HOUSE . . . . . . . . No. 4924
The Commonwealth of Massachusetts
________________________________________
HOUSE OF REPRESENTATIVES, July 29, 2024.
The committee on Children, Families and Persons with Disabilities, to
whom were referred the petition (accompanied by bill, Senate, No. 109) of
Joan B. Lovely, Sean Garballey, Angelo J. Puppolo, Jr., John F. Keenan
and other members of the General Court for legislation relative to
supported decision-making agreements for certain adults with disabilities
and the petition (accompanied by bill, House, No. 201) of Christopher M.
Markey, Vanna Howard and Marc T. Lombardo relative to supported
decision-making agreements, reports recommending that the
accompanying bill (House, No. 4924) ought to pass.
For the committee,
JAY D. LIVINGSTONE. 1 of 14
FILED ON: 7/26/2024
HOUSE . . . . . . . . . . . . . . . No. 4924
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act relative to supported decision making.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 6A of the General Laws is hereby amended by inserting after
2section 16F the following section:-
3 Section 16F½. The executive office of health and human services shall establish a
4training program on supported decision-making. The training program shall include instruction
5by state agencies including, but not limited to, the department of developmental services, the
6department of mental health and the executive office of elder affairs. The training program shall
7be provided to any supporter or decision-maker pursuant to section 5-601 of chapter 190B and
8shall include instruction on the rights and obligations contained in section 5-602 of chapter 190B
9and dispute resolution. The executive office of health and human services shall consult with the
10executive office of elder affairs, the department of developmental services, the department of
11mental health, the department of public health, the Disability Law Center, the Massachusetts
12Health and Hospital Association, the Massachusetts Medical Society, the Massachusetts Bankers
13Association and adults who receive supported decision-making assistance and supporters who
14assist in decision-making pursuant to a supported-decision making agreement in the development 2 of 14
15of the training. The training shall be in a format accessible to the individuals receiving the
16training.
17 SECTION 2. Section 2 of chapter 71B of the General Laws, as appearing in the 2022
18Official Edition, is hereby amended by inserting, in line 86, after the word “sec.” the following
19paragraph:- The department of elementary and secondary education shall promulgate regulations
20in consultation with the department of higher education requiring school districts, as part of their
21transitional planning process for students with disabilities, to inform students and their families
22of the availability of supported decision-making as an alternative to adult guardianship for
23students with disabilities that are receiving services at age sixteen. The department shall provide
24supported decision-making agreement training to schools and post all training materials on the
25department’s website including a sample form for a decision-maker to request the release of
26educational records.
27 SECTION 3. Section 3 of said chapter 71B of the General Laws, as so appearing, is
28hereby amended by inserting, in line 301 after the word “program.” the following paragraph:- At
29the first IEP meeting after a student has turned age sixteen or older, the IEP team shall inform the
30student and their family or guardian, of the availability of supported decision-making agreements
31as an alternative to guardianship. The IEP team shall assist the child and their family or guardian
32in locating resources to assist in establishing a supported decision-making plan if the child and
33their family or guardian are interested in supported decision-making.
34 SECTION 4. Section 5-303 of said chapter 190B, as appearing in the 2022 Official
35Edition, is hereby amended by inserting, in line 50, after the word “guardianship”, the following
36words:- or a supported decision-making agreement. 3 of 14
37
38 SECTION 5. Subsection (b) of section 5-303 of said chapter 190B, as so appearing, is
39hereby amended, by inserting after paragraph (9) the following paragraph:-
40 (9½) a copy of any supported decision-making agreement executed by the person alleged
41to be incapacitated, if available:-
42 SECTION 6. Chapter 190B of the General Laws is hereby amended by inserting after
43section 5-507 the following sections:-
44 Section 5-601. Definitions:
45 As used in this section, the following words shall have the following meaning unless the
46context clearly requires otherwise:
47 “Adult”, an individual 18 years of age or older.
48 “Coercion”, the use of force or threats to persuade someone to do something.
49 “Decision-maker”, an adult who seeks to execute, or has executed, a supported decision-
50making agreement with 1 or more supporters under this chapter.
51 “Executed”, a supported decision-making agreement that is signed by both the decision
52maker and all supporters in accordance with requirements set forth in this chapter.
53 “Supported decision-making”, the process of supporting and accommodating the
54decision-maker, without impeding the self-determination of the decision-maker, in making life
55decisions, including, but not limited to: (i) decisions related to where the decision-maker wants
56to live; (ii) the services, supports, financial decisions and medical care the decision-maker wants 4 of 14
57to receive; (iii) whom the decision-maker wants to live with; and (iv) where the decision-maker
58wants to work.
