Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H5033 Compare Versions

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1	1	HOUSE . . . . . . . . . . . . . . No. 5033
2	2	The Commonwealth of Massachusetts
3	3	_______________
4	4	The committee of conference on the disagreeing votes of the two branches with reference
5	5	to the Senate amendment (striking out all after the enacting clause and inserting in place thereof
6	6	the text contained in Senate document numbered 2900) of the House Bill to improve quality and
7	7	oversight of long-term care (House, No. 4193), reports recommending passage of the
8	8	accompanying bill (House, No. 5033). August 28, 2024.
9	9	Thomas M. StanleyMichael J. RodriguesAlice Hanlon PeischPatricia D. Jehlen Hannah KanePatrick O’Connor 1 of 65
10	10	FILED ON: 8/28/2024
11	11	HOUSE . . . . . . . . . . . . . . . No. 5033
12	12	The Commonwealth of Massachusetts
13	13	_______________
14	14	In the One Hundred and Ninety-Third General Court
15	15	(2023-2024)
16	16	_______________
17	17	An Act to improve quality and oversight of long-term care.
18	18	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
19	19	of the same, as follows:
20	20	1 SECTION 1. Chapter 10 of the General Laws is hereby amended by inserting after
21	21	2section 35SSS the following section:-
22	22	3 SECTION 35TTT. (a) There shall be established and set up on the books of the
23	23	4commonwealth a separate fund known as the Long-Term Care Workforce and Capital Fund. The
24	24	5fund shall be administered by the secretary of health and human services in consultation with the
25	25	6advisory committee established pursuant to subsection (c). The secretary may use amounts
26	26	7credited to the fund to pay for: (i) the administration of the capital loan program pursuant to
27	27	8subsection (e); and (ii) the workforce training programs pursuant to subsection (d), including the:
28	28	9(A) program costs, tuition, books and fees related to the cost of education and training for
29	29	10participants in the programs; (B) costs related to obtaining an applicable license, including, but
30	30	11not limited to, examination and licensing fees; (C) stipends for program participants; and (D)
31	31	12stipends for childcare and transportation for program participants. 2 of 65
32	32	13 (b) The fund shall consist of: (i) any revenues or other financing sources directed to the
33	33	14fund by appropriation; (ii) 50 per cent of any amount recovered by the commonwealth and
34	34	15credited thereto in connection with civil actions brought pursuant to section 72K of chapter 111;
35	35	16(iii) bond revenues or other money authorized by the general court and specifically designated to
36	36	17be credited to the fund; (iv) any income derived from the investment of amounts credited to the
37	37	18fund or repayment of loans from the fund; (v) funds from public or private sources, including,
38	38	19but not limited to, gifts, federal or private grants, donations, rebates and settlements received by
39	39	20the commonwealth that are specifically designated to be credited to the fund; and (vi) all other
40	40	21amounts credited or transferred into the fund from any other source. The executive office of
41	41	22health and human services shall seek to maximize fund revenues through federal money,
42	42	23matching funds and grants. Any unexpended balances in the fund at the end of the fiscal year
43	43	24shall not revert to the General Fund and shall be available for expenditures in subsequent fiscal
44	44	25years. Any fiscal year-end balance in the fund shall be excluded from the calculation of the
45	45	26consolidated net surplus pursuant to section 5C of chapter 29. The fund shall not be subject to
46	46	27appropriation.
47	47	28 (c) There shall be an advisory committee that shall consist of the following members: the
48	48	29assistant secretary for MassHealth, or their designee, who shall serve as chair; the secretary of
49	49	30labor and workforce development, or their designee; the commissioner of public health, or their
50	50	31designee; and 2 persons to be appointed by the governor, 1 of whom shall be a representative of
51	51	32the Massachusetts Senior Care Association, Inc. and 1 of whom shall be a representative of
52	52	33Local 1199 Service Employees International Union. 3 of 65
53	53	34 (d) The secretary of health and human services, in consultation with the advisory
54	54	35committee, shall establish, and the executive office of health and human services shall
55	55	36administer, workforce training grant programs to:
56	56	37 (i) train new certified nurses’ aides to work in licensed long-term care facilities;
57	57	38 (ii) advance the skills of certified nurses’ aides, home health aides, homemakers and
58	58	39other entry-level workers in long-term care facilities to improve quality of care and improve
59	59	40worker access to and participation in a career pathway to become a licensed practical nurse; and
60	60	41 (iii) provide long-term care supervisory and leadership training, which shall consist of
61	61	42evidence-based supervisory training for the purposes of improving staff satisfaction, retaining
62	62	43staff and reducing staff turnover.
63	63	44 (e) The secretary of health and human services, in consultation with the advisory
64	64	45committee, shall establish a no interest or forgivable capital loan program for skilled nursing
65	65	46facilities to:
66	66	47 (i) support the development of specialized care units, including, but not limited to: (A)
67	67	48infectious disease isolation units; (B) dementia special care units; (C) degenerative neurological
68	68	49units; (D) geriatric psychiatry units; (E) traumatic brain injury units; (F) in-house dialysis
69	69	50treatment units; (G) behavioral health and substance use disorder units; and (H) bariatric patient
70	70	51care units;
71	71	52 (ii) enable facilities to offset the costs of pay-go capital; and
72	72	53 (iii) support innovative projects, including, but not limited to: (A) converting of sections
73	73	54within skilled nursing facilities into affordable housing, veterans housing or assisted living units 4 of 65
74	74	55to accommodate individual needs of residents; (B) converting multi-bed rooms to single
75	75	56occupancy to enhance privacy and dignity; and (C) establishing voluntary skilled nursing facility
76	76	57reconfigurations, including, but not limited to, providing financial incentives to reduce capacity
77	77	58and balance supply and demand based on regional needs.
78	78	59 (f) Annually, not later than December 1, the secretary of health and human services shall
79	79	60report on the activities of the fund to the clerks of the house of representatives and the senate and
80	80	61to the house and senate committees on ways and means. The report shall include: (i) an
81	81	62accounting of expenditures made from the fund with a description of the authorized purpose of
82	82	63each expenditure; (ii) an accounting of amounts credited to the fund; and (iii) any unexpended
83	83	64balance remaining in the fund.
84	84	65 SECTION 2. Section 1 of chapter 19D of the General Laws, as appearing in the 2022
85	85	66Official Edition, is hereby amended by inserting after the definition of “Assisted living
86	86	67residence” or “Residence” the following 3 definitions:-
87	87	68 “Authorized medical professional”, an advanced practice registered nurse with
88	88	69prescriptive authority, a physician assistant or a physician; provided, however, that an authorized
89	89	70medical professional shall have been granted authority by a resident to issue care orders for the
90	90	71resident.
91	91	72 “Basic health services”, certain services provided at an assisted living residence by
92	92	73employees of the residence that are qualified to administer such services or a qualified third party
93	93	74in accordance with a care order issued by an authorized medical professional; provided,
94	94	75however, that such services shall include all of the following: (i) injections; (ii) the application or
95	95	76replacement of simple non-sterile dressings; (iii) the management of oxygen on a regular and 5 of 65
96	96	77continuing basis; (iv) specimen collection and the completion of a home diagnostic test,
97	97	78including, but not limited to, warfarin, prothrombin or international normalized ratio testing and
98	98	79glucose testing; provided, that such home diagnostic test or monitoring is approved by the United
99	99	80States Food and Drug Administration for home use; and (v) application of ointments or drops.
100	100	81 “Care order”, a written order for basic health services issued by an authorized medical
101	101	82professional.
102	102	83 SECTION 3. Said section 1 of said chapter 19D, as so appearing, is hereby further
103	103	84amended by striking out the definition of “Elderly housing”.
104	104	85 SECTION 4. Said section 1 of said chapter 19D, as so appearing, is hereby further
105	105	86amended by striking out the definition of “Skilled nursing care” and inserting in place thereof the
106	106	87following definition:-
107	107	88 "Skilled nursing care", skilled services described in 130 CMR 456.409 or any successor
108	108	89regulation.
109	109	90 SECTION 5. Section 2 of said chapter 19D, as so appearing, is hereby amended by
110	110	91striking out clauses (v) and (vi) and inserting in place thereof the following 2 clauses:-
111	111	92 (v) provide services to residents in accordance with service plans developed through a
112	112	93process by which employees of the residence discuss the service plan and the needs of the
113	113	94resident with the resident and their representative or designee and ensure the consequences of a
114	114	95decision, including any inherent risk, are understood by all parties; provided, however, that such
115	115	96parties shall review the service plan periodically and consider changes in the resident's status and
116	116	97the ability of the residence to respond accordingly and as set forth in section 12; provided 6 of 65
117	117	98further, that if a resident is receiving basic health services, the staff of the residence shall consult
118	118	99the resident’s authorized medical professional when developing the resident’s service plan;
119	119	100 (vi) coordinate and provide personal services, basic health services, where applicable, and
120	120	101other services required under service plans as set forth in section 12;.
121	121	102 SECTION 6. Said chapter 19D is hereby further amended by striking out sections 3 to 6,
122	122	103inclusive, as so appearing, and inserting in place thereof the following 4 sections:-
123	123	104 Section 3. (a) No person shall advertise, operate or maintain an assisted living residence
124	124	105without the certification required under this chapter, including assisted living residences
125	125	106sponsored by the following entities; provided, however, that the provisions of this chapter shall
126	126	107not apply to entities for the original facilities and services for which said entities were originally
127	127	108licensed or organized to provide: (i) convalescent homes, licensed nursing homes, licensed rest
128	128	109homes, charitable homes for the aged or intermediate care facilities for persons with an
129	129	110intellectual disability licensed pursuant to section 71 of chapter 111; (ii) hospices licensed
130	130	111pursuant to the provisions of section 57D of said chapter 111; (iii) facilities providing continuing
131	131	112care to residents, as those terms are defined by section 76 of chapter 93; (iv) congregate housing
132	132	113authorized by section 39 of chapter 121B; (v) group homes or supported living programs
133	133	114operating under contract with the department of mental health, the rehabilitation commission or
134	134	115the department of developmental services; or (vi) housing operated for only those duly ordained
135	135	116priests or for the members of the religious orders of the Roman Catholic church in their own
136	136	117locations, buildings, residences or headquarters to provide care, shelter, treatment and medical
137	137	118assistance for any of the said duly ordained priests or members of the said religious order. 7 of 65
138	138	119 (b) The provisions of this chapter shall not apply to any residential premises available for
139	139	120lease by elderly or disabled individuals that is financed or subsidized in whole or in part by local,
140	140	121state or federal housing programs established primarily to develop or operate housing rather than
141	141	122to provide housing and personal services in combination; provided, however, that such premises
142	142	123are not currently licensed under chapter 111.
143	143	124 Section 4. (a) The department shall issue a certification for a term of 2 years, and shall
144	144	125renew for like terms, to any applicant whom the department determines meets the regulatory
145	145	126requirements promulgated by the department in accordance with this chapter; provided, however,
146	146	127that a certification shall be subject to corrective action, modification, suspension or revocation
147	147	128for cause, as determined by the department. Such certification shall: (i) not be transferable or
148	148	129assignable; (ii) be issued only to the person and for the premises named in the application; (iii)
149	149	130indicate whether the residence has been approved to provide basic health services; and (iv)
150	150	131indicate the certification’s expiration date. The department shall issue a certificate, which shall
151	151	132be posted by the residence in a conspicuous place on the approved premises and on the
152	152	133residence’s website.
153	153	134 (b) Upon applying for initial certification or renewal, an applicant shall pay the
154	154	135department a fee based on the number of units at the assisted living residence, established by the
155	155	136secretary of administration and finance pursuant to the provisions of section 3B of chapter 7;
156	156	137provided, however, that a minimum fee shall be established notwithstanding the number of units
157	157	138at the residence. No fees for initial certification or renewal shall be due from any provider for
158	158	139assisted living units created under the United States Department of Housing and Urban
159	159	140Development Assisted Living Conversion Program. 8 of 65
160	160	141 (c) If an application for renewal of a certification is filed not less than 30 days before the
161	161	142expiration date, such certification shall not expire until the department notifies the sponsor that
162	162	143the application for renewal has been denied.
163	163	144 (d) Applicants for initial certification shall file with the department an operating plan that
164	164	145includes: (i) the number of units; (ii) the number of residents allowed per unit; (iii) the location
165	165	146of resident units, common spaces and egresses by floor; (iv) the base fee to be charged for each
166	166	147such unit; (v) the services to be offered, including basic health services, if applicable, and
167	167	148arrangements for providing such services, including linkages with hospitals and nursing
168	168	149facilities, if any; (vi) the number of staff to be employed; and (vii) other information the
169	169	150department deems necessary.
170	170	151 (e) Residences may seek certification by the department to provide basic health services;
171	171	152provided, however, that such residences shall offer all such basic health services defined in
172	172	153section 1; and provided further, that residences offering basic health services shall not restrict
173	173	154resident choice in the delivery of said services by third party providers. The residence shall
174	174	155submit a revised operating plan to the department in the event of a change in the scope of basic
175	175	156health services offered to residents. A residence seeking to provide basic health services shall
176	176	157include in its operating plan: (i) a proposed administrative and operational structure to ensure the
177	177	158safe and effective use of basic health services and meet the needs of its residents; and (ii) a
178	178	159compliance plan to meet the requirements established under this chapter and promulgated
179	179	160regulations, which shall include, but not be limited to: (A) staff qualifications and training; and
180	180	161(B) effective policies and procedures to ensure the availability of adequate supplies necessary for
181	181	162basic health services and the safe administration and secure storage of medications. 9 of 65
182	182	163 (f) Applicants and sponsors shall file material changes to the assisted living residence’s
183	183	164operating plan prior to the change’s effective date and as may otherwise be required by the
184	184	165department. A sponsor shall file annually on a date established by and on a form prescribed by
185	185	166the department, a statement and a professional opinion prepared by a certified public accountant
186	186	167or comparable reviewer indicating whether the assisted living residence is in sound fiscal
187	187	168condition and is maintaining sufficient cash flow and reserves to meet the requirements of the
188	188	169service plans established for its residents.
