approve or
284	284	273disapprove within 30 days after a written request by an applicant shall be deemed a disapproval.
285	285	274 (3) If the division of professional licensure or, where applicable, the department approves
286	286	275the issuance of a certificate of inspection after an appeal, the certificate shall be issued by the
287	287	276issuing agency. If the division of professional licensure or, where applicable, the department
288	288	277does not approve the issuance of a certificate of inspection, the applicant may appeal to the
289	289	278superior court. Failure of said division or said department to either approve or disapprove the
290	290	279issuance of a certificate of inspection within 30 days after receipt of an appeal shall be deemed a
291	291	280disapproval. The department shall not issue a license until issuance of an approved certificate of
292	292	281inspection, as required pursuant to paragraph (1).
293	293	282 (4) Nothing in this section or in sections 72 or 73 shall be construed to supersede or
294	294	283otherwise affect any laws, ordinances, by-laws, rules or regulations relating to building, zoning,
295	295	284registration or maintenance of a long-term care facility.
296	296	285 (n)(1) For cause, the department may limit, restrict, suspend or revoke a license.
297	297	286 (2) Grounds for cause on which the department may take action pursuant to paragraph (1)
298	298	287shall include: (i) substantial or sustained failure or inability to provide adequate care to residents;
299	299	288(ii) substantial or sustained failure to maintain compliance with applicable statutes, rules and 14 of 35
300	300	289regulations; or (iii) the lack of financial capacity to maintain and operate a long-term care
301	301	290facility.
302	302	291 (3) The limits or restrictions the department may impose on a licensee include requiring a
303	303	292facility to limit new admissions.
304	304	293 (4) Suspension of a license may include suspending the license during a pending license
305	305	294revocation action or suspending the license to permit the licensee a period of time, not less than
306	306	29560 days, to terminate operations, and discharge and transfer all residents, if applicable.
307	307	296 (5) With respect to an order by the department to limit, restrict or suspend a license,
308	308	297within 7 days of receipt of the written order, the licensee may file a written request with the
309	309	298department for an adjudicatory proceeding pursuant to chapter 30A.
310	310	299 (6) Upon a written request by a licensee who is aggrieved by the revocation or limitation
311	311	300of a license or by an applicant who is aggrieved by the refusal of the department to renew a
312	312	301license, the licensee or applicant so aggrieved shall have all the rights provided in chapter 30A
313	313	302with respect to adjudicatory proceedings. In no case shall the revocation of such a license take
314	314	303effect in less than 30 days after written notification by the department to the licensee.
315	315	304 (o) In the case of the new construction of, or major addition, alteration or repair to, any
316	316	305long-term care facility, preliminary and final architectural plans and specifications shall be
317	317	306submitted to a qualified person designated by the commissioner. Written approval of the final
318	318	307architectural plans and specifications shall be obtained from said person prior to said new
319	319	308construction or major addition, alteration or repair. 15 of 35
320	320	309 (p) Notwithstanding any of the other provisions of this section, the department shall not
321	321	310issue a license to establish or maintain and operate a long-term care facility to an applicant who
322	322	311applies to the department for said license to establish or maintain and operate a convalescent or
323	323	312nursing home unless the applicant for such license submits to the department a certificate that
324	324	313each building to be occupied by residents of such convalescent or nursing home meets the
325	325	314construction standards of the state building code, and is of at least type 1–B fireproof
326	326	315construction; provided, however, that this subsection shall not apply in the instance of a transfer
327	327	316of facility operations of a convalescent or nursing home whose license has not been revoked as
328	328	317of the time of such transfer; and provided, further, that a public medical institution as defined in
329	329	318section 8 of chapter 118E, which meets the construction standards as defined herein, shall not be
330	330	319denied a license as a long-term care facility pursuant to this section because it was not of new
331	331	320construction and designed for the purpose of operating a long-term care facility at the time of
332	332	321application for a license to operate a long-term care facility. An intermediate care facility for
333	333	322persons with an intellectual disability shall be required to meet the construction standards
334	334	323established for such facilities by Title XIX of the Social Security Act, Public Law 89-97 and any
335	335	324regulations promulgated pursuant thereto, and by regulations promulgated by the department.
336	336	325 (q) The department shall notify the secretary of elder affairs of the pendency of any
337	337	326proceeding, public hearing or action to be taken pursuant to this section relating to any
338	338	327convalescent or nursing home, rest home or charitable home for the aged. The department shall
339	339	328notify the commissioner of the department of developmental services of the pendency of any
340	340	329proceeding, public hearing or action to be taken pursuant to this section relating to any
341	341	330intermediate care facility for persons with an intellectual disability. 16 of 35
342	342	331 SECTION 3. Said chapter 111 is hereby further amended by striking out section 72 and
343	343	332inserting in place thereof the following section:-
344	344	333 Section 72. (a)(1) The department shall classify long-term care facilities and shall, after a
345	345	334public hearing, promulgate rules and regulations for the conduct of such facilities. Rules and
346	346	335regulations for long-term care facilities shall include, but not be limited to, minimum
347	347	336requirements for medical and nursing care, the keeping of proper medical and nursing records,
348	348	337uniform requirements for the handling of patient funds, minimum requirements relative to the
349	349	338prevention and reparation of lost or damaged patient possessions, including personal clothing
350	350	339and minimum requirements relative to facility sanitation.