59 “Supported decision-making agreement”, a voluntary, written agreement, written in plain
60language that is accessible and understood by the decision-maker and entered into by the
61decision-maker with one or more supporters pursuant to section 5-602 used to support decision-
62making.
63 “Supporter”, an adult who meets the requirements of section 5-602 and has executed a
64supported decision-making agreement with a decision-maker.
65 Section 5-602.
66 (1)(a) A decision-maker may voluntarily enter into a supported decision-making
67agreement with 1 or more supporters.
68 (b) The decision-maker may amend or terminate a supported decision-making agreement
69at any time pursuant to section 5-602(3)(e).
70 (2)(a) Any person, eighteen years of age or older, may be a supporter.
71 (b) A person shall not serve as a supporter in a supported decision-making agreement
72when:
73 (1) The decision-maker previously made, or makes, an allegation of elder abuse against
74the supporter. 5 of 14
75 (2) The decision-maker has obtained or obtains a Protection from Abuse Order against
76the supporter or a harassment prevention order against the supporter under chapter 258 of the
77General Laws.
78 (3) The supporter is the subject of a civil or criminal order prohibiting contact with the
79decision-maker;
80 (4) The supporter has been removed as the conservator of the decision-maker, based upon
81a finding that they did not act in the conservatee’s best interest; or
82 (5) The supporter is found criminally, civilly, or administratively liable for abuse,
83neglect, mistreatment, coercion, or fraud.
84 (3)(a) Except as limited by a supported decision-making agreement, a supporter shall do
85all the following:
86 (1) Respect the values, beliefs, and preferences of the decision-maker.
87 (2) Act honestly, diligently, and in good faith.
88 (3) Act within the scope identified by the decision-maker.
89 (4) Support and implement the direction, will, and preferences of the decision-maker.
90 (5) Maintain confidentiality of any information obtained by a supporter, unless the
91decision-
92 maker specifically authorizes its disclosure.
93 (6) Exercise only the authority granted to the supporter in the supported decision-making 6 of 14
94 agreement.
95 (b)(1) Except as limited by a supported decision-making agreement, a supporter may,
96with the consent of the decision-maker, provide to the decision-maker decision-making
97assistance regarding the decision-maker’s affairs, including, but not limited to: (i)
98communicating decisions and understanding information about, options for, the responsibilities
99of and the consequences of decisions; (ii) accessing, obtaining and understanding information
100that is relevant to decisions, necessary for the decision-maker to manage their affairs, including,
101but not limited to, medical records, including protected health information under the Health
102Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191); psychological and
103financial records; educational records under the Family Education Rights and Privacy Act of
1041974 (20 U.S.C. s. 1232g), or information protected by 42 U.S.C.A. s. 290dd-2, 4 C.F.R. Part 2;
105as well as other educational records including Individualized Education Programs, transcripts, a
106transition plan, a student summary of performance and any other materials as requested; (iii)
107ascertaining the wishes and decisions of the decision-maker, assisting in communicating those
108wishes and decisions to other persons and assisting to ensure the decision-maker’ wishes and
109decisions are implemented; and (iv) accompanying the decision-maker and participating in
110discussions with other persons when the decision-maker is making decisions or attempting to
111obtain information needed to make decisions.
112 (c) Unless the supporter has a valid legal authorization to do so and the action is within
113the scope of their authority, a supporter shall not do either of the following: (i) make decisions
114for, or on behalf of, the decision-maker, or (ii) sign documents on behalf of the decision-maker. 7 of 14
115 (d) A supporter shall not participate in any life decision in which they have a conflict of
116interest. This includes, but is not limited to, any decision in which the supporter, his or her
117immediate family or partner, a business organization in which he or she is serving as officer,
118director, trustee, partner or employee has a financial interest or other direct and substantial
119interest in the outcome.
120 (e) A supporter shall only be authorized to assist the decision-maker in accessing,
121collecting or obtaining information that is relevant to a decision authorized under the supported
122decision-making agreement and to which the decision-maker agrees that the supporter should
123have access pursuant to a written authorization in accordance with the applicable federal or state
124privacy laws. The decision-maker may withdraw the authorization at any time in whatever
125manner is authorized by applicable state or federal law. A supporter shall keep confidential any
126information obtained in the process of assisting the decision-maker.
