Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S2900 Compare Versions

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1	1	1 of 51
2	2	SENATE . . . . . . . . . . . . . . No. 2900
3	3	Senate, June 25, 2024 -- Text of the Senate amendment to the House Bill relative to long-term
4	4	care and assisted living (House, No. 4193) (being the text of Senate, No. 2889, printed as
5	5	amended)
6	6	The Commonwealth of Massachusetts
7	7	_______________
8	8	In the One Hundred and Ninety-Third General Court
9	9	(2023-2024)
10	10	_______________
11	11	1 SECTION 1. Section 1 of chapter 19D of the General Laws, as appearing in the 2022
12	12	2Official Edition, is hereby amended by inserting after the definition of “Assisted living
13	13	3residence” or “Residence,” the following 3 definitions:-
14	14	4 “Authorized medical professional”, an advanced practice registered nurse with
15	15	5prescriptive authority, a physician assistant or a physician; provided, however, that an authorized
16	16	6medical professional shall have been granted authority by a resident to issue care orders for the
17	17	7resident.
18	18	8 “Basic health services”, certain services provided at an assisted living residence by
19	19	9employees of the residence that are qualified to administer such services or a qualified third party
20	20	10in accordance with a care order issued by an authorized medical professional; provided,
21	21	11however, that such services shall include all of the following: (i) injections; (ii) the application or
22	22	12replacement of simple non-sterile dressings; (iii) the management of oxygen on a regular and
23	23	13continuing basis; (iv) specimen collection and the completion of a home diagnostic test,
24	24	14including, but not limited to, warfarin, prothrombin or international normalized ratio testing and
25	25	15glucose testing; and provided further, that such home diagnostic test or monitoring is approved 2 of 51
26	26	16by the United States Food and Drug Administration for home use; and (v) application of
27	27	17ointments or drops.
28	28	18 “Care Order”, a written order for basic health services issued by an authorized medical
29	29	19professional.
30	30	20 SECTION 2. Said section 1 of said chapter 19D, as so appearing, is hereby further
31	31	21amended by striking out the definition of “Elderly housing”.
32	32	22 SECTION 3. Said section 1 of said chapter 19D, as so appearing, is hereby further
33	33	23amended by striking out the definition of “Skilled nursing care” and inserting in place thereof the
34	34	24following definition:-
35	35	25 "Skilled nursing care", skilled services described in 130 CMR 456.409 or any successor
36	36	26regulation.
37	37	27 SECTION 4. Section 2 of said chapter 19D, as so appearing, is hereby amended by
38	38	28striking out clauses (v) and (vi) and inserting in place thereof the following 2 clauses:-
39	39	29 (v) provide services to residents in accordance with service plans developed through a
40	40	30process by which employees of the residence discuss the service plan and the needs of the
41	41	31resident with the resident and their representative or designee and ensure the consequences of a
42	42	32decision, including any inherent risk, are understood by all parties; provided, however, that such
43	43	33parties shall review the service plan periodically and consider changes in the resident's status and
44	44	34the ability of the residence to respond accordingly and as set forth in section 12; provided
45	45	35further, that if a resident is receiving basic health services, the staff of the residence shall consult
46	46	36the resident’s authorized medical professional when developing the resident’s service plan; 3 of 51
47	47	37 (vi) coordinate and provide personal services, basic health services, where applicable, and
48	48	38other services required under service plans as set forth in section 12;.
49	49	39 SECTION 5. Said chapter 19D is hereby further amended by striking out sections 3 to 6,
50	50	40inclusive, as so appearing, and inserting in place thereof the following 4 sections:-
51	51	41 Section 3. (a) No person shall advertise, operate or maintain an assisted living residence
52	52	42without the certification required under this chapter; provided, however, that the provisions of
53	53	43this chapter shall not apply to entities for the original facilities and services for which said
54	54	44entities were originally licensed or organized to provide. Assisted living residences may be
55	55	45sponsored by: (i) convalescent homes, licensed nursing homes, licensed rest homes, charitable
56	56	46homes for the aged or intermediate care facilities for persons with an intellectual disability
57	57	47licensed pursuant to section 71 of chapter 111; (ii) hospices licensed pursuant to the provisions
58	58	48of section 57D of said chapter 111; (iii) facilities providing continuing care to residents, as
59	59	49defined by section 76 of chapter 93; (iv) congregate housing authorized by section 39 of chapter
60	60	50121B; (v) group homes or supported living programs operating under contract with the
61	61	51department of mental health, the rehabilitation commission or the department of developmental
62	62	52services; or (vi) housing operated for only those duly ordained priests or for the of the religious
63	63	53orders of the Roman Catholic church in their own locations, buildings, residences or
64	64	54headquarters to provide care, shelter, treatment and medical assistance for any of the said duly
65	65	55ordained priests or members of the said religious order.
66	66	56 (b) The provisions of this chapter shall not apply to any residential premises available for
67	67	57lease by elderly or disabled individuals that is financed or subsidized in whole or in part by local,
68	68	58state or federal housing programs established primarily to develop or operate housing rather than 4 of 51
69	69	59to provide housing and personal services in combination; provided, however, that such premises
70	70	60are not currently licensed under chapter 111.
71	71	61 Section 4. (a) The department shall issue a certification for a term of 2 years, and shall
72	72	62renew for like terms, to any applicant whom the department determines meets the regulatory
73	73	63requirements promulgated by the department in accordance with this chapter; provided, however,
74	74	64that a certification shall be subject to corrective action, modification, suspension or revocation
75	75	65for cause, as determined by the department. Such certification shall: (i) not be transferable or
76	76	66assignable; (ii) be issued only to the person and for the premises named in the application; (iii)
77	77	67indicate whether the residence has been approved to provide basic health services; and (iv)
78	78	68indicate the certification’s expiration date. The department shall issue a certificate, which shall
79	79	69be posted by the residence and on the residence’s website in a conspicuous place on the approved
80	80	70premises.
81	81	71 (b) Upon applying for initial certification or renewal, an applicant shall pay the
82	82	72department a fee based on the number of units at the assisted living residence, established by the
83	83	73secretary of administration and finance pursuant to the provisions of section 3B of chapter 7;
84	84	74provided, however, that a minimum fee shall be established notwithstanding the number of units
85	85	75at the residence. No fees for initial certification or renewal shall be due from any provider for
86	86	76assisted living units created under the United States Department of Housing and Urban
87	87	77Development Assisted Living Conversion Program.
88	88	78 (c) If an application for renewal of a certification is filed not less than 30 days before the
89	89	79expiration date, such certification shall not expire until the department notifies the sponsor that
90	90	80the application for renewal has been denied. 5 of 51
91	91	81 (d) Applicants for initial certification shall file with the department an operating plan that
92	92	82includes: (i) the number of units; (ii) the number of residents allowed per unit; (iii) the location
93	93	83of resident units, common spaces and egresses by floor; (iv) the base fee to be charged for each
94	94	84such unit; (v) the services to be offered, including basic health services, if applicable, and
95	95	85arrangements for providing such services, including linkages with hospital and nursing facilities,
96	96	86if any; (vi) the number of staff to be employed; and (vii) other information the department deems
97	97	87necessary.