351	351	340 (2) Regulations for intermediate care facilities for persons with an intellectual disability
352	352	341shall, in addition to the requirements pursuant to paragraph (1), include minimum requirements
353	353	342for social services, psychological services and other services appropriate for the care of persons
354	354	343with an intellectual disability and shall limit the size of such facilities to not more than 15 beds.
355	355	344 (3) The department in promulgating rules and regulations for long-term care facilities
356	356	345shall consider the ability of long-term care facilities to provide service under rates set pursuant to
357	357	346section 13C of chapter 118E. No such rule or regulation shall apply to a long-term care facility
358	358	347licensed at the time of promulgation of such rule or regulation, or a long-term care facility being
359	359	348constructed at the time of such promulgation under plans approved by the department, unless
360	360	349such rule or regulation has a direct and material relation to patient diet, cleanliness, nursing care
361	361	350or health, or to habilitative services and active treatment for persons with an intellectual
362	362	351disability or persons with related conditions; provided, however, that nothing herein contained 17 of 35
363	363	352shall be interpreted to prevent the department from adopting or interpreting rules and regulations
364	364	353more favorable toward existing long-term care facilities.
365	365	354 (b)(1) The department or its agents and the board of health or its agents of the city or
366	366	355town wherein any portion of such long-term care facility is located may visit and inspect such
367	367	356institution at any time; provided, that a board of health or its agents conducting an inspection of a
368	368	357long-term care facility located within its city or town shall notify the department of the results of
369	369	358any inspection conducted pursuant to this paragraph.
370	370	359 (2) Any person making an inspection pursuant to paragraph (1) shall record in writing
371	371	360every violation of the applicable rules and regulations of the department that they discover
372	372	361during the course of their inspection. Every record of inspection shall be treated as a public
373	373	362record except to such extent the record or a portion thereof is expressly exempt from such
374	374	363treatment pursuant to clause Twenty-sixth of section 7 of chapter 4. A record of inspection
375	375	364containing violations shall be made public by the department at the same time that a written plan
376	376	365of correction is submitted. If a written plan of correction is not submitted within the allowable
377	377	366time, said violations shall be made public at the expiration of the allowable time. Inspections
378	378	367hereunder shall be unannounced and made at such intervals as the department shall specify in its
379	379	368rules and regulations; provided, that, each long-term care facility shall be subject to not less than
380	380	3691 periodic, resident-centered inspection per year pursuant to subsection (b) of section 71. A visit
381	381	370made to a facility for the purpose of providing consultation shall not be considered to be an
382	382	371inspection.
383	383	372 (c) The superior court shall have jurisdiction in equity to enforce the rules and regulations
384	384	373promulgated pursuant to this section. 18 of 35
385	385	374 (d)(1) The department shall promulgate regulations for the operation of small house
386	386	375nursing homes. Newly constructed small house nursing homes shall house no more than 14
387	387	376individuals per unit, in resident rooms that accommodate not more than 1 resident per room;
388	388	377provided, however, that if a resident requests to share a room with another resident to
389	389	378accommodate a spouse, partner, family member or friend, such resident room shall have
390	390	379sufficient space and equipment, as established by the department, for 2 residents; provided,
391	391	380further, that determinations to grant such requests shall be determined based on space and
392	392	381availability of rooms. All resident rooms shall contain a full private and accessible bathroom.
393	393	382 (2) The department shall promulgate regulations for construction and physical plant
394	394	383standards for small house nursing homes that shall consider environmental standards and
395	395	384sustainability.
396	396	385 (3) The department may promulgate regulations for small house nursing homes for a
397	397	386staffing model that: (i) allows for a universal worker approach to resident care that is organized
398	398	387to support and empower all staff to respond to the needs and desires of residents, including, but
399	399	388not limited to, cooking and meal preparation, without exceeding the lawful scope of practice of
400	400	389said employee; and (ii) provides for consistent staff in each small house nursing home.
401	401	390 (4) The regulations promulgated pursuant to this subsection shall ensure the convalescent
402	402	391or nursing home meets the requirements necessary to be eligible to participate in both the
403	403	392Medicare and Medicaid programs.
404	404	393 SECTION 4. Said chapter 111 is hereby further amended by striking out section 72E and
405	405	394inserting in place thereof the following section:- 19 of 35
406	406	395 Section 72E. (a) The department shall, after every inspection by its agent pursuant to
407	407	396section 72, provide the licensee of the inspected long-term care facility notice in writing of every
408	408	397violation of the applicable statutes, rules and regulations found during said inspection. With
409	409	398respect to the date by which the licensee shall remedy or correct each violation, the department
410	410	399in such notice shall specify a reasonable time, not more than 60 days after receipt, by which time
411	411	400the licensee shall remedy or correct each violation cited or, in the case of any violation which in
412	412	401the opinion of the department is not reasonably capable of correction within 60 days, the
413	413	402department shall require only that the licensee submit a written plan for the timely correction of
414	414	403the violation in a reasonable manner. The department may modify any nonconforming plan upon
415	415	404notice, in writing, to the licensee.