127 (f) A decision-maker may bring a civil action for damages and equitable relief, including
128injunctive relief, resulting from a violation of this section or a regulation promulgated under this
129section in any court of competent jurisdiction.
130 (4) The existence of a supported decision-making agreement shall not preclude a
131decision-maker from seeking personal information without the assistance of a supporter.
132 (5) To be valid, a supported decision-making agreement shall be signed and dated by the
133decision-maker and each applicable supporter in the presence of a notary public. The decision-
134maker may use reasonable modifications, such as assistive technology or physical assistance, to
135sign the agreement. 8 of 14
136 (6) Evidence of undue influence or coercion in the creation or signing of a supported
137decision-making agreement shall render the supported decision-making agreement invalid.
138 (7) A supported decision-making agreement shall be personalized by the decision-maker
139to reflect the decision-maker’s personal circumstances. A supported decision-making agreement
140shall:
141 (a) be in writing in plain language that is accessible and understood by the decision-
142maker;
143 (b) identify the decision-maker and all supporters;
144 (c) describe the types of decisions with which each supporter shall assist the decision-
145maker. If the decision-maker wants assistance to access their medical records, the agreement
146must specifically reference that the supporter shall have access to protected health information
147under the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191). If the
148decision-maker wants assistance to access their education records, the agreement must
149specifically reference that the supporter shall have access to protected education records under
150the Family Education Rights and Privacy Act of 1974 (20 U.S.C. s. 1232g) or information
151protected by 42 U.S.C. a. s. 290dd-2, 4 C.F.R. Part2; as well as other education records including
152Individualized Education Programs, transcripts, a transition plan, a student summary of
153performance and any other materials.
154 (d) indicate that all supporters agree to assist the decision-maker in making such
155decisions, to respect the decision maker's decisions and to assist the decision-maker in
156communicating such decisions; 9 of 14
157 (e) state that supporters shall not make decisions for the decision-maker;
158 (f) indicate that the decision-maker may amend or terminate the supported decision-
159making agreement at any time and for any reason subject to the requirements of subsection (e);
160 (g) list contact information for the disabled persons protection commission, the elder
161abuse hotline and all programs providing services to the decision-maker; and
162 (h) include a statement from each supporter that they understand and accept their roles,
163responsibilities and limitations as outlined in section 5-602(3)(a).
164 (8) A person who receives the original or a copy of a supported decision-making
165agreement shall rely on the agreement and recognize a decision, request or communication made
166with the decision-making assistance of a supporter as the decision, request or communication of
167the decision-maker. A written confirmation from the decision-maker may be required affirming
168that the supported decision-making agreement presented is current.
169 (9) A person or entity that, in good faith, acts in reliance on a decision made pursuant to a
170supported decision-making agreement shall not be subject to civil or criminal liability or to
171professional discipline.
172 (10)(a) The supported decision-making agreement shall remain in effect until it is
173terminated or expires.
174 (b) A supportive decision-making agreement shall be terminated as follows:
175 (1) On any termination date set forth in the agreement but no more than a term of three
176years, unless extended by agreement, in writing, of the decision-maker and supporters, pursuant
177to section 5-602 with terms of execution. 10 of 14
178 (2) A supporter may terminate participation in a supported decision-making agreement at
179any time, by written notice to the decision-maker and any other supporters to the agreement;
180provided, however, that if the agreement has more than 1 supporter, the agreement shall remain
181valid as to all other supporters.
182 (3) A decision-maker may terminate a supported decision-making agreement at any time
183by written notice to all supporters to the agreement.
184 (4) Notice of the suspension of a supporter pursuant to section 5-602 shall be given in
185writing and delivered in hand to said person or his or her attorney, or sent by registered mail to
186said person at his or her residence or his place of business. Such notice so given, delivered or
187sent shall automatically suspend the authority of such person to perform the duties of his or her
188office or employment until he or she is notified in like manner that his or her suspension is
189removed.
190 (5) The death or incapacitation of the decision-maker.
191 (6) In the event that the decision-maker becomes subject to a guardianship order, the
192scope of the supported decision-making agreement may be limited in whole or in part by the
193probate and family court to those decisions reserved for the decision-maker after the issuance of
194the guardianship order.