189	189	170 (g) Applicants for initial certification or renewal shall disclose the name and address of
190	190	171each officer, director, trustee and limited partner or shareholder with not less than 5 per cent
191	191	172interest in the assisted living residence and shall provide to the department documentation of the
192	192	173history of each such individual or entity, including, but not limited to: (i) all multifamily housing,
193	193	174assisted living residences or health care facilities in which the individual or entity has been an
194	194	175officer, director, trustee or partner and, if applicable, evidence from the relevant regulatory
195	195	176authority that said applicant has met criteria for licensure or certification; (ii) documentation of
196	196	177any enforcement action against the applicant and, if applicable, evidence that the applicant has
197	197	178corrected all cited deficiencies without revocation of licensure or certification; and (iii) any other
198	198	179evidence, as determined by the department.
199	199	180 (h) The department may deny certification to an applicant who had an ownership interest
200	200	181in an entity licensed under chapter 111, a licensed medical provider or a home health agency
201	201	182certified under Title XVIII of the Social Security Act, as amended, that: (i) has been subject to a
202	202	183patient care receivership action; (ii) has ceased to operate such an entity as a result of: (A)
203	203	184suspension or revocation of license or certification; (B) receivership; or (C) a settlement
204	204	185agreement arising from suspension or revocation of a license or certification; (iii) has a 10 of 65
205	205	186settlement agreement in lieu of or as a result of subclause (B) of clause (ii); (iv) has been the
206	206	187subject of a substantiated case of patient abuse or neglect involving material failure to provide
207	207	188adequate protection or services for the resident in order to prevent such abuse or neglect; or (v)
208	208	189has over the course of its operation been cited for repeated, serious and willful violations of rules
209	209	190and regulations governing the operation of said entity that indicate a disregard for resident safety
210	210	191and an inability to responsibly operate an assisted living residence.
211	211	192 Section 5. (a) The department or its authorized designee shall biennially review all
212	212	193assisted living residences; provided, however, that an authorized designee shall not include
213	213	194sponsors of assisted living residences.
214	214	195 (b) Prior to the issuance of the sponsor's initial certification, the department shall conduct
215	215	196a review to determine whether an assisted living residence is compliant with this chapter;
216	216	197provided, however, that the department may conduct such review of an assisted living residence
217	217	198at any time the department has probable cause to believe that such assisted living residence is in
218	218	199violation of a provision of this chapter or any regulation promulgated thereunder. Such review
219	219	200shall include: (i) an inspection of every part of the common areas of the assisted living residence
220	220	201and the living quarters of a resident with the resident's prior consent; (ii) an examination of the
221	221	202operating plan; (iii) an examination of a resident's service plan and written progress reports with
222	222	203the resident’s consent; and (iv) resident satisfaction surveys. An inspector shall have authority to
223	223	204confidentially and privately interview the sponsor, manager, staff and residents.
224	224	205 (c) Reviews of assisted living residences certified to provide basic health services shall
225	225	206include an inspection of records associated with the provision of basic health services, a review
226	226	207of residence employee qualifications and the residence’s operating plan. 11 of 65
227	227	208 (d) Upon the completion of an annual or biennial review, the department shall prepare a
228	228	209written report summarizing all pertinent information obtained during the review and shall not
229	229	210disclose confidential or privileged information obtained in connection with such review. The
230	230	211department shall promulgate rules and regulations necessary to ensure the sponsor receives such
231	231	212report and, if applicable, has the opportunity to respond to and resolve any findings of
232	232	213noncompliance prior to departmental enforcement action. Completed reports, responses and
233	233	214notices of final action shall be made available to the public at the department during business
234	234	215hours together with the responses of the applicants or the sponsors and said reports, responses
235	235	216and notices of final action shall be posted on the website of the department.
236	236	217 Section 6. (a) If the department determines a sponsor or applicant has failed or refused to
237	237	218comply with requirements established under this chapter or the regulations promulgated
238	238	219thereunder, the department may: (i) deny an application for recertification; (ii) modify, suspend
239	239	220or revoke a certification; or (iii) issue a fine of not more than $500 for each day of such failure or
240	240	221refusal to comply.
241	241	222 (b) Notice of enforcement action and a sponsor’s right to an adjudicatory proceeding
242	242	223shall be governed by the provisions of chapter 30A.
243	243	224 SECTION 7. Section 8 of said chapter 19D, as so appearing, is hereby amended by
244	244	225striking out, in lines 14 and 15, the words “Any person who violates this subsection shall be
245	245	226subject to” and inserting in place thereof the following words:- A violation of this subsection
246	246	227shall constitute a violation of chapter 93A and shall be punishable by. 12 of 65
247	247	228 SECTION 8. Section 10 of said chapter 19D, as so appearing, is hereby amended by
248	248	229striking out subsections (b) to (d), inclusive, and inserting in place thereof the following 9
249	249	230subsections:-
250	250	231 (b) The sponsor of the assisted living residence may provide or arrange for the provision
251	251	232of additional services, including: (i) barber and beauty services, sundries for personal
252	252	233consumption and other amenities; (ii) local transportation for medical and recreational purposes;
253	253	234(iii) assistance with and supervision of instrumental activities of daily living; (iv) assistance to
254	254	235residents with accessing telehealth services; (v) basic health services for residents whose service
255	255	236plan includes basic health services, in accordance with the requirements set forth within this
256	256	237chapter, by personnel who meet standards for professional qualifications and training set forth in
257	257	238regulations promulgated pursuant to this chapter; and (vi) ancillary services for health-related
258	258	239care including, but not limited to, restorative therapies, podiatry, hospice care, home health or
259	259	240other such services; provided, however, that such services shall be delivered by an individual
260	260	241licensed to provide such care.
261	261	242 (c) No employee of an assisted living residence shall control or manage the funds or
262	262	243property of an assisted living resident; provided, however, that if a resident is unable to manage
263	263	244their funds or property, the assisted living residence shall arrange money management and other
264	264	245financial arrangements with an independent party.
265	265	246 (d) A residence certified to provide basic health services may advertise, market and
266	266	247otherwise promote offered services under this chapter and inform residents of the option to
267	267	248directly procure such services from qualified third parties. 13 of 65
268	268	249 (e) The residence shall disclose to each resident through the assisted living residence’s
269	269	250residency agreement the fees associated with basic health services and shall review such fees
270	270	251with the resident upon the implementation of and any revision to a service plan that includes
271	271	252provision of basic health services. The residence shall notify residents of any changes in fees in
272	272	253advance and in a timely manner. Residents who receive basic health services shall receive an
273	273	254additional service plan review on a quarterly basis and shall have the opportunity to discontinue
274	274	255receiving basic health services from the residence upon written notice to the residence and shall
275	275	256not be charged a cancellation fee or a fee for services not provided due to discontinuation of the
276	276	257services.
277	277	258 (f) The department, in consultation with the department of public health, shall promulgate
278	278	259regulations governing the application, criteria for approval or disapproval of such application,
279	279	260and ongoing oversight of residences that elect to offer basic health services authorized in this
280	280	261section. The department may impose an annual fee on assisted living residences that offer basic
281	281	262health services.
282	282	263 (g) To ensure patient safety and clinical competence in the application of subsections (d)
283	283	264to (f), inclusive, the department and the department of public health shall establish operating plan
284	284	265requirements for residences that opt to provide basic health services, including staff access to a
285	285	266licensed practical nurse or registered nurse for consultation at all times; provided, however, that
286	286	267the nurse shall not be required to be on the premises. The department shall make available
287	287	268electronic copies of the required components of operating plans on the department’s website and
288	288	269shall conduct annual compliance reviews on the documentation created and maintained by
289	289	270assisted living residences for an assisted living resident who received basic health services within
290	290	271the previous 12-month period. 14 of 65
291	291	272 (h) No residence shall offer or provide basic health services without first being certified
292	292	273by the department. If the department determines that a residence is offering basic health services
293	293	274without certification, the department shall issue a fine of not more than $1,000 per day.
294	294	275 (i) A residence shall report an incident involving basic health services that causes a
295	295	276resident harm at the residence not later than 24 hours of said incident. The department shall
296	296	277investigate said incidents and may, at the department’s discretion, impose a fine or otherwise
297	297	278take an enforcement action if the department determines that the basic health services resulted in
298	298	279injury to a resident.
299	299	280 (j) The department shall establish criteria to evaluate the quality of basic health services
300	300	281offered by a residence and shall annually publish its evaluation of residences on the department’s
301	301	282website. Such evaluation shall include history of incidents leading to an enforcement action by
302	302	283the department pursuant to subsection (i).
303	303	284 SECTION 9. Section 11 of said chapter 19D, as so appearing, is hereby amended by
304	304	285striking out, in lines 1 to 5, inclusive, the words “No assisted living residence shall admit any
305	305	286resident who requires twenty-four hour skilled nursing supervision. No assisted living residence
306	306	287shall provide, or admit or retain any resident in need of skilled nursing care unless all of the
307	307	288following are the case” and inserting in place thereof the following words:- No assisted living
308	308	289residence shall admit a resident who requires 24-hour skilled nursing supervision unless such
309	309	290resident elects to receive basic health services from residences that are certified to provide such
310	310	291services or from qualified third parties. No assisted living residence shall provide skilled nursing
311	311	292care or admit or retain a resident in need of skilled nursing care unless such resident elects to
312	312	293receive basic health services and the following criteria are met. 15 of 65
313	313	294 SECTION 10. Section 15 of said chapter 19D, as so appearing, is hereby amended by
314	314	295striking out subsection (c) and inserting in place thereof the following subsection:-
315	315	296 (c) No assisted living residence shall discharge, discipline, discriminate against or
316	316	297otherwise retaliate against an employee or resident who, in good faith, files a complaint with or
317	317	298provides information to the department relative to what the employee or resident reasonably
318	318	299believes is a violation of law, rule or regulation or poses a risk to public health or safety or
319	319	300resident or staff well-being. An assisted living residence in violation of this section shall be liable
320	320	301to the person retaliated against by a civil action for up to treble damages, costs and attorney’s
321	321	302fees in the event such violation shall be determined to be egregious or willful.
322	322	303 SECTION 11. Said chapter 19D is hereby further amended by adding the following
323	323	304section:-
324	324	305 Section 19. The department shall promulgate regulations necessary to implement the
325	325	306requirements of this chapter. Such regulations shall include the establishment of standards
326	326	307concerning the education, training and experience of the managers and residence employees,
327	327	308including service coordinators.
328	328	309 SECTION 12. Chapter 111 of the General Laws is hereby amended by striking out
329	329	310section 71, as appearing in the 2022 Official Edition, and inserting in place thereof the following
330	330	311section: -
331	331	312 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the
332	332	313following words shall, unless the context clearly requires otherwise, have the following
333	333	314meanings: 16 of 65
334	334	315 “Applicant”, any person who applies to the department for a license to establish or
335	335	316maintain and operate a long-term care facility.
336	336	317 “Charitable home for the aged”, any institution, however named, conducted for charitable
337	337	318purposes and maintained for the purpose of providing a retirement home for elderly persons and
338	338	319which may provide nursing care within the home for its residents.
339	339	320 “Cohorting”, the practice of grouping patients who: (i) are colonized or infected with the
340	340	321same organism in order to confine their care to 1 area and prevent contact with other patients; or
341	341	322(ii) are not colonized or infected with the same organism in order to confine their care to 1 area
342	342	323and prevent contact with other patients.
343	343	324 “Convalescent or nursing home”, any institution, however named, including a skilled
344	344	325nursing facility, whether conducted for profit or not for profit, which is advertised, announced or
345	345	326maintained for the express or implied purpose of caring for 4 or more persons admitted thereto
346	346	327for the purpose of nursing or convalescent care.
347	347	328 “Correct by date”, the date by which a licensee shall remedy or correct any violation
348	348	329discovered after an inspection by the department pursuant to section 72E.
349	349	330 “Endemic level”, the usual level of a given disease in a geographic area.
350	350	331 “Intermediate care facility for persons with an intellectual disability”, any institution,
351	351	332however named, that: (i) is conducted for charity or not for profit; (ii) is advertised, announced or
352	352	333maintained for the purpose of providing rehabilitative services and active treatment to persons
353	353	334with an intellectual disability or persons with related conditions, as defined in regulations
354	354	335promulgated pursuant to Title XIX of the federal Social Security Act, Public Law 89-97; (iii) is 17 of 65
355	355	336not both owned and operated by a state agency; and (iv) makes application to the department for
356	356	337a license for the purpose of participating in the federal program established by said Title XIX.
357	357	338 “Isolating”, the process of separating persons colonized or infected with a communicable
358	358	339disease from those who are not colonized or infected with a communicable disease.
359	359	340 “License”, an initial or renewal license issued by the department and which permits the
360	360	341licensee to establish or maintain and operate a long-term care facility.
361	361	342 “Licensee”, a person permitted to establish or maintain and operate a long-term care
362	362	343facility through a license.
363	363	344 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home,
364	364	345skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest
365	365	346home.
