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