416	416	405 (b) Failure to remedy or correct a cited violation by the correct by date shall be cause to
417	417	406pursue or impose the remedies or sanctions available to the department pursuant to this chapter,
418	418	407unless the licensee demonstrates to the satisfaction of the department or a court, where
419	419	408applicable, that such failure was not due to any neglect of its duty and occurred despite an
420	420	409attempt in good faith to make correction by the correct by date. An aggrieved licensee may
421	421	410pursue the remedies available to it pursuant to chapter 30A.
422	422	411 (c) If the department determines the licensee failed to maintain substantial or sustained
423	423	412compliance with applicable state and federal laws, rules and regulations, in addition to imposing
424	424	413any of the other remedies or sanctions available to it, the department may require the licensee to
425	425	414engage, at the licensee’s own expense, a temporary manager to assist the licensee with bringing
426	426	415the facility into substantial compliance and with sustaining such compliance. Such temporary
427	427	416manager shall be subject to the department’s approval; provided, that such approval shall not be
428	428	417unreasonably withheld. Any such engagement of a temporary manager shall be for a period of 20 of 35
429	429	418not less than 3 months and shall be pursuant to a written agreement between the licensee and the
430	430	419management company. A copy of said agreement shall be provided by the licensee to the
431	431	420department promptly after execution. Any payment terms included in the agreement shall be
432	432	421confidential and exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter
433	433	4224 and chapter 66.
434	434	423 (d) Nothing in this section shall be construed to prohibit the department from enforcing a
435	435	424statute, rule or regulation, administratively or in court, without first affording formal opportunity
436	436	425to make correction pursuant to this section, where, in the opinion of the department, the violation
437	437	426of such statute, rule or regulation jeopardizes the health or safety of residents or the public or
438	438	427seriously limits the capacity of a licensee to provide adequate care, or where the violation of such
439	439	428statute, rule or regulation is the second such violation occurring during a period of 12 full
440	440	429months.
441	441	430 SECTION 5. Section 72K of said chapter 111, as appearing in the 2022 Official Edition,
442	442	431is hereby amended by striking out subsection (b) and inserting in place thereof the following 2
443	443	432subsections:-
444	444	433 (b) The attorney general may file a civil action against a person who: (i) commits abuse,
445	445	434mistreatment or neglect of a patient or resident; (ii) misappropriates patient or resident property;
446	446	435or (iii) wantonly or recklessly permits or causes another to commit abuse, mistreatment or
447	447	436neglect of a patient or resident or misappropriate patient or resident property. The civil penalty
448	448	437for such abuse, mistreatment, neglect or misappropriation shall not exceed: $25,000 if no bodily
449	449	438injury results; $50,000 if bodily injury results; $100,000 if sexual assault or serious bodily injury
450	450	439results; and $250,000 if death results. Section 60B of chapter 231 shall not apply to an action 21 of 35
451	451	440brought by the attorney general pursuant to this section. Nothing in this section shall preclude the
452	452	441filing of any action brought by the attorney general or a private party pursuant to chapter 93A or
453	453	442any action by the department pursuant to this chapter. The comptroller shall deposit not less than
454	454	44350 per cent of any amount secured by the attorney general as a result of a civil action brought
455	455	444pursuant to this section into the Long-Term Care Workforce and Capital Fund established in
456	456	445section 35TTT of chapter 10.
457	457	446 (c) Notwithstanding section 5 of chapter 260, the attorney general may file a civil action
458	458	447within 4 years next after an offense is committed.
459	459	448 SECTION 5A. Said chapter 111 is hereby further amended by inserting after section
460	460	44972W, the following section:-
461	461	450 Section 72W½. (a) For the purposes of this section the following words shall, unless the
462	462	451context clearly requires otherwise, have the following meanings:
463	463	452 “Certified medication aide,” an employee of a long-term care facility that satisfies
464	464	453eligibility criteria established by the department and that has successfully completed the required
465	465	454training and competency testing developed by the department to administer medications to
466	466	455residents of long-term care facilities.
467	467	456 “Medication”, any non-narcotic, prescription or non-prescription drug that may be
468	468	457administered via oral, sublingual, buccal, inhalation, spray on oral mucosa, topical, nasal, ocular,
469	469	458or otic route.
470	470	459 (b) The department shall create a program for the certification, training and oversight of
471	471	460certified medication aides who shall be authorized to administer medications to residents of long- 22 of 35
472	472	461term care facilities. Certified medication aides shall be supervised by a licensed practical nurse, a
473	473	462licensed registered nurse, a licensed advanced practice registered nurse or a licensed physician,
474	474	463and shall be evaluated by their supervisor regularly, but not less than once every 6 months.
475	475	464 (c) The department, in consultation with the board of registration in nursing, shall
476	476	465develop and approve training curricula, competency evaluation procedures and standards for
477	477	466qualifications of applicants for certification; provided, that such standards shall include the
478	478	467completion of not less than 60 hours of training on the proper administration of medication.
479	479	468 (d) The department shall establish regulations that include (i) provisions for continuing
480	480	469education requirements, (ii) requirements for re-certification on a biennial basis, and (iii) fees for
481	481	470the issuance of certifications.
482	482	471 (e) The department shall allow for the creation of apprenticeship programs for resident
483	483	472care assistants and certified nurses’ aides to become certified medication aides.