366	366	347 “Long-term care services”, services including: (i) long-term resident, nursing,
367	367	348convalescent or rehabilitative care; (ii) supervision and care incident to old age for ambulatory
368	368	349persons; or (iii) retirement home care for elderly persons.
369	369	350 “Management company”, an organization engaged by a licensee to manage the operations
370	370	351at a long-term care facility.
371	371	352 “Outbreak”, any unusual occurrence of disease or any disease above endemic levels.
372	372	353 “Owner”, any person with an ownership interest of not less than 5 per cent, or with a
373	373	354controlling interest in an applicant, licensee, potential transferee or the real property on which a
374	374	355long-term care facility is located. 18 of 65
375	375	356 “Person”, an individual, trust, partnership, association, corporation or other form of
376	376	357business association.
377	377	358 “Potential transferee”, a person who submits to the department a notice of intent to
378	378	359acquire the facility operations of a currently operating long-term care facility.
379	379	360 “Religious and recreational activities”, any religious, social or recreational activity that is
380	380	361consistent with the resident’s preferences and choosing, regardless of whether the activity is
381	381	362coordinated, offered, provided or sponsored by facility staff or by an outside activities provider.
382	382	363 “Resident”, an individual who resides in a long-term care facility.
383	383	364 “Rest home”, any institution, however named, which is advertised, announced or
384	384	365maintained for the express or implied purpose of providing care incident to old age to 4 or more
385	385	366persons who are ambulatory and who do not require a specific level of nursing care or other
386	386	367medically related services on a routine basis.
387	387	368 “Skilled nursing facility”, any institution, however named, whether conducted for profit
388	388	369or not for profit, which is certified by the federal Centers for Medicare and Medicaid Services for
389	389	370the purpose of providing continuous skilled nursing care and rehabilitative services for 4 or more
390	390	371persons.
391	391	372 “Small house nursing home”, 1 or more units of a convalescent or nursing home designed
392	392	373and modeled as a residential home including a central living space, kitchen, dining area, living
393	393	374area and outdoor space.
394	394	375 “Transfer of facility operations”, a transfer of the operations of a long-term care facility
395	395	376from a licensee to a potential transferee. 19 of 65
396	396	377 (b)(1) The department shall issue for a term of 2 years, and shall renew for like terms, a
397	397	378license, subject to the restrictions in this section, to each applicant the department deems
398	398	379responsible and suitable to establish or maintain and operate a long-term care facility and which
399	399	380meets all other requirements for long-term care facility licensure pursuant to this chapter. A
400	400	381license issued pursuant to this section shall not be transferable or assignable and shall be issued
401	401	382only for the premises named in the application.
402	402	383 (2) Each long-term care facility shall be subject to not less than 1 periodic, resident-
403	403	384centered inspection per year for the purpose of gathering information about the quality of
404	404	385services furnished in the long-term care facility to determine compliance with applicable state
405	405	386and federal requirements.
406	406	387 (3) The department may, when public necessity and convenience require, or to prevent
407	407	388undue hardship to an applicant or licensee, pursuant to such rules and regulations as it may
408	408	389adopt, grant a temporary provisional or probationary license pursuant to this section; provided,
409	409	390however, that no such license shall be for a term exceeding 1 year.
410	410	391 (4) The fee for a license to establish or maintain and operate a long-term care facility
411	411	392shall be determined annually by the secretary of administration and finance pursuant to section
412	412	3933B of chapter 7.
413	413	394 (c) The department shall not issue a license to establish or maintain an intermediate care
414	414	395facility for persons with an intellectual disability unless the department determines that there is a
415	415	396need for such a facility at the designated location; provided, however, that in the case of a facility
416	416	397previously licensed as an intermediate care facility for persons with an intellectual disability in
417	417	398which there is a change in ownership or transfer of operations, no such determination shall be 20 of 65
418	418	399required; and provided further, that in the case of a facility previously licensed as an intermediate
419	419	400care facility for persons with an intellectual disability in which there is a change in location, such
420	420	401determination shall be limited to consideration of the suitability of the new location.
421	421	402 (d)(1) In the case of the transfer of facility operations of a long-term care facility, a
422	422	403potential transferee shall submit a notice of intent to acquire to the department not less than 90
423	423	404days prior to the proposed transfer date. The notice of intent to acquire shall be on a form
424	424	405supplied by the department and shall be deemed complete upon submission of all information the
425	425	406department requires on said form. The potential transferee shall be deemed responsible and
426	426	407suitable upon the expiration of the 90-day period, or upon the expiration of said period as
427	427	408extended, if the department fails to notify said potential transferee in writing of its decision
428	428	409within the 90-day period or within the expiration of the extension period, whichever is
429	429	410applicable.
430	430	411 (2) A potential transferee shall, concurrently with the submission of an intent to acquire,
431	431	412provide notice to the current staff of the facility, and to any labor organization that represents the
432	432	413facility’s staff at the time the notice of intent to acquire is submitted, of the potential transferee’s
433	433	414plans to retain or not retain the facility staff and to recognize and bargain with any labor
434	434	415organizations currently representing the facility staff.
435	435	416 (3) Upon determination by the department that a potential transferee is responsible and
436	436	417suitable for licensure, the potential transferee may file an application for a license. In the case of
437	437	418a potential transfer of facility operations, the filing of an application for a license shall have the
438	438	419effect of a temporary provisional or probationary license until the department takes final action
439	439	420on such application. 21 of 65
440	440	421 (4) Upon an approved transfer of facility operations, the department shall not reduce the
441	441	422number of beds it originally approved in granting a license, unless a reduction in the number of
442	442	423beds is in the interest of public health, welfare or safety.
443	443	424 (e) Every applicant for a license shall provide on or with its application, and every
444	444	425potential transferee shall provide on or with its notice of intent to acquire, a sworn statement of
445	445	426the names and addresses of any owner of the applicant or the potential transferee.
446	446	427 (f) No license shall be issued to an applicant or potential transferee prior to a
447	447	428determination by the department that the applicant or potential transferee is responsible and
448	448	429suitable pursuant to subsection (g).
449	449	430 (g) For the purposes of this section, the department’s determination of responsibility and
450	450	431suitability shall include, but shall not be limited to, the following factors:
451	451	432 (1) the criminal history of the applicant or the potential transferee, including its respective
452	452	433owners and management companies, and, to the extent possible, the civil litigation history of the
453	453	434applicant or potential transferee, including its respective owners and contracted management
454	454	435companies, including litigation related to the operation of a long-term care facility, such as
455	455	436quality of care, safety of residents or staff, employment and labor issues, fraud, unfair or
456	456	437deceptive business practices and landlord-tenant issues; provided, however, that such criminal
457	457	438and civil litigation history may include pending or other court proceedings in the commonwealth
458	458	439and in any other state or federal jurisdiction. Any information obtained by the department
459	459	440pursuant to this section that is related to criminal or civil litigation or otherwise protected from
460	460	441public disclosure by federal or state law shall be confidential and exempt from disclosure under
461	461	442clause Twenty-sixth of section 7 of chapter 4 and chapter 66; 22 of 65
462	462	443 (2) the financial capacity of the applicant or potential transferee, including its respective
463	463	444owners and management companies, to establish or maintain and operate a long-term care
464	464	445facility; provided, that financial capacity may include, but shall not be limited to, recorded liens
465	465	446or unpaid fees or taxes in the commonwealth or in other states;
466	466	447 (3) the history of the applicant or potential transferee, including its respective owners and
467	467	448management companies, and if applicable, the involvement of private equity firms, in providing
468	468	449quality long-term care in the commonwealth as measured by compliance with applicable quality
469	469	450measures, statutes and regulations governing the operation of long-term care facilities; provided,
470	470	451however, that applicable quality measures may include the Centers for Medicare and Medicaid
471	471	452Services Quality Rating System; and
472	472	453 (4) the history of the applicant or potential transferee, including its respective owners and
473	473	454management companies, and if applicable, the involvement of private equity firms, in providing
474	474	455quality long-term care in states other than the commonwealth, if any, as measured by compliance
475	475	456with the applicable quality measures, statutes and regulations governing the operation of long-
476	476	457term care facilities in said states; provided, however, that applicable quality measures may
477	477	458include the Centers for Medicare and Medicaid Services Quality Rating System.
478	478	459 (h)(1) If the department determines that an applicant or potential transferee is not
479	479	460responsible and suitable, the department’s determination shall take effect on the date of the
480	480	461department’s notice to the applicant or potential transferee. In such cases and upon the filing of a
481	481	462written request, the department shall afford the applicant or potential transferee an adjudicatory
482	482	463hearing pursuant to chapter 30A. 23 of 65
483	483	464 (2) During the pendency of an adjudicatory hearing, the applicant or potential transferee
484	484	465shall not operate the facility as a licensee, nor, without prior approval of the department, manage
485	485	466such facility.
486	486	467 (i) Each applicant, potential transferee and licensee shall maintain current records of all
487	487	468information provided to the department. After the applicant, potential transferee or licensee
488	488	469becomes aware of any change related to information it has provided or is required to provide to
489	489	470the department, such person shall submit to the department written notice of the change as soon
490	490	471as practicable and without unreasonable delay; provided, that any change in financial status shall
491	491	472be provided to the department and shall include, but shall not be limited to, filing for bankruptcy,
492	492	473any default under a lending agreement or under a lease, the appointment of a receiver or the
493	493	474recording of any lien. Failure to provide timely notice of such change shall be subject to the
494	494	475remedies or sanctions available to the department pursuant to this chapter.
495	495	476 (j) An applicant, potential transferee or licensee and its respective owners and
496	496	477management companies shall comply with all applicable federal, state and local laws, rules and
497	497	478regulations.
498	498	479 (k)(1) Prior to entering into a contract with a management company, an applicant,
499	499	480potential transferee or licensee shall notify and receive a determination from the department that
500	500	481the management company is responsible and suitable to manage a long-term care facility.
501	501	482 (2) In its notification to the department and to inform the department’s review, the
502	502	483applicant, potential transferee or licensee shall provide the proposed management company’s
503	503	484name, contact information and any other information on the proposed management company and
504	504	485its personnel that may be reasonably requested by the department, including, but not limited to, 24 of 65
505	505	486information required pursuant to subsection (g). Upon a determination by the department that the
506	506	487proposed management company is responsible and suitable to manage a long-term care facility,
507	507	488the applicant, potential transferee or licensee may engage said company to manage the long-term
508	508	489care facility.
509	509	490 (3) The applicant, potential transferee or licensee shall memorialize any such engagement
510	510	491in a written agreement with the management company. Such written agreement shall include a
511	511	492requirement that the management company and its personnel comply with all applicable federal,
512	512	493state and local laws, regulations and rules. Promptly after the effective date of any such
513	513	494agreement, the applicant, potential transferee or licensee shall provide to the department a copy
514	514	495of the valid, fully executed agreement. Any payment terms included in the agreement shall be
515	515	496confidential and exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 and
516	516	497chapter 66.
517	517	498 (4) If the department determines that a management company is not responsible and
518	518	499suitable, the department’s determination shall take effect on the date of the department’s notice
519	519	500to the applicant, potential transferee or licensee. In such cases and upon the filing of a written
520	520	501request, the department shall afford the applicant, potential transferee, licensee or management
521	521	502company an adjudicatory hearing pursuant to chapter 30A.
522	522	503 (l) The department shall not reduce the number of beds it originally approved in granting
523	523	504a license for a convalescent or nursing home or rest home upon the transfer of facility operations
524	524	505of said convalescent or nursing home or rest home from 1 licensee to another, unless a reduction
525	525	506in the number of beds is in the interest of public health, welfare or safety. 25 of 65
526	526	507 (m)(1) The department shall not issue a license unless the applicant first submits to the
527	527	508department, with respect to each building occupied by residents: (i) a certificate of inspection of
528	528	509the egresses, the means of preventing the spread of fire and apparatus for extinguishing fire,
529	529	510issued by an inspector of the office of public safety and inspections within the division of
530	530	511professional licensure; and (ii) a certificate of inspection issued by the head of the local fire
531	531	512department certifying compliance with local ordinances; provided, however, that for
532	532	513convalescent or nursing homes, the division of health care quality within the department shall
533	533	514have sole authority to inspect and issue a certificate required pursuant to clause (i) of this
534	534	515paragraph.
535	535	516 (2) Any applicant who is aggrieved, on the basis of a written disapproval of a certificate
536	536	517of inspection by the head of the local fire department or by the office of public safety and
537	537	518inspections of the division of occupational licensure, may, within 30 days from such disapproval,
538	538	519appeal in writing to the division of occupational licensure. Failure to either approve or
539	539	520disapprove within 30 days after a written request by an applicant shall be deemed a disapproval.
540	540	521For certificates of inspection issued to convalescent or nursing homes by the bureau of health
541	541	522care safety and quality within the department, an applicant may, within 30 days of disapproval of
542	542	523a certificate of inspection, submit a written appeal to the department; provided, however, that
543	543	524failure of the department to either approve or disapprove of a written appeal within 30 days of
544	544	525the submission of such written appeal shall constitute a disapproval.
545	545	526 (3) If the division of occupational licensure or, where applicable, the department
546	546	527approves the issuance of a certificate of inspection after an appeal, the certificate shall be issued
547	547	528by the issuing agency. If the division of occupational licensure or, where applicable, the
548	548	529department does not approve the issuance of a certificate of inspection, the applicant may appeal 26 of 65
549	549	530to the superior court. Failure of said division or said department to either approve or disapprove
550	550	531the issuance of a certificate of inspection within 30 days after receipt of an appeal shall be
551	551	532deemed a disapproval. The department shall not issue a license until issuance of an approved
552	552	533certificate of inspection, as required pursuant to paragraph (1).