195 (11)(a) The disabled persons protection commission, an elder protective services agency,
196the department of developmental services, the department of mental health or any person
197interested in the decision-maker's welfare may petition the probate and family court to revoke or
198suspend the role of the supporter within one or more supported decision-making agreements on
199the grounds of abuse, neglect, exploitation or failure of the supporter to follow their roles and 11 of 14
200responsibilities resulting in serious physical, emotional, or financial harm to the decision-maker,
201or on the grounds that the supporter is not qualified pursuant to section 5-602(2)(b). The court
202shall provide notice to the decision-maker and supporter and provide an opportunity for the
203decision-maker and supporter to be heard. The court shall revoke or suspend the role of the
204supporter within the supported decision-making agreement, in whole or in part, if the court
205makes a finding under any grounds set forth in this paragraph. The court shall not order a
206supported decision-making agreement to remain in effect over the objection of the decision-
207maker. If the decision-maker is indigent, the court shall appoint counsel for the decision-maker
208upon the filing of any petition under this paragraph.
209 The court shall tally the number of individuals who appear before the court on supported
210decision-making agreement issues. A report of the court’s findings shall be submitted annually,
211as of June 30, to the clerks of the senate and house of representatives, the joint committee on
212committee on children, families and persons with disabilities and the senate house committees on
213ways and means.
214 (b)(1) If a person who receives a copy of a supported decision-making agreement or is
215aware of the existence of a supported decision-making agreement has cause to believe that the
216decision maker is being abused, neglected or exploited by a supporter, the person may report the
217alleged abuse, neglect or exploitation to the disabled persons protection commission pursuant to
218chapter 19C or the elder abuse prevention hotline pursuant to chapter 19A.
219 (2) If a mandated reporter pursuant to subsection (a) of section 15 of said chapter 19A or
220said chapter 19C has reasonable cause to believe that the decision-maker has been abused, 12 of 14
221neglected or exploited by a supporter, the mandated reporter shall make a report to the disabled
222persons protection commission or an elder protective services agency, as applicable.
223 (c) Execution of a supported decision-making agreement shall not be a condition of
224participation in any activity, service or program.
225 (d) Nothing in this section shall be interpreted to limit or restrict the right of an individual
226to execute a health care proxy pursuant to chapter 201D or a power of attorney pursuant to this
227chapter.
228 SECTION 7. There shall be established pursuant to section 2A of chapter 4 of the
229General Laws a special legislative commission, known as the Supported Decision-Making
230Commission, to study, examine and make recommendations regarding: (i) the expansion of an
231existing state registry to tally the number of individuals with a supported decision-making
232agreement and that enables providers to verify that the supported decision-making agreement
233presented by a decision-maker or a supporter is current; and (2) the creation of a new online
234registry to tally the number of individuals with a supported decision-making agreement and that
235enables providers to verify that the supported decision-making agreement presented by a
236decision-maker or a supporter is current.
237 (a) The commission shall consist of: the chairs of the joint committee on children,
238families and persons with disabilities, who shall serve as co-chairs; 1 member to be appointed by
239the senate president; 1 member to be appointed by the speaker of the house of representatives; 1
240member to be appointed by the minority leader of the senate; 1 member to be appointed by the
241minority leader of the house of representatives; the secretary of health and human services or a
242designee; the secretary of the executive office of technology services and security or a designee; 13 of 14
243the commissioner of public health or a designee; the chief justice of the trial court or a designee;
2441 member representing the Massachusetts Health and Hospital Association; 1 member
245representing the Massachusetts Bankers Association; 1 member representing The Arc of
246Massachusetts; and 1 member representing the Disability Law Center.
247 (b) State agencies shall make available to the commission any documents, data or
248materials in a timely manner when reasonably requested by the commission.
249 (c) The commission shall submit a report of its findings and recommendations to the
250clerks of the senate and house of representatives, the joint committee on committee on children,
251families and persons with disabilities and the senate house committees on ways and means not
252later than June 1, 2025.
253 SECTION 8. A supported decision-making agreement executed before July 31, 2025,
254shall be valid until July 31, 2026. Thereafter, only supported decision-making agreements that
255conform to the requirements of section 5-602 of chapter 190B of the General Laws shall be
256valid.
257 SECTION 9. Section 6 shall take effect on July 31, 2025.
258 SECTION 10. The training program required by section 16F½ of chapter 6A of the
259General Laws shall be implemented by the department of health and human services no later
260than 6 months after the passage of this act.
261 SECTION 11. The department of elementary and secondary education shall promulgate
262regulations pursuant to section 2 of chapter 71B of the General Laws no later than 6 months after
263passage of this act. 14 of 14
264 SECTION 12. The executive office of health and human services shall promulgate
265regulations no later than 6 months after the passage of this act.