484	484	473 (f) Nothing in this section shall be construed to authorize certified medication aides to
485	485	474engage in prescriptive practice.
486	486	475 (g) The department shall promulgate rules and regulations to carry out the provisions of
487	487	476this section.
488	488	477 SECTION 6. Said chapter 111 is hereby further amended by inserting after section 72BB
489	489	478the following 4 sections:-
490	490	479 Section 72CC. (a) The department shall require long-term care facilities to develop an
491	491	480outbreak response plan which shall be customized to the long-term care facility. Each long-term
492	492	481care facility’s plan shall include, but shall not be limited to: 23 of 35
493	493	482 (1) a protocol for isolating and cohorting infected and at-risk patients in the event of an
494	494	483outbreak of a contagious disease until the cessation of the outbreak;
495	495	484 (2) clear policies for the notification of residents, residents’ families, visitors and staff in
496	496	485the event of an outbreak of a contagious disease at a long-term care facility;
497	497	486 (3) information on the availability of laboratory testing, protocols for screening visitors
498	498	487and staff for the presence of a communicable disease, protocols to require infected staff to not
499	499	488present at the long-term care facility for work duties and processes for implementing evidence-
500	500	489based outbreak response measures;
501	501	490 (4) policies to conduct routine monitoring of residents and staff to quickly identify signs
502	502	491of a communicable disease that could develop into an outbreak;
503	503	492 (5) policies for reporting outbreaks to public health officials, including the chief
504	504	493executive officer or the chief administrative officer of the municipality in which the facility is
505	505	494located, in accordance with applicable laws and regulations; and
506	506	495 (6) policies to meet staffing, training and long-term care facility demands during an
507	507	496infectious disease outbreak and to successfully implement the outbreak response plan.
508	508	497 (b) The department shall verify that the outbreak response plans submitted by long-term
509	509	498care facilities are in compliance with the requirements of subsection (a).
510	510	499 (c)(1) Every long-term care facility shall review the outbreak response plan it submitted
511	511	500to the department pursuant to subsection (a) on an annual basis.
512	512	501 (2) If a long-term care facility makes any material changes to its outbreak response plan,
513	513	502the facility shall submit to the department an updated outbreak response plan within 30 days. The 24 of 35
514	514	503department shall, upon receiving an updated outbreak response plan, verify that the plan is in
515	515	504compliance with the requirements of subsection (a).
516	516	505 (d) The department shall promulgate regulations necessary to implement this section.
517	517	506 Section 72DD. (a) The division of health care facility licensure and certification shall
518	518	507establish and implement a process and program for providing training and education to staff of
519	519	508long-term care facilities licensed by the department pursuant to section 71. The training and
520	520	509education program may include, but shall not be limited to: (i) infection prevention and control;
521	521	510(ii) development, implementation, adherence and review of comprehensive resident care plans;
522	522	511(iii) falls prevention; (iv) procedures to ensure timely notification of changes in a resident’s
523	523	512condition to the resident’s primary care physician; (v) prevention of abuse and neglect; (vi)
524	524	513development and implementation of a program to ensure staff safety; and (vii) review of the
525	525	514inspection process established in section 72.
526	526	515 (b) The training and education program shall be interactive and shall include, but shall
527	527	516not be limited to: (i) an annual training for long-term care facility supervisory and leadership
528	528	517staff on the licensure and certification process, including, but not limited to, the department’s
529	529	518interpretation of the general laws and relevant changes or additions to applicable rules,
530	530	519regulations, procedures and policies concerning the licensure and certification process for long-
531	531	520term care facilities; and a (ii) biannual training of staff of long-term care facilities on the most
532	532	521frequently cited deficiencies, identified deficiency trends, both state and federal, and best
533	533	522practices to ensure resident quality of care.
534	534	523 (c) The department may consult with industry trade associations before issuing or
535	535	524promulgating guidance, regulations, interpretations, program letters, memoranda or any other 25 of 35
536	536	525materials used in inspector training for the inspection of long-term care facilities pursuant to
537	537	526section 72.
538	538	527 Section 72EE. (a) The department shall promulgate regulations to encourage and enable
539	539	528residents of a long-term care facility to engage in in-person, face-to-face, verbal or auditory-
540	540	529based contact, communications and religious and recreational activities with others to the extent
541	541	530that in-person contact, communication or activities are not prohibited, restricted or limited by
542	542	531federal or state statute, rule or regulation. Said regulations shall include specific protocols and
543	543	532procedures to provide for residents of the facility who have disabilities that impede their ability
544	544	533to communicate, including, but not limited to, residents who are blind, deaf, have Alzheimer’s
545	545	534disease or other dementias and developmental disabilities.
546	546	535 (b) The department may distribute federal civil monetary penalty funds, subject to
547	547	536approval by the federal Centers for Medicare and Medicaid Services, and any other available
548	548	537federal and state funds, upon request, to facilities for communicative technologies and
549	549	538accessories pursuant to this section.
550	550	539 Section 72FF. (a) The department, in consultation with the center for health information
551	551	540and analysis, the division of medical assistance, the executive office of elder affairs and the
552	552	541health policy commission, shall annually conduct an examination and report on cost trends and
553	553	542financial performance among skilled nursing facilities. The information shall be analyzed on an
554	554	543institution-specific and industry-wide basis. The examination shall aggregate information
555	555	544collected on multiple skilled nursing facilities that are owned and operated by a single owner.