553	553	534 (4) Nothing in this section or in sections 72 or 73 shall be construed to supersede or
554	554	535otherwise affect any laws, ordinances, by-laws, rules or regulations relating to building, zoning,
555	555	536registration or maintenance of a long-term care facility.
556	556	537 (n)(1) For cause, the department may limit, restrict, suspend or revoke a license;
557	557	538provided, however, that the department may temporarily suspend a license without a hearing if:
558	558	539(i) the suspension is due to an emergency; and (ii) the department allows for a hearing on the
559	559	540suspension in a reasonable timeframe.
560	560	541 (2) Grounds for cause on which the department may take action pursuant to paragraph (1)
561	561	542shall include: (i) substantial or sustained failure or inability to provide adequate care to residents;
562	562	543(ii) substantial or sustained failure to maintain compliance with applicable statutes, rules and
563	563	544regulations; or (iii) the lack of financial capacity to maintain and operate a long-term care
564	564	545facility.
565	565	546 (3) The limits or restrictions the department may impose on a licensee include requiring a
566	566	547facility to limit new admissions.
567	567	548 (4) Suspension of a license may include suspending the license during a pending license
568	568	549revocation action or suspending the license to permit the licensee a period of time, not less than
569	569	55060 days, to terminate operations, and discharge and transfer all residents, if applicable. 27 of 65
570	570	551 (5) With respect to an order by the department to limit, restrict or suspend a license,
571	571	552within 7 days of receipt of the written order, the licensee may file a written request with the
572	572	553department for an adjudicatory proceeding pursuant to chapter 30A.
573	573	554 (6) Upon a written request by a licensee who is aggrieved by the revocation or limitation
574	574	555of a license or by an applicant who is aggrieved by the refusal of the department to renew a
575	575	556license, the licensee or applicant so aggrieved shall have all the rights provided in chapter 30A
576	576	557with respect to adjudicatory proceedings. In no case shall the revocation of such a license take
577	577	558effect in less than 30 days after written notification by the department to the licensee.
578	578	559 (o) In the case of the new construction of, or major addition, alteration or repair to, any
579	579	560long-term care facility, preliminary and final architectural plans and specifications shall be
580	580	561submitted to a qualified person designated by the commissioner. Written approval of the final
581	581	562architectural plans and specifications shall be obtained from said person prior to said new
582	582	563construction or major addition, alteration or repair.
583	583	564 (p) Notwithstanding any of the other provisions of this section, the department shall not
584	584	565issue a license to establish or maintain and operate a long-term care facility to an applicant who
585	585	566applies to the department for said license to establish or maintain and operate a convalescent or
586	586	567nursing home unless the applicant for such license submits to the department a certificate that
587	587	568each building to be occupied by residents of such convalescent or nursing home meets the
588	588	569construction standards of the state building code, and is of at least type 1–B fireproof
589	589	570construction; provided, however, that this subsection shall not apply in the instance of a transfer
590	590	571of facility operations of a convalescent or nursing home whose license has not been revoked as
591	591	572of the time of such transfer; and provided, further, that a public medical institution as defined in 28 of 65
592	592	573section 8 of chapter 118E, which meets the construction standards as defined herein, shall not be
593	593	574denied a license as a long-term care facility pursuant to this section because it was not of new
594	594	575construction and designed for the purpose of operating a long-term care facility at the time of
595	595	576application for a license to operate a long-term care facility. An intermediate care facility for
596	596	577persons with an intellectual disability shall be required to meet the construction standards
597	597	578established for such facilities by Title XIX of the Social Security Act, Public Law 89-97 and any
598	598	579regulations promulgated pursuant thereto, and by regulations promulgated by the department.
599	599	580 (q) The department shall notify the secretary of elder affairs of the pendency of any
600	600	581proceeding, public hearing or action to be taken pursuant to this section relating to any
601	601	582convalescent or nursing home, rest home or charitable home for the aged. The department shall
602	602	583notify the commissioner of the department of developmental services of the pendency of any
603	603	584proceeding, public hearing or action to be taken pursuant to this section relating to any
604	604	585intermediate care facility for persons with an intellectual disability.
605	605	586 (r) The department shall notify the clerks of the senate and house of representatives, the
606	606	587joint committee on elder affairs and the senate and house committees on ways and means within
607	607	5883 business days of being notified of a long-term care facility’s decision to close pursuant to
608	608	589department regulations.
609	609	590 SECTION 13. Said chapter 111 is hereby further amended by striking out section 72, as
610	610	591so appearing, and inserting in place thereof the following section:-
611	611	592 Section 72. (a)(1) The department shall classify long-term care facilities and shall, after a
612	612	593public hearing, promulgate rules and regulations for the conduct of such facilities. Rules and
613	613	594regulations for long-term care facilities shall include, but not be limited to, minimum 29 of 65
614	614	595requirements for medical and nursing care, the keeping of proper medical and nursing records,
615	615	596uniform requirements for the handling of patient funds, minimum requirements relative to the
616	616	597prevention and reparation of lost or damaged patient possessions, including personal clothing
617	617	598and minimum requirements relative to facility sanitation.
618	618	599 (2) Regulations for intermediate care facilities for persons with an intellectual disability
619	619	600shall, in addition to the requirements pursuant to paragraph (1), include minimum requirements
620	620	601for social services, psychological services and other services appropriate for the care of persons
621	621	602with an intellectual disability and shall limit the size of such facilities to not more than 15 beds.
622	622	603 (3) The department in promulgating rules and regulations for long-term care facilities
623	623	604shall consider the ability of long-term care facilities to provide service under rates set pursuant to
624	624	605section 13C of chapter 118E. No such rule or regulation shall apply to a long-term care facility
625	625	606licensed at the time of promulgation of such rule or regulation, or a long-term care facility being
626	626	607constructed at the time of such promulgation under plans approved by the department, unless
627	627	608such rule or regulation has a direct and material relation to patient diet, cleanliness, nursing care
628	628	609or health, or to habilitative services and active treatment for persons with an intellectual
629	629	610disability or persons with related conditions; provided, however, that nothing herein contained
630	630	611shall be interpreted to prevent the department from adopting or interpreting rules and regulations
631	631	612more favorable toward existing long-term care facilities.
632	632	613 (4) The department may authorize specialized care units serving persons requiring
633	633	614treatment for infectious diseases, isolation, strokes, degenerative neurological conditions,
634	634	615traumatic brain injuries, in-house dialysis treatments, behavioral health treatments, substance use
635	635	616disorder treatments, bariatric patient care and conditions requiring 24-hour or 1-on-1 patient 30 of 65
636	636	617supervision. The department may promulgate rules and regulations to regulate the conduct of any
637	637	618such specialized care units.
638	638	619 (b)(1) The department or its agents and the board of health or its agents of the city or
639	639	620town wherein any portion of such long-term care facility is located may visit and inspect such
640	640	621institution at any time; provided, that a board of health or its agents conducting an inspection of a
641	641	622long-term care facility located within its city or town shall notify the department of the results of
642	642	623any inspection conducted pursuant to this paragraph.
643	643	624 (2) Any person making an inspection pursuant to paragraph (1) shall record in writing
644	644	625every violation of the applicable rules and regulations of the department that they discover
645	645	626during the course of their inspection. Every record of inspection shall be treated as a public
646	646	627record except to such extent the record or a portion thereof is expressly exempt from such
647	647	628treatment pursuant to clause Twenty-sixth of section 7 of chapter 4. A record of inspection
648	648	629containing violations shall be made public by the department at the same time that a written plan
649	649	630of correction is submitted. If a written plan of correction is not submitted within the allowable
650	650	631time, said violations shall be made public at the expiration of the allowable time. Inspections
651	651	632hereunder shall be unannounced and made at such intervals as the department shall specify in its
652	652	633rules and regulations; provided, that, each long-term care facility shall be subject to not less than
653	653	6341 periodic, resident-centered inspection per year pursuant to subsection (b) of section 71. A visit
654	654	635made to a facility for the purpose of providing consultation shall not be considered to be an
655	655	636inspection.
656	656	637 (c) The superior court shall have jurisdiction in equity to enforce the rules and regulations
657	657	638promulgated pursuant to this section. 31 of 65
658	658	639 (d)(1) The department shall promulgate regulations for the construction, physical plant
659	659	640standards and operation of small house nursing homes. Newly constructed small house nursing
660	660	641homes shall house no more than 14 individuals per unit, in resident rooms that accommodate not
661	661	642more than 1 resident per room; provided, however, that if a resident requests to share a room
662	662	643with another resident to accommodate a spouse, partner, family member or friend, such resident
663	663	644room shall have sufficient space and equipment, as established by the department, for 2
664	664	645residents; provided, further, that determinations to grant such requests shall be determined based
665	665	646on space and availability of rooms. All resident rooms shall contain a full private and accessible
666	666	647bathroom.
667	667	648 (2) The department shall promulgate regulations for construction and physical plant
668	668	649standards for small house nursing homes that shall consider environmental standards and
669	669	650sustainability.
670	670	651 (3) The department may promulgate additional regulations for small house nursing homes
671	671	652for a staffing model that: (i) allows for a universal worker approach to resident care that is
672	672	653organized to support and empower all staff to respond to the needs and desires of residents,
673	673	654including, but not limited to, cooking and meal preparation, without exceeding the lawful scope
674	674	655of practice of said employee; and (ii) provides for consistent staff in each small house nursing
675	675	656home.
676	676	657 (4) The regulations promulgated pursuant to this subsection shall ensure the convalescent
677	677	658or nursing home meets the requirements necessary to be eligible to participate in both the
678	678	659Medicare and Medicaid programs. 32 of 65
679	679	660 SECTION 14. Said chapter 111 is hereby further amended by striking out section 72E, as
680	680	661so appearing, and inserting in place thereof the following section:-
681	681	662 Section 72E. (a) The department shall, after every inspection by its agent pursuant to
682	682	663section 72, provide the licensee of the inspected long-term care facility notice in writing of every
683	683	664violation of the applicable statutes, rules and regulations found during said inspection. With
684	684	665respect to the date by which the licensee shall remedy or correct each violation, the department
685	685	666in such notice shall specify a reasonable time, not more than 60 days after receipt, by which time
686	686	667the licensee shall remedy or correct each violation cited or, in the case of any violation which in
687	687	668the opinion of the department is not reasonably capable of correction within 60 days, the
688	688	669department shall require only that the licensee submit a written plan for the timely correction of
689	689	670the violation in a reasonable manner. The department may modify any nonconforming plan upon
690	690	671notice, in writing, to the licensee.
691	691	672 (b) Failure to remedy or correct a cited violation by the correct by date shall be cause to
692	692	673pursue or impose the remedies or sanctions available to the department pursuant to this chapter,
693	693	674unless the licensee demonstrates to the satisfaction of the department or a court, where
694	694	675applicable, that such failure was not due to any neglect of its duty and occurred despite an
695	695	676attempt in good faith to make correction by the correct by date. An aggrieved licensee may
696	696	677pursue the remedies available to it pursuant to chapter 30A.
697	697	678 (c) If the department determines the licensee failed to maintain substantial or sustained
698	698	679compliance with applicable state and federal laws, rules and regulations, in addition to imposing
699	699	680any of the other remedies or sanctions available to it, the department may require the licensee to
700	700	681engage, at the licensee’s own expense, a temporary manager to assist the licensee with bringing 33 of 65
701	701	682the facility into substantial compliance and with sustaining such compliance. Such temporary
702	702	683manager shall be subject to the department’s approval; provided, that such approval shall not be
703	703	684unreasonably withheld. Any such engagement of a temporary manager shall be for a period of
704	704	685not less than 3 months and shall be pursuant to a written agreement between the licensee and the
705	705	686management company. A copy of said agreement shall be provided by the licensee to the
706	706	687department promptly after execution. Any payment terms included in the agreement shall be
707	707	688confidential and exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter
708	708	6894 and chapter 66.
709	709	690 (d) Nothing in this section shall be construed to prohibit the department from enforcing a
710	710	691statute, rule or regulation, administratively or in court, without first affording formal opportunity
711	711	692to make correction pursuant to this section, where, in the opinion of the department, the violation
712	712	693of such statute, rule or regulation jeopardizes the health or safety of residents or the public or
713	713	694seriously limits the capacity of a licensee to provide adequate care, or where the violation of such
714	714	695statute, rule or regulation is the second such violation occurring during a period of 12 full
715	715	696months.
716	716	697 SECTION 15. Section 72K of said chapter 111, as appearing in the 2022 Official Edition,
717	717	698is hereby amended by striking out subsection (b) and inserting in place thereof the following 2
718	718	699subsections:-
719	719	700 (b) The attorney general may file a civil action against a person who: (i) commits abuse,
720	720	701mistreatment or neglect of a patient or resident; (ii) misappropriates patient or resident property;
721	721	702or (iii) wantonly or recklessly permits or causes another to commit abuse, mistreatment or
722	722	703neglect of a patient or resident or misappropriate patient or resident property. The civil penalty 34 of 65
723	723	704for such abuse, mistreatment, neglect or misappropriation shall not exceed: $25,000 if no bodily
724	724	705injury results; $50,000 if bodily injury results; $100,000 if sexual assault or serious bodily injury
725	725	706results; and $250,000 if death results. Section 60B of chapter 231 shall not apply to an action
726	726	707brought by the attorney general pursuant to this section. Nothing in this section shall preclude the
727	727	708filing of any action brought by the attorney general or a private party pursuant to chapter 93A or
728	728	709any action by the department pursuant to this chapter. The comptroller shall deposit not less than
729	729	71050 per cent of any amount secured by the attorney general as a result of a civil action brought
730	730	711pursuant to this section into the Long-Term Care Workforce and Capital Fund established in
731	731	712section 35TTT of chapter 10.