98	98	88 (e) Residences may seek certification by the department to provide basic health services;
99	99	89provided, however, that residences offering basic health services shall not restrict resident choice
100	100	90in the delivery of said services by third party providers. The residence shall submit a revised
101	101	91operating plan to the department in the event of a change in the scope of basic health services
102	102	92offered to residents. A residence seeking to provide basic health services shall include in its
103	103	93operating plan: (i) a proposed administrative and operational structure to ensure the safe and
104	104	94effective use of basic health services and meet the needs of its residents; and (ii) a compliance
105	105	95plan to meet the requirements established under this chapter and promulgated regulations, which
106	106	96shall include, but not be limited to: (A) staff qualifications and training; and (B) effective
107	107	97policies and procedures to ensure the availability of adequate supplies necessary for basic health
108	108	98services and the safe administration and secure storage of medications.
109	109	99 (f) Applicants and sponsors shall file material changes to the assisted living residence’s
110	110	100operating plan prior to the change’s effective date and as may otherwise be required by the
111	111	101department. A sponsor shall file annually on a date established by and on a form prescribed by
112	112	102the department, a statement and a professional opinion prepared by a certified public account or
113	113	103comparable reviewer indicating whether the assisted living residence is in sound fiscal condition 6 of 51
114	114	104and is maintaining sufficient cash flow and reserves to meet the requirements of the service plans
115	115	105established for its residents.
116	116	106 (g) Applicants for initial certification or renewal shall disclose the name and address of
117	117	107each officer, director, trustee and limited partner or shareholder with not less than 5 per cent
118	118	108interest in the assisted living residence and shall provide to the department documentation of the
119	119	109history of each such individual or entity, including, but not limited to: (i) all multifamily housing,
120	120	110assisted living residences or health care facilities in which the individual or entity has been an
121	121	111officer, director, trustee or partner and, if applicable, evidence from the relevant regulatory
122	122	112authority that said applicant has met criteria for licensure or certification; (ii) documentation of
123	123	113any enforcement action against the applicant and, if applicable, evidence that the applicant has
124	124	114corrected all cited deficiencies without revocation of licensure or certification; and (iii) any other
125	125	115evidence, as determined by the department.
126	126	116 (h) The department may deny certification to an applicant who had an ownership interest
127	127	117in an entity licensed under chapter 111, a licensed medical provider or a home health agency
128	128	118certified under Title XVIII of the Social Security Act, as amended, that: (i) has been subject to a
129	129	119patient care receivership action; (ii) has ceased to operate such an entity as a result of: (A)
130	130	120suspension or revocation of license or certification; (B) receivership; or (C) a settlement
131	131	121agreement arising from suspension or revocation of a license or certification; (iii) a settlement
132	132	122agreement in lieu of or as a result of subclause (B); (iv) has been the subject of a substantiated
133	133	123case of patient abuse or neglect involving material failure to provide adequate protection or
134	134	124services for the resident in order to prevent such abuse or neglect; or (v) has over the course of
135	135	125its operation been cited for repeated, serious and willful violations of rules and regulations 7 of 51
136	136	126governing the operation of said health care facility that indicate a disregard for resident safety
137	137	127and an inability to responsibly operate an assisted living residence.
138	138	128 Section 5. (a) The department or its authorized designee, shall biennially review all
139	139	129assisted living residences; provided, however, that an authorized designee shall not include
140	140	130sponsors of assisted living residences.
141	141	131 (b) Prior to the issuance of the sponsor's initial certification, the department shall conduct
142	142	132a review to determine whether an assisted living residence is compliant with this chapter;
143	143	133provided, however, that the department may conduct such review of an assisted living residence
144	144	134at any time the department has probable cause to believe that such assisted living residence is in
145	145	135violation of a provision of this chapter or any regulation promulgated thereunder. Such review
146	146	136shall include: (i) an inspection of every part of the common areas of the assisted living residence
147	147	137and the living quarters of a resident with the resident's prior consent; (ii) an examination of the
148	148	138operating plan; (iii) an examination of a resident's service plan and written progress reports with
149	149	139the resident’s consent; and (iv) resident satisfaction surveys. An inspector shall have authority to
150	150	140confidentially and privately interview the sponsor, manager, staff and residents.
151	151	141 (c) Reviews of assisted living residences certified to provide basic health services shall
152	152	142include an inspection of records associated with the provision of basic health services, a review
153	153	143of residence employee qualifications and the residence’s operating plan.
154	154	144 (d) Upon the completion of an annual or biennial review, the department shall prepare a
155	155	145written report summarizing all pertinent information obtained during the review and shall not
156	156	146disclose confidential or privileged information obtained in connection with such review. The
157	157	147department shall promulgate rules and regulations necessary to ensure the sponsor receives such 8 of 51
158	158	148report and, if applicable, has the opportunity to respond to and resolve any findings of
159	159	149noncompliance prior to departmental enforcement action. Completed reports, responses and
160	160	150notices of final action shall be made available to the public at the department during business
161	161	151hours together with the responses of the applicants or the sponsors and said reports, responses
162	162	152and notices of final action shall be posted on the website of the department.
163	163	153 Section 6. (a) If the department determines a sponsor or applicant has failed or refused to
164	164	154comply with requirements established under this chapter or the regulations promulgated
165	165	155thereunder, the department may: (i) deny an application for recertification; (ii) modify, suspend
166	166	156or revoke a certification; or (iii) issue a fine of not more than $500 for each day of such failure or
167	167	157refusal to comply.
168	168	158 (b) Notice of enforcement action and a sponsor’s right to an adjudicatory proceeding
169	169	159shall be governed by the provisions of chapter 30A.
170	170	160 SECTION 6. Section 8 of said chapter 19D, as so appearing, is hereby amended by
171	171	161striking out, in lines 14 and 15, the words “Any person who violates this subsection shall be
172	172	162subject to” and inserting in place thereof the following words:- A violation of this subsection
173	173	163shall constitute a violation of chapter 93A and shall be punishable by.
174	174	164 SECTION 7. Section 10 of said chapter 19D, as so appearing, is hereby amended by
175	175	165striking out subsections (b) to (d), inclusive, and inserting in place thereof the following 7
176	176	166subsections:-
177	177	167 (b) The sponsor of the assisted living residence may provide or arrange for the provision
178	178	168of additional services, including: (i) barber and beauty services, sundries for personal
179	179	169consumption and other amenities; (ii) local transportation for medical and recreational purposes; 9 of 51
180	180	170(iii) assistance with and supervision of instrumental activities of daily living; (iv) assistance to
181	181	171residents with accessing telehealth services;(v) basic health services for residents whose service
182	182	172plan includes basic health services, in accordance with the requirements set forth within this
183	183	173chapter, by personnel who meet standards for professional qualifications and training set forth in
184	184	174regulations promulgated pursuant to this chapter; and (vi) ancillary services for health-related
185	185	175care including, but not limited to, restorative therapies, podiatry, hospice care, home health or
186	186	176other such services; provided, however, that such services shall be delivered by an individual
187	187	177licensed to provide such care.