556	556	545 (b) The examination and report shall include, but shall not be limited to collection and
557	557	546analysis of: (i) gross and net patient service revenues; (ii) other sources of operating and non- 26 of 35
558	558	547operating revenue; (iii) trends in relative price, payer mix, case mix, utilization and length of
559	559	548stay; (iv) affiliations with other health care providers, including, but not limited to, preferred
560	560	549clinical relationships and partnerships; (v) categories of costs, including, but not limited to,
561	561	550general and administrative costs, nursing and other labor costs and salaries, building costs,
562	562	551capital costs and other operating costs; (vi) total spending on direct patient care as a percent of
563	563	552total operating expenses; (vii) operating and total margin; (viii) occupancy rates and total
564	564	553resident population; and (ix) any other relevant measures of financial performance and service
565	565	554delivery the department deems necessary; provided, that these measures shall distinguish long-
566	566	555term residents from short-stay residents where possible.
567	567	556 (c) Annually, not later than December 1, the report and any policy recommendations shall
568	568	557be filed with the clerks of the house of representatives and the senate, the house and senate
569	569	558committees on ways and means and the joint committee on elder affairs.
570	570	559 (d) The department shall utilize ownership information submitted as part of the long-term
571	571	560care facility licensure determination process pursuant to section 71 to determine affiliations
572	572	561between skilled nursing facilities and other health care providers as required.
573	573	562 SECTION 7. Said chapter 111 is hereby further amended by striking out section 73 and
574	574	563inserting in place thereof the following section:-
575	575	564 Section 73. (a) Whoever advertises, announces, establishes or maintains, or is concerned
576	576	565in establishing or maintaining, a long-term care facility, or otherwise is engaged in any such
577	577	566business without a license granted pursuant to section 71, or whoever being licensed pursuant to
578	578	567said section 71 violates any provision of sections 71 to 73, inclusive, shall for a first offense be 27 of 35
579	579	568punished by a fine of not more than $1,000, and for a subsequent offense by a fine of not more
580	580	569than $2,000 or by imprisonment for not more than 2 years.
581	581	570 (b) Whoever violates any rule or regulation promulgated pursuant to sections 71, 72 and
582	582	57172C shall be punished by a fine, not to exceed $500. If any person violates any such rule or
583	583	572regulation by allowing a condition to exist which may be corrected or remedied, the department
584	584	573shall order such person, in writing, to correct or remedy such condition. If such person fails or
585	585	574refuses to comply with such order by the correct by date, each day after the correct by date
586	586	575during which such failure or refusal to comply continues shall constitute a separate offense. A
587	587	576failure to pay the fine imposed by this section shall be a violation of this subsection.
588	588	577 SECTION 8. Section 25 of chapter 118E of the General Laws, as appearing in the 2022
589	589	578Official Edition, is hereby amended by inserting after the word “provided.”, in line 61, the
590	590	579following 2 sentences:- In the case of an incompetent applicant or member that requires long-
591	591	580term care services, the division shall authorize a deduction from the applicant or member’s
592	592	581income for guardianship fees and related expenses when the appointment of a guardian is
593	593	582essential to enable an incompetent applicant or member to gain access or consent to medical
594	594	583treatment. The division shall authorize a deduction for the reasonable costs, as approved by the
595	595	584probate and family court, associated with: (i) the appointment of a guardian; (ii) the guardian’s
596	596	585services during the application process; and (iii) the guardian’s services during the
597	597	586redetermination process; provided, however, that said deduction shall not exceed, in any case,
598	598	587$1,500.
599	599	588 SECTION 9. Said chapter 118E is hereby further amended by adding the following 2
600	600	589sections:- 28 of 35
601	601	590 Section 83. To establish Medicaid rates for skilled nursing facilities licensed pursuant to
602	602	591section 71 of chapter 111, the division of medical assistance shall use as base year costs for rate
603	603	592determination purposes the reported costs of the calendar year not more than 2 years prior to the
604	604	593current rate year.
605	605	594 Section 84. (a) The division of medical assistance shall establish a skilled nursing facility
606	606	595rate add-on program for bariatric patient care and a rate add-on program for 1-on-1 staffing of at-
607	607	596risk residents requiring 24-hour monitoring and supervision for their safety and the safety of
608	608	597other residents and staff. The division of medical assistance shall identify at-risk resident
609	609	598populations to include in the rate add-on program for 1-on-1 staffing which shall include, but not
610	610	599be limited to, residents that: (i) have demonstrated suicidal ideation; (ii) have demonstrated
611	611	600aggressive behavior toward other residents or staff; (iii) have demonstrated exit-seeking
612	612	601behavior; or (vi) are registered sex offenders. The rate add-ons for said program shall be
613	613	602sufficient to defray the cost of employing the required staff to conduct the 24-hour monitoring
614	614	603and supervision of the at-risk residents.
615	615	604 (b) The division of medical assistance may develop an add-on to rate of payment for
616	616	605skilled nursing facilities that develop small house nursing homes and meet criteria established by
617	617	606the executive office.