732	732	713 (c) Notwithstanding section 5 of chapter 260, the attorney general may file a civil action
733	733	714within 4 years next after an offense is committed.
734	734	715 SECTION 16. Said chapter 111 is hereby further amended by inserting after section
735	735	71672W, the following section:-
736	736	717 Section 72W½. (a) For the purposes of this section the following words shall, unless the
737	737	718context clearly requires otherwise, have the following meanings:
738	738	719 “Certified medication aide”, an employee of a long-term care facility that satisfies
739	739	720eligibility criteria established by the department and that has successfully completed the required
740	740	721training and competency testing developed by the department to administer medications to
741	741	722residents of long-term care facilities.
742	742	723 “Medication”, any non-narcotic, prescription or non-prescription drug that may be
743	743	724administered via oral, sublingual, buccal, inhalation, spray on oral mucosa, topical, nasal, ocular,
744	744	725or otic route. 35 of 65
745	745	726 (b) The department shall create a program for the certification, training and oversight of
746	746	727certified medication aides who shall be authorized to administer medications to residents of long-
747	747	728term care facilities. Certified medication aides shall be supervised by a licensed practical nurse, a
748	748	729licensed registered nurse, a licensed advanced practice registered nurse or a licensed physician,
749	749	730and shall be evaluated by their supervisor regularly, not less than once every 6 months.
750	750	731 (c) The department, in consultation with the board of registration in nursing, shall
751	751	732develop and approve training curricula, competency evaluation procedures and standards for
752	752	733qualifications of applicants for certification; provided, that such standards shall include the
753	753	734completion of not less than 60 hours of training on the proper administration of medication.
754	754	735 (d) The department shall establish regulations that include: (i) provisions for continuing
755	755	736education requirements; (ii) requirements for re-certification on a biennial basis; and (iii) fees for
756	756	737the issuance of certifications.
757	757	738 (e) The department shall allow for the creation of apprenticeship programs for resident
758	758	739care assistants and certified nurses’ aides to become certified medication aides.
759	759	740 (f) Nothing in this section shall be construed to authorize certified medication aides to
760	760	741engage in prescriptive practice.
761	761	742 (g) The department shall promulgate rules and regulations to carry out the provisions of
762	762	743this section.
763	763	744 SECTION 17. Said chapter 111 is hereby further amended by inserting after section
764	764	74572BB the following 5 sections:- 36 of 65
765	765	746 Section 72CC. (a) The department shall require long-term care facilities to develop and
766	766	747submit to the department an outbreak response plan, which shall be customized to the long-term
767	767	748care facility. The department shall review such plan to ensure compliance with the requirements
768	768	749under this section. Each long-term care facility’s plan shall include, but shall not be limited to:
769	769	750 (1) a protocol for isolating and cohorting infected and at-risk patients in the event of an
770	770	751outbreak of a contagious disease until the cessation of the outbreak;
771	771	752 (2) clear policies for the notification of residents, residents’ families, visitors and staff in
772	772	753the event of an outbreak of a contagious disease at a long-term care facility;
773	773	754 (3) information on the availability of laboratory testing, protocols for screening visitors
774	774	755and staff for the presence of a communicable disease, protocols to prohibit infected staff from
775	775	756appearing for work at the long-term care facility and processes for implementing evidence-based
776	776	757outbreak response measures;
777	777	758 (4) policies to conduct routine monitoring of residents and staff to quickly identify signs
778	778	759of a communicable disease that could develop into an outbreak;
779	779	760 (5) policies for reporting outbreaks to public health officials, including the chief
780	780	761executive officer or the chief administrative officer of the municipality in which the facility is
781	781	762located, in accordance with applicable laws and regulations; and
782	782	763 (6) policies to meet staffing, training and long-term care facility demands during an
783	783	764infectious disease outbreak and to successfully implement the outbreak response plan.
784	784	765 (b) The department shall verify that the outbreak response plans submitted by long-term
785	785	766care facilities are in compliance with the requirements of subsection (a); provided, however, that 37 of 65
786	786	767a long-term care facility shall review the outbreak response plan it submitted to the department
787	787	768pursuant to subsection (a) on an annual basis and if it makes any material changes to such plan,
788	788	769the facility shall submit to the department an updated outbreak response plan within 30 days of
789	789	770making such change. The department shall, upon receiving an updated outbreak response plan,
790	790	771verify that the plan is in compliance with the requirements of subsection (a).
791	791	772 (c)(1) Every long-term care facility shall review the outbreak response plan it submitted
792	792	773to the department pursuant to subsection (a) on an annual basis.
793	793	774 (2) If a long-term care facility makes any material changes to its outbreak response plan,
794	794	775the facility shall submit to the department an updated outbreak response plan within 30 days. The
795	795	776department shall, upon receiving an updated outbreak response plan, verify that the plan is in
796	796	777compliance with the requirements of subsection (a).
797	797	778 (d) The department shall promulgate regulations necessary to implement this section.
798	798	779 Section 72DD. (a) The division of health care facility licensure and certification shall
799	799	780establish and implement a process and program for providing training and education to staff of
800	800	781long-term care facilities licensed by the department pursuant to section 71. The training and
801	801	782education program may include, but shall not be limited to: (i) infection prevention and control;
802	802	783(ii) development, implementation, adherence and review of comprehensive resident care plans;
803	803	784(iii) falls prevention; (iv) procedures to ensure timely notification of changes in a resident’s
804	804	785condition to the resident’s primary care physician; (v) prevention of abuse and neglect; (vi)
805	805	786development and implementation of a program to ensure staff safety; and (vii) review of the
806	806	787inspection process established in section 72. 38 of 65
807	807	788 (b) The training and education program shall be interactive and shall include, but shall
808	808	789not be limited to: (i) an annual training for long-term care facility supervisory and leadership
809	809	790staff on the licensure and certification process, including, but not limited to, the department’s
810	810	791interpretation of the General Laws and relevant changes or additions to applicable rules,
811	811	792regulations, procedures and policies concerning the licensure and certification process for long-
812	812	793term care facilities; and (ii) a biannual training of staff of long-term care facilities on the most
813	813	794frequently cited deficiencies, identified deficiency trends, both state and federal, and best
814	814	795practices to ensure resident quality of care.
815	815	796 (c) The department may consult with industry trade associations before issuing or
816	816	797promulgating guidance, regulations, interpretations, program letters, memoranda or any other
817	817	798materials used in inspector training for the inspection of long-term care facilities pursuant to
818	818	799section 72.
819	819	800 Section 72EE. (a) The department shall promulgate regulations to encourage and enable
820	820	801residents of a long-term care facility to engage in in-person, face-to-face, verbal or auditory-
821	821	802based contact, communications and religious and recreational activities with others to the extent
822	822	803that in-person contact, communication or activities are not prohibited, restricted or limited by
823	823	804federal or state statute, rule or regulation. Said regulations shall include specific protocols and
824	824	805procedures to provide for residents of the facility who have disabilities that impede their ability
825	825	806to communicate, including, but not limited to, residents who are blind, deaf, have Alzheimer’s
826	826	807disease or other dementias and developmental disabilities.
827	827	808 (b) The department may distribute federal civil monetary penalty funds, subject to
828	828	809approval by the federal Centers for Medicare and Medicaid Services, and any other available 39 of 65
829	829	810federal and state funds, upon request, to facilities for communicative technologies and
830	830	811accessories pursuant to this section.
831	831	812 Section 72FF. (a) The department, in consultation with the center for health information
832	832	813and analysis, the division of medical assistance, the executive office of elder affairs and the
833	833	814health policy commission, shall annually conduct an examination and report on cost trends and
834	834	815financial performance among skilled nursing facilities. The information shall be analyzed on an
835	835	816institution-specific and industry-wide basis. The examination shall aggregate information
836	836	817collected on multiple skilled nursing facilities that are owned and operated by a single owner.
837	837	818 (b) The examination and report shall include, but shall not be limited to collection and
838	838	819analysis of: (i) gross and net patient service revenues; (ii) other sources of operating and non-
839	839	820operating revenue; (iii) trends in relative price, payer mix, case mix, utilization and length of
840	840	821stay; (iv) affiliations with other health care providers, including, but not limited to, preferred
841	841	822clinical relationships and partnerships; (v) categories of costs, including, but not limited to,
842	842	823general and administrative costs, nursing and other labor costs and salaries, building costs,
843	843	824capital costs and other operating costs; (vi) total spending on direct patient care as a percent of
844	844	825total operating expenses; (vii) operating and total margin; (viii) occupancy rates and total
845	845	826resident population; and (ix) any other relevant measures of financial performance and service
846	846	827delivery the department deems necessary; provided, that these measures shall distinguish long-
847	847	828term residents from short-stay residents where possible.
848	848	829 (c) Annually, not later than December 1, the report and any policy recommendations shall
849	849	830be filed with the clerks of the house of representatives and the senate, the house and senate
850	850	831committees on ways and means and the joint committee on elder affairs. 40 of 65
851	851	832 (d) The department shall utilize ownership information submitted as part of the long-term
852	852	833care facility licensure determination process pursuant to section 71 to determine affiliations
853	853	834between skilled nursing facilities and other health care providers as required.
854	854	835 Section 72GG. (a) As used in this section the following words shall have the following
855	855	836meanings unless the context clearly requires otherwise:
856	856	837 "Gender expression", the manner in which a person represents or expresses gender to
857	857	838others, often through behavior, clothing, hairstyles, activities, voice or mannerisms.
858	858	839 "Gender identity" or “gender”, a person’s gender identity, appearance or behavior,
859	859	840whether or not that gender identity, appearance or behavior is different from that traditionally
860	860	841associated with the person’s physiology or birth sex; provided, however, that gender identity
861	861	842may be demonstrated through medical history, care or treatment of the gender identity, consistent
862	862	843and uniform assertion of the gender identity or any other evidence that the gender identity is
863	863	844sincerely held as part of a person’s core identity; and provided further, that gender identity shall
864	864	845not be asserted for any improper purpose.
865	865	846 "Gender-nonconforming", gender expression does not conform to stereotypical
866	866	847expectations of such gender.
867	867	848 "Gender transition", a process in which a person begins to live according to that person's
868	868	849gender identity, rather than the sex the person was assigned at birth, which may include changing
869	869	850one's clothing, appearance, name or identification documents or undergoing medical treatments.
870	870	851 “HIV”, human immunodeficiency virus. 41 of 65
871	871	852 "Intersex", a person whose sexual or reproductive anatomy or chromosomal pattern is not
872	872	853consistent with typical definitions of male or female.
873	873	854 "LGBTQI", lesbian, gay, bisexual, transgender, questioning, queer and intersex.
874	874	855 "Long-term care facility staff", all individuals employed by, or contracted directly with, a
875	875	856long-term care facility.
876	876	857 "Non-binary" describes a person whose gender identity falls outside of the traditional
877	877	858gender binary structure of man and woman.
878	878	859 "Queer", a person whose gender expression, gender identity or sexual orientation does
879	879	860not conform to dominant expectations or standards.
880	880	861 "Questioning", a person who is exploring or unsure about their own sexual orientation or
881	881	862gender identity or expression.
882	882	863 "Sexual orientation", a person's romantic or sexual attraction to other people.
883	883	864 "Transgender", a person whose gender identity or gender expression differs from the birth
884	884	865sex of that person.
885	885	866 (b) Except as provided in subsection (c), long-term care facilities and long-term care
886	886	867facility staff shall not take any of the following actions based in whole or in part on a person's
887	887	868actual or perceived sexual orientation, gender identity, gender expression, intersex status or HIV
888	888	869status: 42 of 65
889	889	870 (i) denying admission to a long-term care facility, transferring or refusing to transfer a
890	890	871resident within a facility or to another facility or discharging or evicting a resident from a
891	891	872facility;
892	892	873 (ii) denying a request by residents to share a room;
893	893	874 (iii) where rooms are assigned by gender, assigning, reassigning or refusing to assign a
894	894	875room to (A) a transgender resident other than in accordance with the transgender resident's
895	895	876gender identity, unless at the transgender resident's request, or (B) a non-binary resident other
896	896	877than in accordance with the non-binary resident’s preference;
897	897	878 (iv) prohibiting a resident from using or harassing a resident for using or seeking to use, a
898	898	879restroom available to other persons of the same gender identity, regardless of whether the
899	899	880resident is making a gender transition, has taken or is taking hormones, has undergone gender
900	900	881affirmation surgery or presents as gender-nonconforming; provided, however, that for the
901	901	882purposes of this clause, harassment shall include, but not be limited to, requiring a resident to
902	902	883show identity documents to gain entrance to a restroom;
903	903	884 (v) repeatedly and intentionally failing to use a resident's chosen name or pronouns after
904	904	885being informed of the chosen name or pronouns, in a manner that constitutes discrimination or
905	905	886harassment in violation of any applicable federal, state or local law;
906	906	887 (vi) denying a resident the right to wear or be dressed in clothing, accessories or
907	907	888cosmetics or to engage in grooming practices that are permitted to any other resident; 43 of 65
908	908	889 (vii) restricting a resident's right to associate with other residents or with visitors,
909	909	890including the right to consensual sexual relations where sexual relations would not be restricted
910	910	891if the participants were heterosexual or married;
911	911	892 (viii) denying or restricting medical or nonmedical care that is appropriate to a resident's
912	912	893organs and bodily needs or providing such care that unduly demeans the resident or causes
913	913	894avoidable discomfort or harm; or
914	914	895 (ix) refusing or willfully failing to provide any service, care or reasonable
915	915	896accommodation to a resident or an applicant for services or care.