188	188	178 (c) No employee of an assisted living residence shall control or manage the funds or
189	189	179property of an assisted living resident; provided, however, that if a resident is unable to manage
190	190	180their funds or property, the assisted living residence shall arrange money management and other
191	191	181financial arrangements with an independent party.
192	192	182 (d) A residence certified to provide basic health services may advertise, market and
193	193	183otherwise promote offered services under this chapter and inform residents of the option to
194	194	184directly procure such services from qualified third parties.
195	195	185 (e) The residence shall disclose to each resident through the assisted living residence’s
196	196	186residency agreement the fees associated with basic health services and shall review such fees
197	197	187with the resident upon the implementation of and any revision to a service plan that includes
198	198	188provision of basic health services. The residence shall notify residents of any changes in fees in
199	199	189advance and in a timely manner. Residents who receive basic health services shall receive an
200	200	190additional service plan review on a quarterly basis and shall have the opportunity to discontinue
201	201	191receiving basic health services from the residence upon written notice to the residence and shall 10 of 51
202	202	192not be charged a cancellation fee or a fee for services not provided due to discontinuation of the
203	203	193services.
204	204	194 (f) The department, in consultation with the department of public health, shall promulgate
205	205	195regulations governing the application, criteria for approval or disapproval of such application,
206	206	196and ongoing oversight of residences that elect to offer basic health services authorized in this
207	207	197section. The department may impose an annual fee on assisted living residences that offer basic
208	208	198health services.
209	209	199 (g) To ensure patient safety and clinical competence in the application of subsections (d)
210	210	200to (f), inclusive, the department and the department of public health shall establish operating plan
211	211	201requirements for residences that opt to provide basic health services, including staff access to a
212	212	202licensed practical nurse or registered nurse for consultation at all times; provided, however, that
213	213	203the nurse shall not be required to be on the premises. The department shall make available
214	214	204electronic copies of the required components of operating plans on the department’s website and
215	215	205shall conduct annual compliance reviews on the documentation created and maintained by
216	216	206assisted living residences for an assisted living resident who received basic health services within
217	217	207the previous 12-month period.
218	218	208 (h) No residence shall offer or provide basic health services without first being certified
219	219	209by the department. If the department determines that a residence is offering basic health services
220	220	210without certification, the department shall issue a fine of not more than $1,000 per day.
221	221	211 SECTION 8. Section 11 of said chapter 19D, as so appearing, is hereby amended by
222	222	212striking out, in lines 1 to 5, inclusive, the words “No assisted living residence shall admit any
223	223	213resident who requires twenty-four hour skilled nursing supervision. No assisted living residence 11 of 51
224	224	214shall provide, or admit or retain any resident in need of skilled nursing care unless all of the
225	225	215following are the case” and inserting in place thereof the following words:- No assisted living
226	226	216residence shall admit a resident who requires 24-hour skilled nursing supervision unless such
227	227	217resident elects to receive basic health services from residences that are certified to provide such
228	228	218services or from qualified third parties. No assisted living residence shall provide skilled nursing
229	229	219care or admit or retain a resident in need of skilled nursing care unless such resident elects to
230	230	220receive basic health services and the following criteria are met.
231	231	221 SECTION 9. Section 15 of said chapter 19D, as so appearing, is hereby amended by
232	232	222striking out subsection (c) and inserting in place thereof the following subsection:-
233	233	223 (c) No assisted living residence shall discharge, discipline, discriminate against or
234	234	224otherwise retaliate against an employee or resident who, in good faith, files a complaint with or
235	235	225provides information to the department relative to what the employee reasonably believes is a
236	236	226violation of law, rule or regulation or poses a risk to public health or safety or resident or staff
237	237	227well-being. An assisted living residence in violation of this section shall be liable to the person
238	238	228retaliated against by a civil action for up to treble damages, costs and attorney’s fees in the event
239	239	229such violation shall be determined to be egregious or willful.
240	240	230 SECTION 10. Said chapter 19D is hereby further amended by adding the following
241	241	231section:-
242	242	232 Section 19. The department shall promulgate regulations necessary to implement the
243	243	233requirements of this chapter. Such regulations shall include the establishment of standards
244	244	234concerning the education, training and experience of the managers and residence employees,
245	245	235including service coordinators. 12 of 51
246	246	236 SECTION 11. Chapter 111 of the General Laws is hereby amended by striking out
247	247	237section 71, as appearing in the 2022 Official Edition, and inserting in place thereof the following
248	248	238section:-
249	249	239 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the
250	250	240following words shall have the following meanings unless the context clearly requires otherwise:
251	251	241 “Applicant”, a person who applies to the department for a license to establish or maintain
252	252	242and operate a long-term care facility.
253	253	243 “Charitable home for the aged”, an institution conducted for charitable purposes and
254	254	244maintained for the purpose of providing a retirement home for elderly persons and which may
255	255	245provide nursing care within the home for its residents.
256	256	246 “Cohorting”, the practice of grouping patients who: (i) are colonized or infected with the
257	257	247same organism in order to confine their care to 1 area and prevent contact with other patients; or
258	258	248(ii) are not colonized or infected with the same organism in order to confine their care to 1 area
259	259	249and prevent contact with other patients.
260	260	250 “Convalescent or nursing home”, an institution including a skilled nursing facility, which
261	261	251is advertised, announced or maintained for the express or implied purpose of caring for 4 or more
262	262	252persons admitted thereto for the purpose of nursing or convalescent care.
263	263	253 “Correct by date”, the date by which a licensee shall remedy or correct a violation
264	264	254discovered after an inspection by the department pursuant to section 72E.
265	265	255 “Endemic level”, the usual level of a given disease in a geographic area. 13 of 51
266	266	256 “Intermediate care facility for persons with an intellectual disability”, an institution that:
267	267	257(i) is conducted for charity or not for profit; (ii) is advertised, announced or maintained for the
268	268	258purpose of providing rehabilitative services and active treatment to persons with an intellectual
269	269	259disability or persons with related conditions, as defined in regulations promulgated pursuant to
270	270	260Title XIX of the Social Security Act, Public Law 89-97; (iii) is not both owned and operated by a
271	271	261state agency; and (iv) makes application to the department for a license for the purpose of
272	272	262participating in the federal program established by said Title XIX.
273	273	263 “Isolating”, the process of separating persons colonized or infected with a communicable
274	274	264disease from those who are not colonized or infected with a communicable disease.
275	275	265 “License”, an initial or renewal license issued by the department and permits the licensee
276	276	266to establish or maintain and operate a long-term care facility.
277	277	267 “Licensee”, a person permitted to establish or maintain and operate a long-term care
278	278	268facility through a license.
279	279	269 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home,
280	280	270skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest
281	281	271home.
282	282	272 “Long-term care services”, services including: (i) long-term resident, nursing,
283	283	273convalescent or rehabilitative care; (ii) supervision and care incident to old age for ambulatory
284	284	274persons; or (iii) retirement home care for elderly persons.
285	285	275 “Management company”, an organization engaged by a licensee to manage the operations
286	286	276at a long-term care facility. 14 of 51
287	287	277 “Outbreak”, an unusual occurrence of disease or any disease above endemic levels.