618	618	607 SECTION 10. Subsection (c) of section 25 of chapter 176O of the General Laws, as
619	619	608appearing in the 2022 Official Edition, is hereby amended by inserting after the second sentence
620	620	609the following sentence:- The division shall develop and implement a uniform prior authorization
621	621	610form for the admission of patients from an acute care hospital to a post-acute care facility or 29 of 35
622	622	611transitioned to a home health agency certified by the federal Centers for Medicare and Medicaid
623	623	612Services for covered post-acute care services.
624	624	613 SECTION 11. (a) For the purposes of this section, the following words shall have the
625	625	614following meanings unless the context clearly requires otherwise:
626	626	615 “Enrollee”, as defined in section 8A of chapter 118E of the General Laws; provided, that
627	627	616“enrollee” shall include “insured” as defined in section 1 of chapter 176O of the General Laws.
628	628	617 “Payer”, the group insurance commission under chapter 32A of the General Laws, the
629	629	618division of medical assistance under chapter 118E of the General Laws, insurance companies
630	630	619organized under chapter 175 of the General Laws, non-profit hospital service corporations
631	631	620organized under chapter 176A of the General Laws, medical service corporations organized
632	632	621under chapter 176B of the General Laws, health maintenance organizations organized under
633	633	622chapter 176G of the General Laws and preferred provider organizations organized under chapter
634	634	623176I of the General Laws, or a utilization review organization acting under contract with the
635	635	624aforementioned entities.
636	636	625 “Post-acute care facility or agency”, any: (i) facility licensed under chapter 111 of the
637	637	626General Laws to provide inpatient post-acute care services, including, but not limited to skilled
638	638	627nursing facilities, long-term care hospitals, intermediate care facilities, or rehabilitation facilities;
639	639	628or (ii) a home health agency certified by the federal Centers for Medicare and Medicaid Services.
640	640	629 (b) Notwithstanding any general or special law to the contrary, all payers shall approve or
641	641	630deny a request for prior authorization for admission to a post-acute care facility or transition to a
642	642	631post-acute care agency for any inpatient of an acute care hospital requiring covered post-acute
643	643	632care services by the next business day following receipt by the payer of all necessary information 30 of 35
644	644	633to establish medical necessity of the requested service. If the calendar day immediately following
645	645	634the date of submission of the completed request is not a payer’s business day, and the payer
646	646	635cannot otherwise make a determination by the next calendar day, and the receiving post-acute
647	647	636care facility or agency is both open to new admissions and has indicated that said facility or
648	648	637agency will accept the enrollee, then prior authorization shall be waived; provided, that the payer
649	649	638shall provide coverage and may begin its concurrent review of the admission on the next
650	650	639business day; provided further, that the payer shall not retrospectively deny coverage for services
651	651	640to an enrollee admitted to a post-acute care facility or transitioned to a post-acute care agency
652	652	641after a waiver of prior authorization pursuant to this section unless the claim was a result of
653	653	642fraud, waste or abuse. An adverse determination of a prior authorization request pursuant to this
654	654	643section may be appealed by an enrollee or the enrollee’s provider and such appeal, in the case of
655	655	644an enrollee of a commercial payer, shall be subject to the expedited grievance process pursuant
656	656	645to clause (iv) of subsection (b) of section 13 of chapter 176O of the General Laws. An enrollee
657	657	646of an insurance program of the division of medical assistance or the enrollee’s provider may
658	658	647request an expedited appeal of an adverse determination of a prior authorization request. Nothing
659	659	648in this section shall be construed to require a payer to reimburse for services that are not a
660	660	649covered benefit.
661	661	650 (c) In the case of non-emergency transportation between an acute care hospital and a
662	662	651post-acute care facility, payers shall approve or deny a request for prior authorization according
663	663	652to the same process provided pursuant to subsection (b); provided, that once authorization has
664	664	653been granted, said authorization shall be valid for not less than 7 calendar days following
665	665	654approval. 31 of 35
666	666	655 (d) The division of insurance and the division of medical assistance shall issue sub-
667	667	656regulatory guidance to effectuate the purposes of this subsection.
668	668	657 SECTION 12. (a) There shall be a task force to study and propose recommendations to
669	669	658address acute care hospital throughput challenges and the impact of persistent delays in
670	670	659discharging patients from acute to post-acute care settings. The task force shall examine: (i)
671	671	660hospital discharge planning and case management practices; (ii) payer administrative barriers to
672	672	661discharge; (iii) legal and regulatory barriers to discharge; (iv) efforts to increase public
673	673	662awareness of health care proxies and the importance of designating a health care agent; (v) post-
674	674	663acute care capacity constraints and additional opportunities to provide financial incentives to
675	675	664increase capacity; (vi) administrative day rates and the cost to hospitals of discharge delays; (vii)
676	676	665enhanced hospital case management practices and reimbursement for wraparound services; (viii)
677	677	666the adequacy of post-acute care facility insurance networks and the establishment of an out-of-
678	678	667network rate for post-acute care facilities; (ix) expanding MassHealth Limited coverage to
679	679	668include post-acute and long-term care services; (x) the effectiveness of interagency coordination
680	680	669to resolve complex case discharges; (xi) the adequacy of reimbursement rates of MassHealth and
681	681	670commercial carriers for nonemergency medical transportation; (xii) opportunities to expand
682	682	671coverage and reimbursement for services delivered by mobile integrated health programs
683	683	672certified by the department of public health and by participating providers in the federal Centers
684	684	673for Medicare and Medicaid Services acute hospital care at home program; (xiii) alternative
685	685	674transportation options for patients being discharged and transferred to post-acute care facilities or
686	686	675home health agencies; and (xiv) the adequacy of state resources and infrastructure to place
687	687	676complex case discharges in appropriate post-acute care settings, including, but not limited to,
688	688	677patients with dementia diagnoses, geriatric patients with psychiatric diagnoses, patients with 32 of 35
689	689	678behavioral health diagnoses, patients with substance use disorder diagnoses, justice-involved
690	690	679patients, and patients who have been unable to find an appropriate placement for post-acute care
691	691	680for 6 months or longer.