916	916	897 (c) The requirements of this section shall not apply to the extent that compliance with the
917	917	898requirement is incompatible with any professionally reasonable clinical judgment or inconsistent
918	918	899with 42 CFR § 483.15(c)(1), 42 CFR § 483.24 and 105 CMR 150.003.
919	919	900 (d) Each facility shall distribute a document containing the following notice alongside the
920	920	901informational document required by section 72AA:
921	921	902 "[Name of facility] does not discriminate and does not permit discrimination by persons
922	922	903employed by the facility including, but not limited to, abuse or harassment, on the basis of actual
923	923	904or perceived sexual orientation, gender identity, gender expression, intersex status or HIV status
924	924	905or based on association with another individual on account of that individual's actual or
925	925	906perceived sexual orientation, gender identity, gender expression, intersex status or HIV status.
926	926	907You may file a complaint with the office of the long-term care ombudsman, [provide current
927	927	908contact information] if you believe you have experienced this kind of discrimination." 44 of 65
928	928	909 (e) Each long-term care facility shall ensure that resident records, including records
929	929	910generated at the time of admission, include the resident's gender and the name and pronouns by
930	930	911which the resident would like to be identified, as indicated by the resident.
931	931	912 (f) Unless expressly authorized by the resident or the resident's authorized representative,
932	932	913long-term care facility staff not involved in providing direct care to a resident shall not be present
933	933	914during physical examination of, or the provision of personal care to, that resident if the resident
934	934	915is partially or fully unclothed.
935	935	916 (g) Transgender residents shall be provided access to such transition-related assessments,
936	936	917therapy and treatments as have been recommended by the resident's health care provider,
937	937	918including, but not limited to, transgender-related medical care, including hormone therapy and
938	938	919supportive counseling, subject to availability and third-party medical coverage.
939	939	920 (h) LGBTQI-related programming, such as an LGBTQI Pride Month event or a
940	940	921Transgender Day of Remembrance event, shall be allowed and treated equally to other cultural
941	941	922celebrations or commemorations.
942	942	923 (i) The department shall promulgate regulations relative to discipline and penalties for
943	943	924long-term care facilities that violate the requirements of this section or that employ a staff
944	944	925member who violates the requirements of this section, which shall include, but not be limited to,
945	945	926civil penalties and other administrative action. Nothing in this section shall be construed to limit
946	946	927the ability of any party to bring a civil, criminal or administrative action for conduct constituting
947	947	928a violation of any other provision of law.
948	948	929 (j) (1) A long-term care facility shall ensure that the long-term care facility staff receive
949	949	930training, on at least a biennial basis, concerning: 45 of 65
950	950	931 (i) the care of LGBTQI older adults and older adults living with HIV; and
951	951	932 (ii) the prevention of discrimination based on sexual orientation, gender identity or
952	952	933expression, intersex status and HIV status.
953	953	934 (2) The training required by this section shall include, but not be limited to:
954	954	935 (i) the definition of the terms commonly associated with sexual orientation, gender
955	955	936identity and expression, intersex status and HIV status;
956	956	937 (ii) best practices for communicating with or about LGBTQI older adults and older adults
957	957	938living with HIV and others who are LGBTQI or living with HIV, including the use of any name
958	958	939and pronouns by which residents may express the desire to be identified;
959	959	940 (iii) a description of the health and social challenges historically experienced by LGBTQI
960	960	941older adults and older adults living with HIV and others who are LGBTQI or living with HIV,
961	961	942including discrimination when seeking or receiving care at long-term care facilities, and the
962	962	943demonstrated physical and mental health effects within the LGBTQI community associated with
963	963	944such discrimination;
964	964	945 (iv) strategies to create a safe and affirming environment for LGBTQI seniors and
965	965	946residents living with HIV, including suggested changes to facility policies and procedures,
966	966	947forms, signage, communication between residents and their families, activities and staff training
967	967	948and in-services; and
968	968	949 (v) an overview of the provisions of this section.
969	969	950 (3) The department shall select an entity that has demonstrated expertise in creating safe
970	970	951and affirming environments and identifying the legal, social and medical challenges faced by 46 of 65
971	971	952LGBTQI older adults and older adults living with HIV and others who are LGBTQI or living
972	972	953with HIV, who reside in long-term care facilities, to provide the training required by this section.
973	973	954 (4) Long-term care facility staff shall complete all training required by this section within
974	974	9551 year of their date of hire unless the new hire provides the long-term care facility with
975	975	956documentation demonstrating that they have completed equivalent training within the past 2
976	976	957years.
977	977	958 (5) Each long-term care facility shall retain records documenting the completion of the
978	978	959training required pursuant to this section by each administrator and staff member at the long-term
979	979	960care facility. Compliance records shall be made available, upon request, to the department, the
980	980	961executive office of health and human services and the office of the statewide long-term care
981	981	962ombudsman.
982	982	963 (6) Each long-term care facility shall assume the cost of providing the training required
983	983	964pursuant to this section.
984	984	965 (k) The commissioner and the secretary of health and human services shall adopt rules
985	985	966and regulations as may be necessary to implement this section.
986	986	967 SECTION 18. Said chapter 111 is hereby further amended by striking out section 73, as
987	987	968appearing in the 2022 Official Edition, and inserting in place thereof the following section:-
988	988	969 Section 73. (a) Whoever advertises, announces, establishes or maintains, or is concerned
989	989	970in establishing or maintaining, a long-term care facility, or otherwise is engaged in any such
990	990	971business without a license granted pursuant to section 71, or whoever being licensed pursuant to
991	991	972said section 71 violates any provision of sections 71 to 73, inclusive, shall for a first offense be 47 of 65
992	992	973punished by a fine of not more than $1,000, and for a subsequent offense by a fine of not more
993	993	974than $2,000 or by imprisonment for not more than 2 years.
994	994	975 (b) Whoever violates any rule or regulation promulgated pursuant to sections 71, 72 and
995	995	97672C shall be punished by a fine, not to exceed $500, unless the department determines a higher
996	996	977amount is appropriate in accordance with 42 CFR 488.438. If any person violates any such rule
997	997	978or regulation by allowing a condition to exist which may be corrected or remedied, the
998	998	979department shall order such person, in writing, to correct or remedy such condition. If such
999	999	980person fails or refuses to comply with such order by the correct by date, each day after the
1000	1000	981correct by date during which such failure or refusal to comply continues shall constitute a
1001	1001	982separate offense. A failure to pay the fine imposed by this section shall be a violation of this
1002	1002	983subsection.
1003	1003	984 SECTION 19. Section 28 of chapter 118E of the General Laws, as so appearing, is
1004	1004	985hereby amended by adding the following paragraph:-
1005	1005	986 The division shall consider a transfer of assets by an individual age 65 or older or a
1006	1006	987transfer made for the sole benefit of an individual age 65 or older into a trust pursuant to 42
1007	1007	988U.S.C. 1396p(d)(4)(C), established for the sole benefit of said individual, to be a disposal of
1008	1008	989resources for fair market value, to the extent that such resources shall be available, under any
1009	1009	990circumstances, to be used by the trustee to provide goods and services to the individual, or to
1010	1010	991reimburse such costs, at fair market value.
1011	1011	992 SECTION 20. Section 31 of said chapter 118E is hereby amended by striking out
1012	1012	993subsection (b), as so appearing, and inserting in place thereof the following 2 subsections:- 48 of 65
1013	1013	994 (b) This subsection shall apply to estates of individuals dying on or after April 1, 1995
1014	1014	995but not after July 31, 2024. There shall be no adjustments or recovery of medical assistance
1015	1015	996correctly paid except as follows:
1016	1016	997 (1) Recovery from the Permanently Institutionalized: From the estate of an individual,
1017	1017	998regardless of age, who was an inpatient in a nursing facility or other medical institution when
1018	1018	999said individual received such assistance. Recovery of such assistance shall be limited to
1019	1019	1000assistance provided on or after March 22, 1991.
1020	1020	1001 (2) Recovery from Persons Age 65 and Over: From the estate of an individual who was
1021	1021	1002not less than 65 years of age when said individual received such assistance.
1022	1022	1003 (3) Recovery from Persons Age 55 and Over for Post–October 1, 1993 Medicaid: From
1023	1023	1004the estate of an individual who was not less than 55 years of age when said individual received
1024	1024	1005such assistance, where such assistance was for services provided on or after October 1, 1993.
1025	1025	1006 Recovery may be made only after the death of the surviving spouse, if any, and only at a
1026	1026	1007time when such surviving spouse has no surviving child who is under 21 years of age or is blind
1027	1027	1008or permanently and totally disabled. The division shall waive recovery if such recovery would
1028	1028	1009work an undue hardship, as defined by the division in its regulations.
1029	1029	1010 (b½) This subsection shall apply to estates of individuals dying on or after August 1,
1030	1030	10112024. There shall be no adjustments or recovery of medical assistance correctly paid except for
1031	1031	1012recovery from the estate of an individual who was:
1032	1032	1013 (i) regardless of age, a resident in a nursing facility or other medical institution within the
1033	1033	1014meaning of 42 U.S.C. 1396p(a)(1)(B)(i) when the individual received such assistance; provided, 49 of 65
1034	1034	1015however, that recovery of such assistance shall be limited to assistance provided on or after
1035	1035	1016March 22, 1991; or
1036	1036	1017 (ii) 55 years of age or older when the individual received such assistance, where such
1037	1037	1018assistance was for services provided on or after October 1, 1993, but only for medical assistance
1038	1038	1019consisting of nursing facility services, home and community-based services and related hospital
1039	1039	1020and prescription drug services for which estate recovery is mandated under 42 U.S.C.
1040	1040	10211396p(b)(1)(B)(i) or other federal law.
1041	1041	1022 Any recovery may be made only after the death of the surviving spouse, if any, and only
1042	1042	1023at a time when the individual has no surviving child who is: (i) under the age of 21; or (ii) an
1043	1043	1024individual who is blind or an individual with a disability.
1044	1044	1025 SECTION 21. Said section 31 of said chapter 118E, as so appearing, is hereby further
1045	1045	1026amended by adding the following subsection:-
1046	1046	1027 (e) Notwithstanding subsection (b½), there shall be no adjustment or recovery of medical
1047	1047	1028assistance correctly paid from the estate of an individual who was receiving such assistance
1048	1048	1029under the CommonHealth program for adults with disabilities or for payment of personal care
1049	1049	1030attendant services; provided, however, that the executive office shall seek federal authority, if
1050	1050	1031required, to implement this subsection.
1051	1051	1032 SECTION 22. Said chapter 118E is hereby further amended by adding the following 2
1052	1052	1033sections:-
1053	1053	1034 Section 83. To establish Medicaid rates for skilled nursing facilities licensed pursuant to
1054	1054	1035section 71 of chapter 111, the division of medical assistance shall use as base year costs for rate 50 of 65
1055	1055	1036determination purposes the reported costs of the calendar year not more than 2 years prior to the
1056	1056	1037current rate year.
1057	1057	1038 Section 84. (a) The division of medical assistance shall establish a skilled nursing facility
1058	1058	1039rate add-on program for bariatric patient care and a rate add-on program for 1-on-1 staffing of at-
1059	1059	1040risk residents requiring 24-hour monitoring and supervision for their safety and the safety of
1060	1060	1041other residents and staff. The division of medical assistance shall identify at-risk resident
1061	1061	1042populations to include in the rate add-on program for 1-on-1 staffing which shall include, but not
1062	1062	1043be limited to, residents that: (i) have demonstrated suicidal ideation; (ii) have demonstrated
1063	1063	1044aggressive behavior toward other residents or staff; (iii) have demonstrated exit-seeking
1064	1064	1045behavior; or (vi) are registered sex offenders. The rate add-ons for said program shall be
1065	1065	1046sufficient to defray the cost of employing the required staff to conduct the 24-hour monitoring
1066	1066	1047and supervision of the at-risk residents.
1067	1067	1048 (b) The division of medical assistance may develop an add-on to rate of payment for
1068	1068	1049skilled nursing facilities that develop small house nursing homes and meet criteria established by
1069	1069	1050the executive office.
1070	1070	1051 SECTION 23. Subsection (c) of section 25 of chapter 176O of the General Laws, as
1071	1071	1052appearing in the 2022 Official Edition, is hereby amended by inserting after the second sentence
1072	1072	1053the following sentence:- The division shall develop and implement a uniform prior authorization
1073	1073	1054form for the admission of patients from an acute care hospital to a post-acute care facility or
1074	1074	1055transitioned to a home health agency certified by the federal Centers for Medicare and Medicaid
1075	1075	1056Services for covered post-acute care services. 51 of 65
1076	1076	1057 SECTION 24. (a) For the purposes of this section, the following words shall have the
1077	1077	1058following meanings unless the context clearly requires otherwise:
1078	1078	1059 “Enrollee”, as defined in section 8A of chapter 118E of the General Laws; provided, that
1079	1079	1060“enrollee” shall include “insured” as defined in section 1 of chapter 176O of the General Laws.