288	288	278 “Owner”, a person or management company with an ownership interest of not less than 5
289	289	279per cent, or with a controlling interest in an applicant, licensee, potential transferee or the real
290	290	280property on which a long-term care facility is located.
291	291	281 “Person”, an individual, trust, partnership, association, corporation or other form of
292	292	282business association.
293	293	283 “Potential transferee”, a person who submits to the department a notice of intent to
294	294	284acquire the facility operations of a currently operating long-term care facility.
295	295	285 “Religious and recreational activities”, religious, social or recreational activity that is
296	296	286consistent with the resident’s preferences and choosing, regardless of whether the activity is
297	297	287coordinated, offered, provided or sponsored by facility staff or by an outside activity provider.
298	298	288 “Resident”, an individual who resides in a long-term care facility.
299	299	289 “Rest home”, an institution, which is advertised, announced or maintained for the express
300	300	290or implied purpose of providing care incident to old age for 4 or more persons who are
301	301	291ambulatory and who do not require a specific level of nursing care or other medically related
302	302	292services on a routine basis.
303	303	293 “Skilled nursing facility”, an institution, which is certified by the federal Centers for
304	304	294Medicare and Medicaid Services for the purpose of providing continuous skilled nursing care
305	305	295and rehabilitative services for not less than 4 persons. 15 of 51
306	306	296 “Small house nursing home”, 1 or more units of a convalescent or nursing home designed
307	307	297and modeled as a residential home including a central living space, kitchen, dining area, living
308	308	298area and outdoor space.
309	309	299 “Transfer of facility operations”, a transfer of the operations of a long-term care facility
310	310	300from a licensee to a potential transferee.
311	311	301 (b)(1) The department shall issue for a term of 2 years, and shall renew for like terms, a
312	312	302license, subject to the restrictions in this section, to each applicant the department deems
313	313	303responsible and suitable to establish or maintain and operate a long-term care facility and which
314	314	304meets all other requirements for long-term care facility licensure pursuant to this chapter. A
315	315	305license issued pursuant to this section shall not be transferable or assignable and shall be issued
316	316	306only for the premises named in the application.
317	317	307 (2) Each long-term care facility shall be subject to at least 1 periodic, resident-centered
318	318	308inspection every 9 to 15 months for the purpose of gathering information about the quality of
319	319	309services furnished in the long-term care facility to determine compliance with applicable state
320	320	310and federal requirements.
321	321	311 (3) The department may, when public necessity and convenience require or to prevent
322	322	312undue hardship to an applicant or licensee, pursuant to such rules and regulations as it may
323	323	313adopt, grant a temporary provisional or probationary license pursuant to this section; provided,
324	324	314however, that no such license shall be for a term exceeding 1 year.
325	325	315 (4) The fee for a license to establish or maintain and operate a long-term care facility
326	326	316shall be determined annually by the secretary of administration and finance pursuant to section
327	327	3173B of chapter 7. 16 of 51
328	328	318 (c) The department shall not issue a license to establish or maintain an intermediate care
329	329	319facility for persons with an intellectual disability unless the department determines that there is a
330	330	320need for such a facility at the designated location; provided, however, that in the case of a facility
331	331	321previously licensed as an intermediate care facility for persons with an intellectual disability in
332	332	322which there is a change in ownership or transfer of operations, no such determination shall be
333	333	323required; and provided further, that in the case of a facility previously licensed as an intermediate
334	334	324care facility for persons with an intellectual disability in which there is a change in location, such
335	335	325determination shall be limited to consideration of the suitability of the new location.
336	336	326 (d)(1) In the case of the transfer of facility operations of a long-term care facility, a
337	337	327potential transferee shall submit a notice of intent to acquire to the department not less than 90
338	338	328days prior to the proposed transfer date. The notice of intent to acquire shall be on a form
339	339	329supplied by the department and shall be deemed complete upon submission of all information the
340	340	330department requires on said form. The potential transferee shall not be deemed responsible and
341	341	331suitable upon the expiration of the 90-day period or upon the expiration of said period as
342	342	332extended if the department fails to notify said potential transferee in writing of its decision within
343	343	333the 90-day period or within the expiration of the extension period, whichever is applicable;
344	344	334provided, however, that the potential transferee may resubmit its application for transfer.
345	345	335 (2) A potential transferee shall, concurrently with the submission of an intent to acquire,
346	346	336provide notice to the staff of the facility and to any labor organization that represents the
347	347	337facility’s staff at the time the notice of intent to acquire is submitted of the potential transferee’s
348	348	338plans to retain or not retain the facility staff and to recognize and bargain with any labor
349	349	339organizations currently representing the facility staff. 17 of 51
350	350	340 (3) Upon determination by the department that a potential transferee is responsible and
351	351	341suitable for licensure pursuant to subsection (g), the potential transferee may file an application
352	352	342for a license. In the case of a potential transfer of facility operations, the filing of an application
353	353	343for a license shall have the effect of a temporary provisional or probationary license until the
354	354	344department takes final action on such application.
355	355	345 (4) Upon an approved transfer of facility operations, the department shall not reduce the
356	356	346number of beds from the number that was originally approved in granting a license, unless a
357	357	347reduction in the number of beds is in the interest of public health, welfare or safety.
358	358	348 (e) Every applicant for a license shall provide on or with its application, and every
359	359	349potential transferee shall provide on or with its notice of intent to acquire, a sworn statement of
360	360	350the names and addresses of any owner of the applicant or the potential transferee.
361	361	351 (f) No license shall be issued to an applicant or potential transferee prior to a
362	362	352determination by the department that the applicant or potential transferee is responsible and
363	363	353suitable pursuant to subsection (g).
364	364	354 (g) For the purposes of this section, the department’s determination of responsibility and
365	365	355suitability shall include, but not be limited to: (i) the criminal history of the applicant or the
366	366	356potential transferee, including its respective owners and management companies, and, to the
367	367	357extent possible, the civil litigation history of the applicant or potential transferee, including its
368	368	358respective owners and contracted management companies, including litigation related to the
369	369	359operation of a long-term care facility, such as quality of care, safety of residents or staff,
370	370	360employment and labor issues, fraud, unfair or deceptive business practices and landlord-tenant
371	371	361issues; provided, however, that such criminal and civil litigation history may include pending or 18 of 51
372	372	362other court proceedings in the commonwealth and in any other state or federal jurisdiction;
373	373	363provided further, that information protected from public disclosure by federal or state law and
374	374	364obtained by the department pursuant to this section shall be confidential and exempt from
375	375	365disclosure under clause Twenty-sixth of section 7 of chapter 4 and chapter 66; (ii) the financial
376	376	366capacity of the applicant or potential transferee, including its respective owners and management
377	377	367companies, to establish or maintain and operate a long-term care facility; provided, however, that
378	378	368financial capacity may include, but not be limited to, recorded liens or unpaid fees or taxes in the
379	379	369commonwealth or in other states; (iii) the history of the applicant or potential transferee,
380	380	370including its respective owners and management companies, in providing quality long-term care
381	381	371in the commonwealth as measured by compliance with applicable quality measures, statutes and
382	382	372regulations governing the operation of long-term care facilities; provided, however, that
383	383	373applicable quality measures may include the Centers for Medicare and Medicaid Services
384	384	374Quality Rating System; and (iv) the history of the applicant or potential transferee, including its
385	385	375respective owners, management companies and, if applicable, the involvement of private equity
386	386	376firms, in providing quality long-term care in states other than the commonwealth, if any, as
387	387	377measured by compliance with the applicable quality measures, statutes and regulations governing
388	388	378the operation of long-term care facilities in said states; provided, however, that applicable quality
389	389	379measures may include the Centers for Medicare and Medicaid Services Quality Rating System
390	390	380 (h)(1) If the department determines that an applicant or potential transferee is not
391	391	381responsible and suitable, the department’s determination shall take effect on the date of the
392	392	382department’s notice to the applicant or potential transferee. In such cases and upon the filing of a
393	393	383written request, the department shall afford the applicant or potential transferee an adjudicatory
394	394	384hearing pursuant to chapter 30A. 19 of 51
395	395	385 (2) During the pendency of an adjudicatory hearing, the applicant or potential transferee
396	396	386shall not operate the facility as a licensee nor, without prior approval of the department, manage
397	397	387such facility.