692	692	681 (b) The task force shall consist of: the secretary of health and human services, or a
693	693	682designee, who shall serve as chair; the assistant secretary for MassHealth, or a designee; the
694	694	683commissioner of mental health, or a designee; the attorney general, or a designee; the
695	695	684commissioner of correction, or a designee; 1 sheriff appointed by the Massachusetts Sheriffs’
696	696	685Association, Inc.; 1 member representing the division of the probate and family court department
697	697	686of the trial court to be appointed by the chief justice of said division; and 10 members to be
698	698	687appointed by the chair, 1 of whom shall be a representative of the Massachusetts Hospital
699	699	688Association, Inc., 1 of whom shall be a representative of the Massachusetts Senior Care
700	700	689Association, Inc., 1 of whom shall be a representative of the Home Care Alliance of
701	701	690Massachusetts, Inc., 1 of whom shall be a representative of the Massachusetts Academy of Elder
702	702	691Law Attorneys, 1 of whom shall be a representative from the Massachusetts Ambulance
703	703	692Association, Incorporated, 1 of whom shall be a representative from the Massachusetts
704	704	693Association of Health Plans, Inc., 1 of whom shall be a representative from Blue Cross and Blue
705	705	694Shield of Massachusetts, Inc., 1 of whom shall be a representative from an academic medical
706	706	695center located in Worcester county, 1 of whom shall be a representative of an acute care hospital
707	707	696located in Suffolk county and 1 of whom shall be a representative from an acute care hospital
708	708	697designated by the health policy commission as an independent community hospital for the
709	709	698purposes of 105 CMR 100.715(B)(2)(b).
710	710	699 (c) Not later than July 31, 2024, the task force shall submit its report, including its
711	711	700recommendations or any proposed legislation necessary to carry out its recommendations, to the 33 of 35
712	712	701clerks of the house of representatives and the senate, the house and senate committees on ways
713	713	702and means and the joint committee on health care financing.
714	714	703 SECTION 13. The division of medical assistance shall study the cost and feasibility of
715	715	704changes to the eligibility requirements for Medicaid long-term care services with the goal of
716	716	705reducing the time applicants spend at acute care hospitals awaiting long-term care eligibility
717	717	706determinations. The study shall consider: (i) improvements to the eligibility determination
718	718	707process; (ii) establishing a rebuttable presumption of eligibility; (iii) guaranteeing payment for
719	719	708long-term care services for up to 1 year regardless of eligibility status; and (iv) expanding the
720	720	709undue hardship waiver criteria. The division of medical assistance shall seek input from the
721	721	710Massachusetts Senior Care Association, Inc., the Massachusetts Academy of Elder Law
722	722	711Attorneys and other interested stakeholders. The division of medical assistance shall submit a
723	723	712report with the results of its study and policy recommendations to the clerks of the house of
724	724	713representatives and the senate and the house and senate committees on ways and means, not later
725	725	714than 180 days after the effective date of this act.
726	726	715 SECTION 13A. (a) There shall be a task force to evaluate the governance and regulatory
727	727	716structure of rest homes in the commonwealth. The task force shall include, but shall not be
728	728	717limited to, an examination of the following: (i) the licensing, regulatory, and reporting structure
729	729	718for rest homes; (ii) an inventory of licensed rest homes and licensed rest home beds; (iii) the
730	730	719location and service areas of existing rest homes; (iv) a review of rest home closures since 2015;
731	731	720(v) a review of the recommendations implemented from the nursing facility task force report
732	732	721issued pursuant to section 91 of chapter 41 of the acts of 2019; (vi) the feasibility of receiving
733	733	722federal reimbursement for rest home expenses; and (vii) a review of the current rate structure for
734	734	723rest homes compared to the actual cost of care to residents. 34 of 35
735	735	724 (b) The task force shall consist of the secretary of health and human services, or their
736	736	725designee, who shall serve as chair; the secretary of elder affairs, or their designee; the
737	737	726commissioner of public health, or their designee; the assistant secretary for MassHealth, or their
738	738	727designee; the commissioner of the department of mental health, or their designee; the
739	739	728commissioner of the department of transitional assistance, or their designee; the chairs of the
740	740	729joint committee on elder affairs, or their designees; 1 person to be appointed by the minority
741	741	730leader of the house of representatives; 1 person to be appointed by the minority leader of the
742	742	731senate; and 5 members to be appointed by the governor, 1 of whom shall be a representative
743	743	732from the Massachusetts Association of Residential Care Homes, Inc., 1 of whom shall be a
744	744	733representative of LeadingAge Massachusetts, Inc., 1 of whom shall be a representative of
745	745	734Massachusetts Senior Action Council, Inc., 1 of whom shall have direct care giver experience,
746	746	735and 1 of whom shall have experience in health care administration and finance.