1080	1080	1061 “Payer”, the group insurance commission under chapter 32A of the General Laws, the
1081	1081	1062division of medical assistance under chapter 118E of the General Laws, insurance companies
1082	1082	1063organized under chapter 175 of the General Laws, non-profit hospital service corporations
1083	1083	1064organized under chapter 176A of the General Laws, medical service corporations organized
1084	1084	1065under chapter 176B of the General Laws, health maintenance organizations organized under
1085	1085	1066chapter 176G of the General Laws and preferred provider organizations organized under chapter
1086	1086	1067176I of the General Laws, or a utilization review organization acting under contract with the
1087	1087	1068aforementioned entities.
1088	1088	1069 “Post-acute care facility or agency”, any: (i) facility licensed under chapter 111 of the
1089	1089	1070General Laws to provide inpatient post-acute care services, including, but not limited to skilled
1090	1090	1071nursing facilities, long-term care hospitals, intermediate care facilities, or rehabilitation facilities;
1091	1091	1072or (ii) a home health agency certified by the federal Centers for Medicare and Medicaid Services.
1092	1092	1073 (b) Notwithstanding any general or special law to the contrary, all payers shall approve or
1093	1093	1074deny a request for prior authorization for admission to a post-acute care facility or transition to a
1094	1094	1075post-acute care agency for any inpatient of an acute care hospital requiring covered post-acute
1095	1095	1076care services by the next business day following receipt by the payer of all necessary information
1096	1096	1077to establish medical necessity of the requested service; provided, however, that no new
1097	1097	1078admission may occur until the applicable pre-admission screening and resident review required 52 of 65
1098	1098	1079pursuant to 42 CFR 483 is complete. If the calendar day immediately following the date of
1099	1099	1080submission of the completed request is not a payer’s business day, and the payer cannot
1100	1100	1081otherwise make a determination by the next calendar day, and the receiving post-acute care
1101	1101	1082facility or agency is both open to new admissions and has indicated that said facility or agency
1102	1102	1083will accept the enrollee, then prior authorization shall be waived; provided, that the payer shall
1103	1103	1084provide coverage and may begin its concurrent review of the admission on the next business day;
1104	1104	1085provided further, that the payer shall not retrospectively deny coverage for services to an enrollee
1105	1105	1086admitted to a post-acute care facility or transitioned to a post-acute care agency after a waiver of
1106	1106	1087prior authorization pursuant to this section unless the claim was a result of fraud, waste or abuse.
1107	1107	1088An adverse determination of a prior authorization request pursuant to this section may be
1108	1108	1089appealed by an enrollee or the enrollee’s provider and such appeal, in the case of an enrollee of a
1109	1109	1090commercial payer, shall be subject to the expedited grievance process pursuant to clause (iv) of
1110	1110	1091subsection (b) of section 13 of chapter 176O of the General Laws. An enrollee of an insurance
1111	1111	1092program of the division of medical assistance or the enrollee’s provider may request an expedited
1112	1112	1093appeal of an adverse determination of a prior authorization request. Nothing in this section shall
1113	1113	1094be construed to require a payer to reimburse for services that are not a covered benefit.
1114	1114	1095 (c) In the case of non-emergency transportation between an acute care hospital and a
1115	1115	1096post-acute care facility, payers shall approve or deny a request for prior authorization according
1116	1116	1097to the same process provided pursuant to subsection (b); provided, that once authorization has
1117	1117	1098been granted, said authorization shall be valid for not less than 7 calendar days following
1118	1118	1099approval.
1119	1119	1100 (d) The division of insurance and the division of medical assistance shall issue sub-
1120	1120	1101regulatory guidance to effectuate the purposes of this subsection. 53 of 65
1121	1121	1102 SECTION 25. (a) There shall be a task force to study and propose recommendations to
1122	1122	1103address acute care hospital throughput challenges and the impact of persistent delays in
1123	1123	1104discharging patients from acute to post-acute care settings. The task force shall examine: (i)
1124	1124	1105hospital discharge planning and case management practices; (ii) payer administrative barriers to
1125	1125	1106discharge; (iii) legal and regulatory barriers to discharge; (iv) efforts to increase public
1126	1126	1107awareness of health care proxies and the importance of designating a health care agent; (v) post-
1127	1127	1108acute care capacity constraints and additional opportunities to provide financial incentives to
1128	1128	1109increase capacity; (vi) administrative day rates and the cost to hospitals of discharge delays; (vii)
1129	1129	1110enhanced hospital case management practices and reimbursement for wraparound services; (viii)
1130	1130	1111the adequacy of post-acute care facility insurance networks and the establishment of an out-of-
1131	1131	1112network rate for post-acute care facilities; (ix) expanding MassHealth Limited coverage to
1132	1132	1113include post-acute and long-term care services; (x) the effectiveness of interagency coordination
1133	1133	1114to resolve complex case discharges; (xi) the adequacy of reimbursement rates of MassHealth and
1134	1134	1115commercial carriers for nonemergency medical transportation; (xii) opportunities to expand
1135	1135	1116coverage and reimbursement for services delivered by mobile integrated health programs
1136	1136	1117certified by the department of public health and by participating providers in the federal Centers
1137	1137	1118for Medicare and Medicaid Services acute hospital care at home program; (xiii) alternative
1138	1138	1119transportation options for patients being discharged and transferred to post-acute care facilities or
1139	1139	1120home health agencies; and (xiv) the adequacy of state resources and infrastructure to place
1140	1140	1121complex case discharges in appropriate post-acute care settings, including, but not limited to,
1141	1141	1122patients with dementia diagnoses, geriatric patients with psychiatric diagnoses, patients with
1142	1142	1123behavioral health diagnoses, patients with substance use disorder diagnoses, justice-involved 54 of 65
1143	1143	1124patients and patients who have been unable to find an appropriate placement for post-acute care
1144	1144	1125for 6 months or longer.
1145	1145	1126 (b) The task force shall consist of: the secretary of health and human services, or a
1146	1146	1127designee, who shall serve as chair; the assistant secretary for MassHealth, or a designee; the
1147	1147	1128commissioner of mental health, or a designee; the attorney general, or a designee; the
1148	1148	1129commissioner of correction, or a designee; 1 sheriff appointed by the Massachusetts Sheriffs’
1149	1149	1130Association, Inc.; 1 member representing the division of the probate and family court department
1150	1150	1131of the trial court to be appointed by the chief justice of said division; and 10 members to be
1151	1151	1132appointed by the chair, 1 of whom shall be a representative of the Massachusetts Hospital
1152	1152	1133Association, Inc., 1 of whom shall be a representative of the Massachusetts Senior Care
1153	1153	1134Association, Inc., 1 of whom shall be a representative of the Home Care Alliance of
1154	1154	1135Massachusetts, Inc., 1 of whom shall be a representative of the Massachusetts Academy of Elder
1155	1155	1136Law Attorneys, 1 of whom shall be a representative from the Massachusetts Ambulance
1156	1156	1137Association, Incorporated, 1 of whom shall be a representative from the Massachusetts
1157	1157	1138Association of Health Plans, Inc., 1 of whom shall be a representative from Blue Cross and Blue
1158	1158	1139Shield of Massachusetts, Inc., 1 of whom shall be a representative from an academic medical
1159	1159	1140center located in Worcester county, 1 of whom shall be a representative of an acute care hospital
1160	1160	1141located in Suffolk county and 1 of whom shall be a representative from an acute care hospital
1161	1161	1142designated by the health policy commission as an independent community hospital for the
1162	1162	1143purposes of 105 CMR 100.715(B)(2)(b).
1163	1163	1144 (c) Not later than July 31, 2025, the task force shall submit its report, including its
1164	1164	1145recommendations or any proposed legislation necessary to carry out its recommendations, to the 55 of 65
1165	1165	1146clerks of the house of representatives and the senate, the house and senate committees on ways
1166	1166	1147and means and the joint committee on health care financing.
1167	1167	1148 SECTION 26. The division of medical assistance shall study the cost and feasibility of
1168	1168	1149changes to the eligibility requirements for Medicaid long-term care services with the goal of
1169	1169	1150reducing the time applicants spend at acute care hospitals awaiting long-term care eligibility
1170	1170	1151determinations. The study shall consider: (i) improvements to the eligibility determination
1171	1171	1152process; (ii) establishing a rebuttable presumption of eligibility; (iii) guaranteeing payment for
1172	1172	1153long-term care services for up to 1 year regardless of eligibility status; and (iv) expanding the
1173	1173	1154undue hardship waiver criteria. The division of medical assistance shall seek input from the
1174	1174	1155Massachusetts Senior Care Association, Inc., the Massachusetts Academy of Elder Law
1175	1175	1156Attorneys and other interested stakeholders. The division of medical assistance shall submit a
1176	1176	1157report with the results of its study and policy recommendations to the clerks of the house of
1177	1177	1158representatives and the senate and the house and senate committees on ways and means, not later
1178	1178	1159than 180 days after the effective date of this act.
1179	1179	1160 SECTION 27. (a) There shall be a task force to evaluate the governance and regulatory
1180	1180	1161structure of rest homes in the commonwealth. The task force shall include, but shall not be
1181	1181	1162limited to, an examination of the following: (i) the licensing, regulatory and reporting structure
1182	1182	1163for rest homes; (ii) an inventory of licensed rest homes and licensed rest home beds; (iii) the
1183	1183	1164location and service areas of existing rest homes; (iv) a review of rest home closures since 2015;
1184	1184	1165(v) a review of the recommendations implemented from the nursing facility task force report
1185	1185	1166issued pursuant to section 91 of chapter 41 of the acts of 2019; (vi) the feasibility of receiving
1186	1186	1167federal reimbursement for rest home expenses; and (vii) a review of the current rate structure for
1187	1187	1168rest homes compared to the actual cost of care to residents. 56 of 65
1188	1188	1169 (b) The task force shall consist of the secretary of health and human services, or their
1189	1189	1170designee, who shall serve as chair; the secretary of elder affairs, or their designee; the
1190	1190	1171commissioner of public health, or their designee; the assistant secretary for MassHealth, or their
1191	1191	1172designee; the commissioner of the department of mental health, or their designee; the
1192	1192	1173commissioner of the department of transitional assistance, or their designee; the chairs of the
1193	1193	1174joint committee on elder affairs, or their designees; 1 person to be appointed by the minority
1194	1194	1175leader of the house of representatives; 1 person to be appointed by the minority leader of the
1195	1195	1176senate; and 5 members to be appointed by the governor, 1 of whom shall be a representative
1196	1196	1177from the Massachusetts Association of Residential Care Homes, Inc., 1 of whom shall be a
1197	1197	1178representative of LeadingAge Massachusetts, Inc., 1 of whom shall be a representative of
1198	1198	1179Massachusetts Senior Action Council, Inc., 1 of whom shall have direct care giver experience
1199	1199	1180and 1 of whom shall have experience in health care administration and finance.
1200	1200	1181 (c) The task force shall submit a report of its findings, including any recommendations or
1201	1201	1182proposed legislation necessary to carry out its recommendations, to the clerks of the house of
1202	1202	1183representatives and the senate and to the house and senate committees on ways and means, not
1203	1203	1184later than April 1, 2025.
1204	1204	1185 SECTION 28. (a) The health policy commission shall conduct an analysis and issue a
1205	1205	1186report on the impact of the Medicare shared savings program and participating Medicare
1206	1206	1187accountable care organizations, hereinafter referred to as Medicare ACOs, on the financial
1207	1207	1188viability of long-term care facilities in the commonwealth and continued access to long-term care
1208	1208	1189facility services for Medicare patients. The analysis shall include, but not be limited to, an
1209	1209	1190examination of the following: 57 of 65
1210	1210	1191 (i) the impact of Medicare ACOs on clinical eligibility decisions related to initial long-
1211	1211	1192term care facility placement and patient length of stay for Medicare ACO beneficiaries compared
1212	1212	1193to Medicare fee-for-service beneficiaries, including an analysis of the impact of length of stay on
1213	1213	1194quality outcomes including readmissions, functional status and patient experience;
1214	1214	1195 (ii) the amount of payments Medicare ACOs have received from the federal government
1215	1215	1196from capitated, shared savings or other related initiatives and how those payments have been
1216	1216	1197utilized, or not, to enhance patient care and outcomes in long-term care facilities;
1217	1217	1198 (iii) Medicare ACO practices related to patient care utilization controls and the financial
1218	1218	1199and quality care impact of these controls on beneficiaries in the acute and post-acute care system;
1219	1219	1200and
1220	1220	1201 (iv) Medicare ACOs long-term care network adequacy.
1221	1221	1202 (b) The health policy commission shall submit the report to the clerks of the house of
1222	1222	1203representatives and the senate, the house and senate committees on ways and means, the joint
1223	1223	1204committee on health care financing and the joint committee on elder affairs not later than June 1,
1224	1224	12052025.
1225	1225	1206 SECTION 29. (a) There shall be a special legislative commission established pursuant to
1226	1226	1207section 2A of chapter 4 of the General Laws to study oversight of continuing care retirement
1227	1227	1208communities to protect the consumer and financial rights of residents.
1228	1228	1209 (b) The commission shall consist of: the chairs of the joint committee on elder affairs,
1229	1229	1210who shall serve as co-chairs; the attorney general or a designee; the secretary of elder affairs or a
1230	1230	1211designee; the commissioner of public health or a designee; 3 persons to be appointed by the 58 of 65
1231	1231	1212governor, 1 of whom shall be a certified public accountant or an actuary and 2 of whom shall be
1232	1232	1213residents at a continuing care retirement community; a representative of the Massachusetts
1233	1233	1214chapter of National Academy of Elder Law Attorneys; a representative of LeadingAge
1234	1234	1215Massachusetts, Inc.; a representative of Massachusetts Assisted Living Association, Inc.; a
1235	1235	1216representative of AARP Massachusetts; a representative of the Alzheimer’s Association; a
1236	1236	1217representative of Massachusetts Advocates for Nursing Home Reform, Inc.; a representative of
1237	1237	1218the Massachusetts Life Care Residents’ Association, Inc.; a representative of Massachusetts
1238	1238	1219Senior Care Association, Inc.; and a representative of Local 1199 SEIU. The commission shall
1239	1239	1220meet not less than 6 times and shall hold not less than 1 public hearing.