398	398	388 (i) Each applicant, potential transferee and licensee shall maintain current records of all
399	399	389information provided to the department. After the applicant, potential transferee or licensee
400	400	390becomes aware of any change related to information it has provided or is required to provide to
401	401	391the department, such applicant, potential transferee or licensee shall submit to the department
402	402	392written notice of the change as soon as practicable and without unreasonable delay; provided,
403	403	393however, that any change in financial status shall be provided to the department and shall
404	404	394include, but not be limited to, filing for bankruptcy, any default under a lending agreement or
405	405	395under a lease, the appointment of a receiver or the recording of any lien. Failure to provide
406	406	396timely notice of such a change shall be subject to the remedies or sanctions available to the
407	407	397department pursuant to this chapter.
408	408	398 (j) An applicant, potential transferee or licensee and its respective owners and
409	409	399management companies shall comply with applicable federal, state and local laws, rules and
410	410	400regulations.
411	411	401 (k) The department shall not reduce the number of beds it originally approved in granting
412	412	402a license for a convalescent or nursing home or rest home upon the transfer of facility operations
413	413	403of said convalescent or nursing home or rest home from 1 licensee to another unless a reduction
414	414	404in the number of beds is in the interest of public health, welfare or safety.
415	415	405 (l)(1) The department shall not issue a license unless the applicant first submits to the
416	416	406department, with respect to each building occupied by residents: (i) a certificate of inspection of 20 of 51
417	417	407the egresses, the means of preventing the spread of fire and apparatus for extinguishing fire,
418	418	408issued by an inspector of the office of public safety and inspections within the division of
419	419	409occupational licensure; and (ii) a certificate of inspection issued by the head of the local fire
420	420	410department certifying compliance with local ordinances; provided, however, that for
421	421	411convalescent or nursing homes, the bureau of health care safety and quality within the
422	422	412department shall have sole authority to inspect and issue a certificate required pursuant to clause
423	423	413(i) of this paragraph.
424	424	414 (2) An applicant who is aggrieved, based on a written disapproval of a certificate of
425	425	415inspection by the head of the local fire department or by the office of public safety and
426	426	416inspections of the division of occupational licensure, may, within 30 days of such disapproval,
427	427	417submit a written appeal to the division of occupational licensure. Failure to either approve or
428	428	418disapprove within 30 days after a written request by an applicant shall be deemed a disapproval.
429	429	419For certificates of inspection issued to convalescent or nursing homes by the bureau of health
430	430	420care safety and quality within the department, an applicant may, within 30 days of disapproval of
431	431	421a certificate of inspection, submit a written appeal to the department; provided, however, that
432	432	422failure of the department to either approve or disapprove of a written appeal within 30 days of
433	433	423the submission of such written appeal shall constitute a disapproval.
434	434	424 (3) If the division of occupational licensure or, where applicable, the department,
435	435	425approves the issuance of a certificate of inspection after an appeal, the certificate shall be issued
436	436	426by the issuing agency. If the division of occupational licensure or, where applicable, the
437	437	427department, does not approve the issuance of a certificate of inspection, the applicant may appeal
438	438	428to the superior court pursuant to chapter 30A. Failure of the division or the department to either
439	439	429approve or disapprove the issuance of a certificate of inspection within 30 days of the receipt of 21 of 51
440	440	430an appeal shall be deemed a disapproval. The department shall not issue a license until issuance
441	441	431of an approved certificate of inspection, as required pursuant to paragraph (1).
442	442	432 (4) Nothing in this section or in sections 72 or 73 shall be construed to supersede or
443	443	433otherwise affect any laws, ordinances, by-laws, rules or regulations relating to building, zoning,
444	444	434registration or maintenance of a long-term care facility.
445	445	435 (m)(1) For cause, the department may limit, restrict, suspend or revoke a license;
446	446	436provided, however, that the department may temporarily suspend a license without a hearing if:
447	447	437(i) the suspension is due to an emergency; and (ii) the department responds to the suspension in a
448	448	438reasonable timeframe.
449	449	439 (2) Grounds for cause on which the department may take action pursuant to paragraph (1)
450	450	440shall include: (i) substantial or sustained failure or inability to provide adequate care to residents;
451	451	441(ii) substantial or sustained failure to maintain compliance with applicable statutes, rules and
452	452	442regulations; or (iii) the lack of financial capacity to maintain and operate a long-term care
453	453	443facility.
454	454	444 (3) Suspension of a license may include suspending the license during a pending license
455	455	445revocation action or suspending the license to permit the licensee a period of time, not less than
456	456	44660 days, to terminate operations and discharge and transfer all residents, if applicable.
457	457	447 (4) With respect to an order by the department to limit, restrict or suspend a license,
458	458	448within 7 days of receipt of the written order, the licensee may file a written request with the
459	459	449department for an adjudicatory proceeding pursuant to chapter 30A. 22 of 51
460	460	450 (5) Upon a written request by a licensee who is aggrieved by the revocation or limitation
461	461	451of a license or by an applicant who is aggrieved by the refusal of the department to renew a
462	462	452license, the licensee or applicant so aggrieved shall have all the rights provided in chapter 30A
463	463	453with respect to adjudicatory proceedings. In no case shall the revocation of such a license take
464	464	454effect in less than 30 days after written notification by the department to the licensee.
465	465	455 (6) The department may require a facility to limit new admissions.
466	466	456 (n) In the case of the new construction of, major addition to or alteration or repair to any
467	467	457long-term care facility, preliminary and final architectural plans and specifications shall be
468	468	458submitted to a qualified person designated by the commissioner. Written approval of the final
469	469	459architectural plans and specifications shall be obtained from said person prior to the new
470	470	460construction, major addition, alteration or repair.