747	747	736 (c) The task force shall submit a report of its findings, including any recommendations or
748	748	737proposed legislation necessary to carry out its recommendations, to the clerks of the house of
749	749	738representatives and the senate and to the house and senate committees on ways and means, not
750	750	739later than April 1, 2025.
751	751	740 SECTION 14. (a) The health policy commission shall conduct an analysis and issue a
752	752	741report on the impact of the Medicare shared savings program and participating Medicare
753	753	742accountable care organizations, hereinafter referred to as Medicare ACOs, on the financial
754	754	743viability of long-term care facilities in the commonwealth and continued access to long-term care
755	755	744facility services for Medicare patients. The analysis shall include, but not be limited to, an
756	756	745examination of the following: 35 of 35
757	757	746 (i) the impact of Medicare ACOs on clinical eligibility decisions related to initial long-
758	758	747term care facility placement and patient length of stay for Medicare ACO beneficiaries compared
759	759	748to Medicare fee-for-service beneficiaries, including an analysis of the impact of length of stay on
760	760	749quality outcomes including readmissions, functional status and patient experience;
761	761	750 (ii) the amount of payments Medicare ACOs have received from the federal government
762	762	751from capitated, shared savings or other related initiatives and how those payments have been
763	763	752utilized, or not, to enhance patient care and outcomes in long-term care facilities;
764	764	753 (iii) Medicare ACO practices related to patient care utilization controls and the financial
765	765	754and quality care impact of these controls on beneficiaries in the acute and post-acute care system;
766	766	755and
767	767	756 (iv) Medicare ACOs long-term care network adequacy.
768	768	757 (b) The health policy commission shall submit the report to the clerks of the house of
769	769	758representatives and the senate, the house and senate committees on ways and means, the joint
770	770	759committee on health care financing and the joint committee on elder affairs not later than
771	771	760December 31, 2024.
772	772	761 SECTION 15. Notwithstanding any general or special law to the contrary, the division of
773	773	762insurance shall develop the uniform prior authorization form for admission to a post-acute care
774	774	763facility or transition to a home health agency for any inpatient of an acute care hospital requiring
775	775	764covered post-acute care services pursuant to section 25 of chapter 176O of the General Laws, as
776	776	765amended by section 10, not later than 90 days after the effective date of this act. The division of
777	777	766insurance shall develop said uniform prior authorization form in consultation with the division of
778	778	767medical assistance. The division of medical assistance, or any entity acting for the division of 36 of 35
779	779	768medical assistance under contract, shall accept the uniform prior authorization form as sufficient
780	780	769to request prior authorization for the requested service. All acute care hospitals shall use the
781	781	770uniform prior authorization form to request prior authorization for coverage of post-acute care
782	782	771services at a post-acute care facility or home health agency, and all payers, as defined in section
783	783	77211, or entities acting for a payer under contract shall accept such form as sufficient to request
784	784	773prior authorization for the requested service, not later than 30 days after the form has been
785	785	774developed by the division of insurance.
786	786	775 SECTION 16. (a) For the purposes of this section, the terms “licensee” and “management
787	787	776company” shall have the meanings as defined in section 71 of chapter 111 of the General Laws,
788	788	777as amended by section 2.
789	789	778 (b) Pursuant to section 71 of chapter 111 of the General Laws, as amended by section 2, a
790	790	779licensee who has entered into a contract with a management company prior to the effective date
791	791	780of this act shall provide the department of public health with the necessary documentation and
792	792	781materials for a determination by the department of the responsibility and suitability as described
793	793	782in subsection (g) of said section 71 of said chapter 111 of the management company, prior to any
794	794	783issuance of a renewed license; provided, however, that the department shall give a licensee
795	795	784reasonable time to provide the department with the necessary documents and materials if the
796	796	785licensee’s renewal date is within 90 days of the effective date of this act. A licensee’s failure to
797	797	786comply with this section shall subject the licensee to the penalties established in section 73 of
798	798	787said chapter 111, as amended by section 7. 37 of 35
799	799	788 SECTION 17. Pursuant to section 72CC of chapter 111 of the General Laws, as inserted
800	800	789by section 6, each long-term care facility shall submit its outbreak response plan to the
801	801	790department of public health not later than 180 days after the effective date of this act.
802	802	791 SECTION 18. The initial report required by section 72FF of chapter 111 of the General
803	803	792Laws, as inserted by section 6, shall be filed with the clerks of the house of representatives and
804	804	793the senate, the house and senate committees on ways and means and the joint committee on elder
805	805	794affairs not later than 6 months after the effective date of this act.
806	806	795 SECTION 19. Section 11 is hereby repealed.
807	807	796 SECTION 20. Section 19 shall take effect 2 years after the effective date of this act.
808	808	797 SECTION 21. Section 83 of chapter 118E of the General Laws, as inserted by section 9,
809	809	798shall take effect on October 1, 2025.