1240	1240	1221 (c) The commission shall study and report on: (i) continuing care retirement
1241	1241	1222communities, their care contracts and their impact on consumers; (ii) the financial viability of
1242	1242	1223such communities; (iii) the payment and return of entrance fees at such communities; (iv)
1243	1243	1224statutory and regulatory oversight of such communities, including any activities by state agencies
1244	1244	1225to enforce regulatory requirements; (v) advertising practices communicated to potential residents
1245	1245	1226and families about such communities; and (vi) regulatory procedures for the closure or change of
1246	1246	1227ownership of such communities.
1247	1247	1228 (d) The commission shall submit a report with recommendations, including legislation or
1248	1248	1229regulations necessary to carry out such recommendations, to the clerks of the house of
1249	1249	1230representatives and the senate, the joint committee on elder affairs and the senate and house
1250	1250	1231committees on ways and means not later than August 1, 2025.
1251	1251	1232 SECTION 30. (a) The department of public health shall study and report on the need and
1252	1252	1233feasibility of qualified professional guardians to give informed medical consent for indigent 59 of 65
1253	1253	1234persons and whether such guardians would reduce hospital discharge issues and increase access
1254	1254	1235to long-term care and preventive care; provided, however, that the report shall include, but not be
1255	1255	1236limited to: (i) the need for qualified professional guardians to assist indigent persons with
1256	1256	1237accessing appropriate medical care, including preventive care; (ii) data on the current number of
1257	1257	1238Rogers guardians and similar guardians and the financial impact of reimbursing such guardians;
1258	1258	1239(iii) the fiscal impact of establishing MassHealth fee-for-service guardians; (iv) consideration of
1259	1259	1240the benefits to an individual and cost to the commonwealth of deducting from an applicant for
1260	1260	1241MassHealth or a MassHealth member’s income for guardianship fees and related expenses when
1261	1261	1242the appointment of a guardian is essential to enable an applicant or member to gain access or
1262	1262	1243consent to medical treatment and an estimation of reasonable costs for such a deduction; and (v)
1263	1263	1244other recommendations deemed necessary by the department.
1264	1264	1245 (b) Not later than July 31, 2025, the department shall submit its report, including any
1265	1265	1246proposed legislation necessary to carry out its recommendations, to the clerks of the senate and
1266	1266	1247house of representatives, the senate and house committees on ways and means and the joint
1267	1267	1248committee on elder affairs.
1268	1268	1249 SECTION 31. (a) There shall be a task force to review the viability and sustainability of
1269	1269	1250long-term care facilities in the commonwealth.
1270	1270	1251 (b) The task force shall consist of: the secretary of health and human services, who shall
1271	1271	1252serve as chair; the secretary of elder affairs or a designee; commissioner of public health or a
1272	1272	1253designee; 4 persons to be appointed by the governor, 1 of whom shall represent long-term care
1273	1273	1254facilities, 1 of whom shall operate an assisted living residence, 1 of whom shall represent
1274	1274	1255residents of long-term care facilities in the commonwealth and 1 of whom shall be health care 60 of 65
1275	1275	1256economist; a representative of LeadingAge Massachusetts, Inc., a representative of Local 1199
1276	1276	1257SEIU; a representative of Massachusetts Association of Residential Care Homes, Inc.; a
1277	1277	1258representative of the Massachusetts Senior Action Council, Inc.; and a representative of
1278	1278	1259Massachusetts Senior Care Association, Inc.
1279	1279	1260 In making appointments, the governor shall, to the maximum extent feasible, ensure that
1280	1280	1261the task force represents a broad distribution of diverse perspectives and geographic regions.
1281	1281	1262 (c) In making recommendations, the task force shall consider issues including, but not
1282	1282	1263limited to: (i) the demand for long-term care facilities over the next 5 and 10 years and the ability
1283	1283	1264to meet that demand in a cost-effective manner; (ii) the geographic accessibility of such
1284	1284	1265facilities; (iii) staffing challenges and workforce initiatives to support such facilities including,
1285	1285	1266but not limited to, childcare; (iv) the utilization of pharmacists and other health care providers in
1286	1286	1267long-term care; (v) any policy reforms to strengthen long-term care in the commonwealth
1287	1287	1268including, but not limited to, maintaining quality of care; (vi) the adequacy of payor rates; (vii)
1288	1288	1269costs and impacts of financing for facility construction and maintenance including, but not
1289	1289	1270limited to, private equity and real estate investment trusts; and (viii) costs associated with
1290	1290	1271transportation options to and from facilities for individuals.
1291	1291	1272 (d) The task force shall submit its report, recommendations and any proposed legislation
1292	1292	1273necessary to carry out its recommendations to the clerks of the senate and house of
1293	1293	1274representatives, the joint committee on health care financing, the joint committee on elder affairs
1294	1294	1275and the senate and house committees on ways and means not later than July 31, 2025.
1295	1295	1276 SECTION 32. (a) Notwithstanding any general or special law to the contrary, there shall
1296	1296	1277be an assisted living residences commission to study and recommend policies to ensure assisted 61 of 65
1297	1297	1278living residences adequately meet the health and safety needs of residents. The areas examined
1298	1298	1279by the commission shall include, but not be limited to: (i) the current statutory and regulatory
1299	1299	1280oversight of assisted living residences; (ii) assisted living best practices in other states; (iii) the
1300	1300	1281impacts of licensing or certifying such residences; (iv) advertising practices of assisted living
1301	1301	1282residences to potential residents and their families; (v) regulatory procedures for opening, closing
1302	1302	1283or changing ownership of a residence, including determination of need processes and clustering
1303	1303	1284of facilities; (vi) trends in incident reports made to the executive office of elder affairs and the
1304	1304	1285long term care ombudsman’s office and resolutions of such incidents; (vii) methods to provide
1305	1305	1286transparency of information for potential consumers and family members researching and
1306	1306	1287comparing residences; (viii) safety standards; (ix) existing consumer protections for residents in
1307	1307	1288statutes and regulations; and (x) basic health services in residences.
1308	1308	1289 (b) The commission shall consist of: the secretary of elder affairs, who shall serve as
1309	1309	1290chair; the commissioner of public health or a designee; the assistant secretary of MassHealth or a
1310	1310	1291designee; the long term care ombudsman or a designee; the chairs of the joint committee on elder
1311	1311	1292affairs; 1 member to be appointed by the senate president; 1 member to be appointed by the
1312	1312	1293speaker of the house of representatives; 1 member to be appointed by the minority leader of the
1313	1313	1294senate; 1 member to be appointed by the minority leader of the house of representatives; 3
1314	1314	1295members to be appointed by the governor, 2 of whom shall be residents or family members of
1315	1315	1296residents at an assisted living residence; a representative of the Massachusetts chapter of the
1316	1316	1297National Academy of Elder Law Attorneys; a representative of LeadingAge Massachusetts, Inc.;
1317	1317	1298a representative of the Massachusetts Assisted Living Association, Inc.; a representative of
1318	1318	1299AARP Massachusetts; a representative of the New England chapter of the Gerontological
1319	1319	1300Advanced Practice Nurses Association; a representative of the Massachusetts chapter of the 62 of 65
1320	1320	1301Alzheimer’s Association; a representative of MassPACE, Inc.; and a representative of Greater
1321	1321	1302Boston Legal Services, Inc. The commission shall meet not less than 5 times and shall hold at
1322	1322	1303least 1 public hearing.
1323	1323	1304 (c) The commission shall file its report and recommendations, including any proposed
1324	1324	1305legislation necessary to carry out its recommendations, to the clerks of the senate and house of
1325	1325	1306representatives, the joint committee on elder affairs and the house and senate committees on
1326	1326	1307ways and means not later than August 1, 2025.
1327	1327	1308 SECTION 33. (a) Each long-term care facility shall designate 2 employees, including 1
1328	1328	1309employee representing management at the facility and 1 employee representing direct care staff
1329	1329	1310at the facility, to receive in-person training required by section 72GG of chapter 111 of the
1330	1330	1311General Laws within 6 months of the effective date of this section. The designated employees
1331	1331	1312shall serve as points of contact for the long-term care facility regarding compliance with the
1332	1332	1313provisions of this act and shall develop a general training plan for the facility. In the event a
1333	1333	1314designated employee ceases to be employed by the facility, the facility shall designate another
1334	1334	1315employee who is representative of the employee group represented by the former designee, who
1335	1335	1316shall complete the in-person training required pursuant to this section, to serve as a point of
1336	1336	1317contact for the facility regarding compliance with the provisions of this act and have joint
1337	1337	1318responsibility for the facility's training plan.
1338	1338	1319 (b) All long-term care facility staff employed by a long-term care facility on the effective
1339	1339	1320date of this act, other than an employee designated pursuant to subsection (a), shall complete the
1340	1340	1321training required by section 72GG of chapter 111 of the General Laws within 1 year of the
1341	1341	1322effective date of this section. 63 of 65
1342	1342	1323 SECTION 34. (a) For the purposes of this section, “payer” shall mean the group
1343	1343	1324insurance commission under chapter 32A of the General Laws, the division of medical assistance
1344	1344	1325under chapter 118E of the General Laws, insurance companies organized under chapter 175 of
1345	1345	1326the General Laws, non-profit hospital service corporations organized under chapter 176A of the
1346	1346	1327General Laws, medical service corporations organized under chapter 176B of the General Laws,
1347	1347	1328health maintenance organizations organized under chapter 176G of the General Laws and
1348	1348	1329preferred provider organizations organized under chapter 176I of the General Laws, or a
1349	1349	1330utilization review organization acting under contract with the aforementioned entities.
1350	1350	1331 (b) Notwithstanding any general or special law to the contrary, the division of insurance
1351	1351	1332shall develop the uniform prior authorization form for admission to a post-acute care facility or
1352	1352	1333transition to a home health agency for any inpatient of an acute care hospital requiring covered
1353	1353	1334post-acute care services pursuant to section 25 of chapter 176O of the General Laws, not later
1354	1354	1335than 90 days after the effective date of this act. Said uniform prior authorization form shall state
1355	1355	1336that no new admission to a nursing facility may occur until the applicable preadmission
1356	1356	1337screening and resident review required under 42 CFR 483 is complete. The division of insurance
1357	1357	1338shall develop said uniform prior authorization form in consultation with the division of medical
1358	1358	1339assistance. The division of medical assistance, or any entity acting for the division of medical
1359	1359	1340assistance under contract, shall accept the uniform prior authorization form as sufficient to
1360	1360	1341request prior authorization for the requested service. All acute care hospitals shall use the
1361	1361	1342uniform prior authorization form to request prior authorization for coverage of post-acute care
1362	1362	1343services at a post-acute care facility or home health agency, and all payers or entities acting for a
1363	1363	1344payer under contract shall accept such form as sufficient to request prior authorization for the 64 of 65
1364	1364	1345requested service, not later than 30 days after the form has been developed by the division of
1365	1365	1346insurance.
1366	1366	1347 SECTION 35. (a) For the purposes of this section, the terms “licensee” and “management
1367	1367	1348company” shall have the meanings as defined in section 71 of chapter 111 of the General Laws.
1368	1368	1349 (b) Pursuant to section 71 of chapter 111 of the General Laws, a licensee who has entered
1369	1369	1350into a contract with a management company prior to the effective date of this act shall provide
1370	1370	1351the department of public health with the necessary documentation and materials for a
1371	1371	1352determination by the department of the responsibility and suitability as described in subsection
1372	1372	1353(g) of said section 71 of said chapter 111 of the management company, prior to any issuance of a
1373	1373	1354renewed license; provided, however, that the department shall give a licensee reasonable time to
1374	1374	1355provide the department with the necessary documents and materials if the licensee’s renewal date
1375	1375	1356is within 90 days of the effective date of this act. A licensee’s failure to comply with this section
1376	1376	1357shall subject the licensee to the penalties established in section 73 of said chapter 111.
1377	1377	1358 SECTION 36. Pursuant to section 72CC of chapter 111 of the General Laws, inserted by
1378	1378	1359section 17, each long-term care facility shall submit its outbreak response plan to the department
1379	1379	1360of public health not later than 180 days after the effective date of this act.
1380	1380	1361 SECTION 37. The initial report required by section 72FF of chapter 111 of the General
1381	1381	1362Laws, inserted by section 17, shall be filed with the clerks of the house of representatives and the
1382	1382	1363senate, the house and senate committees on ways and means and the joint committee on elder
1383	1383	1364affairs not later than 6 months after the effective date of this act.
1384	1384	1365 SECTION 38. Section 24 is hereby repealed. 65 of 65
1385	1385	1366 SECTION 39. Section 23 of chapter 20 of the acts of 2021 is hereby repealed.
1386	1386	1367 SECTION 40. Sections 17 and 33 shall take effect 180 days after the effective date of this
1387	1387	1368act.
1388	1388	1369 SECTION 41. Section 38 shall take effect 2 years after the effective date of this act.
1389	1389	1370 SECTION 42. Section 83 of chapter 118E of the General Laws, inserted by section 22,
1390	1390	1371shall take effect on October 1, 2025.