471	471	461 (o) Notwithstanding any other provision of this section, the department shall not issue a
472	472	462license to establish or maintain and operate a long-term care facility to an applicant who applies
473	473	463to the department for said license to establish or maintain and operate a convalescent or nursing
474	474	464home unless the applicant for such license submits to the department a certificate that each
475	475	465building to be occupied by residents of such convalescent or nursing home meets the
476	476	466construction standards of the state building code and is of at least type 1–B fireproof
477	477	467construction; provided, however, that this subsection shall not apply in the instance of a transfer
478	478	468of facility operations of a convalescent or nursing home whose license has not been revoked as
479	479	469of the time of such transfer; and provided further, that a public medical institution as defined in
480	480	470section 8 of chapter 118E, which meets the construction standards as defined herein, shall not be
481	481	471denied a license as a long-term care facility pursuant to this section because it was not of new 23 of 51
482	482	472construction and designed for the purpose of operating a long-term care facility at the time of
483	483	473application for a license to operate a long-term care facility. An intermediate care facility for
484	484	474persons with an intellectual disability shall be required to meet the construction standards
485	485	475established for such facilities by Title XIX of the Social Security Act, Public Law 89-97, and any
486	486	476regulations promulgated pursuant thereto and by regulations promulgated by the department.
487	487	477 (p) The department shall notify the secretary of elder affairs of any proceeding, public
488	488	478hearing or action to be taken pursuant to this section relating to any convalescent or nursing
489	489	479home, rest home or charitable home for the aged. The department shall notify the commissioner
490	490	480of developmental services of the pendency of any proceeding, public hearing or action to be
491	491	481taken pursuant to this section relating to any intermediate care facility for persons with an
492	492	482intellectual disability.
493	493	483 (q) The department shall notify the clerks of the senate and house of representatives, the
494	494	484joint committee on elder affairs and the senate and house committees on ways and means within
495	495	4853 business days of being notified of a long-term care facility’s decision to close pursuant to
496	496	486department regulations.
497	497	487 SECTION 12. Said chapter 111 is hereby further amended by striking out section 72, as
498	498	488so appearing, and inserting in place thereof the following section:-
499	499	489 Section 72. (a)(1) The department shall classify long-term care facilities and shall, after a
500	500	490public hearing, promulgate rules and regulations for the conduct of such facilities. Rules and
501	501	491regulations for long-term care facilities shall include, but not be limited to, minimum
502	502	492requirements for medical and nursing care, the keeping of proper medical and nursing records,
503	503	493uniform requirements for the handling of patient funds, minimum requirements relative to the 24 of 51
504	504	494prevention and reparation of lost or damaged patient possessions, including personal clothing,
505	505	495and minimum requirements relative to facility sanitation, minimum standards for clinical
506	506	496expertise, staff licensing, certification and training, use of psychotropic medications and non-
507	507	497pharmacological interventions and other requirements of care and treatment; provided, however,
508	508	498that regulations for intermediate care facilities for persons with an intellectual disability shall
509	509	499include minimum requirements for social services, psychological services and other services
510	510	500appropriate for the care of persons with an intellectual disability and shall limit the size of such
511	511	501facilities to not more than 15 beds; provided further, that in promulgating rules or regulations for
512	512	502long-term care facilities, the department shall consider the ability of long-term care facilities to
513	513	503provide services under rates set pursuant to section 13C of chapter 118E; and provided further,
514	514	504that no such rule or regulation shall apply to a long-term care facility licensed at the time of
515	515	505promulgation of such rule or regulation, or a long-term care facility being constructed at the time
516	516	506of such promulgation under plans approved by the department, unless such rule or regulation has
517	517	507a direct and material relation to patient diet, cleanliness, nursing care or health, or to habilitative
518	518	508services and active treatment for persons with an intellectual disability or persons with related
519	519	509conditions.
520	520	510 (2) The department may authorize specialized care units serving persons requiring
521	521	511treatment for infectious diseases, isolation, strokes, degenerative neurological conditions,
522	522	512traumatic brain injuries, in-house dialysis treatments, behavioral health treatments, substance use
523	523	513disorder treatments, bariatric patient care and conditions requiring 24-hour or 1-on-1 patient
524	524	514supervision. The department may promulgate rules and regulations to regulate the conduct of any
525	525	515such specialized care units. 25 of 51
526	526	516 (b)(1) The department or its agents and the board of health or its agents of the city or
527	527	517town wherein any portion of such long-term care facility is located may visit and inspect such
528	528	518institution at any time; provided, however, that a board of health or its agents conducting an
529	529	519inspection of a long-term care facility located within its city or town shall notify the department
530	530	520of the results of any inspection conducted pursuant to this paragraph.
531	531	521 (2) Any person inspecting pursuant to paragraph (1) shall record in writing every
532	532	522violation of the applicable rules and regulations of the department that they discover during the
533	533	523course of their inspection. Every record of inspection shall be treated as a public record except to
534	534	524such extent the record or a portion of the record is expressly exempt from such treatment
535	535	525pursuant to clause Twenty-sixth of section 7 of chapter 4. A record of inspection containing
536	536	526violations shall be made public by the department when a written plan of correction is submitted.
537	537	527If a written plan of correction is not submitted within the allowable time, said violations shall be
538	538	528made public at the expiration of the allowable time. Inspections hereunder shall be unannounced
539	539	529and made at such intervals as the department shall specify in its rules and regulations; provided,
540	540	530that, each long-term care facility shall be subject to at least 1 periodic, resident-centered
541	541	531inspection every 9 to 15 months, pursuant to subsection (b) of section 71. A visit made to a
542	542	532facility for the purpose of providing consultation shall not be considered an inspection.
543	543	533 (c) The superior court shall have jurisdiction pursuant to chapter 30A to enforce the rules
544	544	534and regulations promulgated pursuant to this section.
545	545	535 (d)(1) The department shall promulgate regulations to govern the conduct of such homes
546	546	536and to regulate construction and physical plant standards for small house nursing homes; 26 of 51
547	547	537provided, however, that such regulations shall consider environmental standards and
548	548	538sustainability.
549	549	539 (2) Newly constructed small house nursing homes shall house not more than 14
550	550	540individuals per unit, in resident rooms that accommodate not more than 1 resident per room;
551	551	541provided, however, that if a resident requests to share a room with another resident to
552	552	542accommodate a spouse, partner, family member or friend, such resident room shall have
553	553	543sufficient space and equipment, as established by the department, for 2 residents; provided
554	554	544further, that determinations to grant such requests shall be determined based on space and
555	555	545availability of rooms at the applicable home. All resident rooms shall contain a full private and
556	556	546accessible bathroom.
557	557	547 (3) The department may promulgate additional regulations for small house nursing homes
558	558	548to establish a staffing model that: (i) allows for a universal worker approach to resident care that
559	559	549is organized to support and empower all staff to respond to the needs and desires of residents,
560	560	550including, but not limited to, cooking and meal preparation, without exceeding the lawful scope
561	561	551of practice of said employee; and (ii) provides for consistent staff in each small house nursing
562	562	552home.
563	563	553 (4) All regulations promulgated pursuant to this subsection shall ensure the convalescent
564	564	554or nursing home meets the requirements to participate in the Medicare and Medicaid programs.
565	565	555 SECTION 13 Said chapter 111 is hereby further amended by striking out section 72E, as
566	566	556appearing in the 2022 Official Edition, and inserting in place thereof the following section:-
567	567	557 Section 72E. (a) The department shall, after every inspection by its agent under section
568	568	55872, provide the licensee of the inspected long-term care facility notice in writing of every 27 of 51
569	569	559violation of the applicable statutes, rules and regulations found during said inspection. With
570	570	560respect to the date by which the licensee shall remedy or correct each violation, the department
571	571	561in such notice shall specify a reasonable time, not more than 60 days after receipt, by which time
572	572	562the licensee shall remedy or correct each violation cited or, in the case of any violation which in
573	573	563the opinion of the department is not reasonably capable of correction within 60 days, the
574	574	564department shall require only that the licensee submit a written plan for the timely correction of
575	575	565the violation in a reasonable manner. The department may modify any nonconforming plan upon
576	576	566notice, in writing, to the licensee.
577	577	567 (b) Failure to remedy or correct a cited violation by the correct by date shall be cause to
578	578	568pursue or impose the remedies or sanctions available to the department pursuant to this chapter,
579	579	569unless the licensee demonstrates to the satisfaction of the department or a court, where
580	580	570applicable, that such failure was not due to any neglect of its duty and occurred despite an
581	581	571attempt in good faith to make correction by the correct by date. An aggrieved licensee may
582	582	572pursue the remedies available to it pursuant to chapter 30A.
583	583	573 (c) If the department determines the licensee failed to maintain substantial or sustained
584	584	574compliance with applicable state and federal laws, rules and regulations, in addition to imposing
585	585	575any of the other remedies or sanctions available to it, the department may require the licensee to
586	586	576engage, at the licensee’s own expense, a temporary manager to assist the licensee with bringing
587	587	577the facility into substantial compliance and with sustaining such compliance. Such temporary
588	588	578manager shall be subject to the department’s approval. Any such engagement of a temporary
589	589	579manager shall be for a period of not less than 3 months and shall be pursuant to a written
590	590	580agreement between the licensee and the management company providing the temporary
591	591	581manager. A copy of said agreement shall be provided by the licensee to the department promptly 28 of 51
592	592	582after execution. Any payment terms included in the agreement shall be confidential and exempt
593	593	583from disclosure pursuant to clause Twenty-sixth of section 7 of chapter 4 and chapter 66.
594	594	584 (d) Nothing in this section shall be construed to prohibit the department from enforcing a
595	595	585statute, rule or regulation, administratively or in court, without first affording formal opportunity
596	596	586to make correction pursuant to this section, where, in the opinion of the department, the violation
597	597	587of such statute, rule or regulation jeopardizes the health or safety of residents or the public or
598	598	588seriously limits the capacity of a licensee to provide adequate care, or where the violation of such
599	599	589statute, rule or regulation is the second such violation occurring during a period of 12 full
600	600	590months.
601	601	591 SECTION 14. Section 72K of said chapter 111, as so appearing, is hereby amended by
602	602	592striking out subsection (b) and inserting in place thereof the following 2 subsections:-
603	603	593 (b) The attorney general may file a civil action against a person who: (i) commits abuse,
604	604	594mistreatment or neglect of a patient or resident; (ii) misappropriates patient or resident property;
605	605	595or (iii) wantonly or recklessly permits or causes another to commit abuse, mistreatment or
606	606	596neglect of a patient or resident or misappropriate patient or resident property. The civil penalty
607	607	597for such abuse, mistreatment, neglect or misappropriation shall not exceed $25,000 if no bodily
608	608	598injury results; $50,000 if bodily injury results; $100,000 if sexual assault or serious bodily injury
609	609	599results; and $250,000 if death results. Section 60B of chapter 231 shall not apply to an action
610	610	600brought by the attorney general pursuant to this section. Nothing in this section shall preclude the
611	611	601filing of any action brought by the attorney general or a private party pursuant to chapter 93A or
612	612	602any action by the department pursuant to this chapter. 29 of 51
613	613	603 (c) Notwithstanding section 5 of chapter 260, the attorney general may file a civil action
614	614	604within 4 years next after an offense is committed.
615	615	605 SECTION 15. Said chapter 111 is hereby further amended by inserting after section
616	616	60672BB the following 4 sections:-
617	617	607 Section 72CC. (a) The department shall require long-term care facilities to develop an
618	618	608outbreak response plan which shall be customized to each long-term care facility and shall
619	619	609review such plan to ensure compliance with the requirements under this section. Each long-term
620	620	610care facility’s plan shall include, but not be limited to: (i) a protocol for isolating and cohorting
621	621	611infected and at-risk patients in the event of an outbreak of a contagious disease until the cessation
622	622	612of the outbreak; (ii) clear policies for the notification of residents, residents’ families, visitors and
623	623	613staff in the event of an outbreak of a contagious disease at a long-term care facility; (iii)
624	624	614information on the availability of laboratory testing, protocols for screening visitors and staff for
625	625	615the presence of a communicable disease, protocols to prohibit infected staff from appearing for
626	626	616work at the long-term care facility and processes for implementing evidence-based outbreak
627	627	617response measures; (iv) policies to conduct routine monitoring of residents and staff to quickly
628	628	618identify signs of a communicable disease that could develop into an outbreak; (v) policies for
629	629	619reporting outbreaks to public health officials, including the municipality in which the facility is
630	630	620located, in accordance with applicable laws and regulations; and (vi) policies to meet staffing,
631	631	621training and long-term care facility demands during an infectious disease outbreak and to
632	632	622successfully implement the outbreak response plan.
633	633	623 (b) A long-term care facility shall review the outbreak response plan it submitted to the
634	634	624department pursuant to subsection (a) on an annual basis and if it makes any material changes to 30 of 51
635	635	625such plan, the facility shall submit to the department an updated outbreak response plan within
636	636	62630 days of making such change. The department shall, upon receiving an updated outbreak
637	637	627response plan, verify that the plan is in compliance with the requirements of subsection (a).
638	638	628 (c) The department shall promulgate regulations necessary to implement this section.
639	639	629 Section 72DD. (a) The division of health care facility licensure and certification within
640	640	630the department of public health shall establish and implement a process and program for
641	641	631providing training and education to staff of long-term care facilities licensed by the department
642	642	632pursuant to section 71. The training and education program may include, but not be limited to: (i)
643	643	633infection prevention and control; (ii) development, implementation, adherence to and review of
644	644	634comprehensive resident care plans; (iii) falls prevention; (iv) procedures to ensure timely
645	645	635notification of changes in a resident’s condition to the resident’s primary care physician; (v)
646	646	636prevention of abuse and neglect; (vi) development and implementation of a program to ensure
647	647	637staff safety; and (vii) review of the inspection process under section 72.
648	648	638 (b) The training and education program shall be interactive and shall include, but not be
649	649	639limited to: (i) an annual training for long-term care facility supervisory and leadership staff on
650	650	640the licensure and certification process, including, but not limited to, the department’s
651	651	641interpretation of relevant general laws and relevant changes or additions to applicable rules,
652	652	642regulations, procedures and policies concerning the licensure and certification process for long-
653	653	643term care facilities; and (ii) a biannual training of staff of long-term care facilities on the most
654	654	644frequently cited deficiencies, identified deficiency trends, both state and federal, and best
655	655	645practices to ensure resident quality of care. 31 of 51
656	656	646 Section 72EE. (a) The department shall promulgate regulations to encourage and enable
657	657	647residents of a long-term care facility to engage in in-person, face-to-face, verbal or auditory-
658	658	648based contact, communications and religious and recreational activities with others to the extent
659	659	649that in-person contact, communication or activities are not prohibited, restricted or limited by
660	660	650federal or state law, rule or regulation. Said regulations shall include specific protocols and
661	661	651procedures to provide for residents of the facility who have disabilities that impede their ability
662	662	652to communicate, including, but not limited to, residents who are blind, deaf, have Alzheimer’s
663	663	653disease or other dementias and developmental disabilities.
664	664	654 (b) The department may distribute federal civil monetary penalty funds, subject to
665	665	655approval by the federal Centers for Medicare and Medicaid Services, and any other available
666	666	656federal and state funds, upon request, to facilities for communicative technologies and
667	667	657accessories pursuant to this section.
668	668	658 Section 72FF. (a) As used in this section the following words shall have the following
669	669	659meanings unless the context requires otherwise:
670	670	660 "Gender expression", the manner in which a person represents or expresses gender to
671	671	661others, often through behavior, clothing, hairstyles, activities, voice or mannerisms.
672	672	662 "Gender identity" or “Gender”, a person’s gender identity, appearance or behavior,
673	673	663whether or not that gender identity, appearance or behavior is different from that traditionally
674	674	664associated with the person’s physiology or birth sex; provided, however, that gender identity
675	675	665may be demonstrated through medical history, care or treatment of the gender identity, consistent
676	676	666and uniform assertion of the gender identity or any other evidence that the gender identity is 32 of 51
677	677	667sincerely held as part of a person’s core identity; and provided further, that gender identity shall
678	678	668not be asserted for any improper purpose.
679	679	669 "Gender-nonconforming", gender expression does not conform to stereotypical
680	680	670expectations of such gender.
681	681	671 "Gender transition", a process in which a person begins to live according to that person's
682	682	672gender identity, rather than the sex the person was assigned at birth, which may include changing
683	683	673one's clothing, appearance, name or identification documents or undergoing medical treatments.
684	684	674 “HIV”, human immunodeficiency virus.
685	685	675 "Intersex", a person whose sexual or reproductive anatomy or chromosomal pattern is not
686	686	676consistent with typical definitions of male or female.
687	687	677 "LGBTQI", lesbian, gay, bisexual, transgender, questioning, queer and intersex.
688	688	678 "Long-term care facility", a charitable home for the aged, convalescent or nursing home,
689	689	679skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest
690	690	680home.
691	691	681 "Long-term care facility staff", all individuals employed by, or contracted directly with, a
692	692	682long-term care facility.
693	693	683 "Non-binary" describes a person whose gender identity falls outside of the traditional
694	694	684gender binary structure of man and woman.
695	695	685 "Resident", a resident or patient of a long-term care facility. 33 of 51
696	696	686 "Queer", a person whose gender expression, gender identity or sexual orientation does
697	697	687not conform to dominant expectations or standards.
698	698	688 "Questioning", a person who is exploring or unsure about their own sexual orientation or
699	699	689gender identity or expression.
700	700	690 "Sexual orientation", a person's romantic or sexual attraction to other people.
701	701	691 "Transgender", a person whose gender identity or gender expression differs from the birth
702	702	692sex of that person.
703	703	693 (b) Except as provided in subsection (c), long-term care facilities and long-term care
704	704	694facility staff shall not take any of the following actions based in whole or in part on a person's
705	705	695actual or perceived sexual orientation, gender identity, gender expression, intersex status or HIV
706	706	696status: (i) denying admission to a long-term care facility, transferring or refusing to transfer a
707	707	697resident within a facility or to another facility or discharging or evicting a resident from a
708	708	698facility; (ii) denying a request by residents to share a room; (iii) where rooms are assigned by
709	709	699gender, assigning, reassigning or refusing to assign a room to a transgender resident other than in
710	710	700accordance with the transgender resident's gender identity, unless at the transgender resident's
711	711	701request, and assigning, reassigning or refusing to assign a room to a non-binary resident other
712	712	702than in accordance with the non-binary resident’s preference; (iv) prohibiting a resident from
713	713	703using or harassing a resident for using or seeking to use, a restroom available to other persons of
714	714	704the same gender identity, regardless of whether the resident is making a gender transition, has
715	715	705taken or is taking hormones, has undergone gender affirmation surgery or presents as gender-
716	716	706nonconforming; provided, however, that for the purposes of this clause, harassment shall include,
717	717	707but not be limited to, requiring a resident to show identity documents to gain entrance to a 34 of 51
718	718	708restroom; (v) repeatedly and intentionally failing to use a resident's chosen name or pronouns
719	719	709after being informed of the chosen name or pronouns, in a manner that constitutes discrimination
720	720	710or harassment in violation of any applicable federal, state or local law; (vi) denying a resident the
721	721	711right to wear or be dressed in clothing, accessories or cosmetics or to engage in grooming
722	722	712practices that are permitted to any other resident; (vii) restricting a resident's right to associate
723	723	713with other residents or with visitors, including the right to consensual sexual relations where
724	724	714sexual relations would not be restricted if the participants were heterosexual or married; (viii)
725	725	715denying or restricting medical or nonmedical care that is appropriate to a resident's organs and
726	726	716bodily needs or providing such care that unduly demeans the resident or causes avoidable
727	727	717discomfort or harm; or (ix) refusing or willfully failing to provide any service, care or reasonable
728	728	718accommodation to a resident or an applicant for services or care.
729	729	719 (c) The requirements of this section shall not apply to the extent that compliance with the
730	730	720requirement is incompatible with any professionally reasonable clinical judgment or inconsistent
731	731	721with 42 CFR § 483.15(c)(1), 42 CFR § 483.24 and 105 CMR 150.003.
732	732	722 (d) Each facility shall distribute a document containing the following notice alongside the
733	733	723informational document required by section 72AA:
734	734	724 "[Name of facility] does not discriminate and does not permit discrimination by any
735	735	725person, including persons employed by the facility, residents, family members and other visitors
736	736	726to the facility including, but not limited to, abuse or harassment, on the basis of actual or
737	737	727perceived sexual orientation, gender identity, gender expression, intersex status or HIV status or
738	738	728based on association with another individual on account of that individual's actual or perceived
739	739	729sexual orientation, gender identity, gender expression, intersex status or HIV status. You may 35 of 51
740	740	730file a complaint with the office of the long-term care ombudsman, [provide current contact
741	741	731information] if you believe you have experienced this kind of discrimination."
742	742	732 (e) Each long-term care facility shall ensure that resident records, including records
743	743	733generated at the time of admission, include the resident's gender and the name and pronouns by
744	744	734which the resident would like to be identified, as indicated by the resident.
745	745	735 (f) Unless expressly authorized by the resident or the resident's authorized representative,
746	746	736long-term facility staff not involved in providing direct care to a resident shall not be present
747	747	737during physical examination of, or the provision of personal care to, that resident if the resident
748	748	738is partially or fully unclothed.
749	749	739 (g) Transgender residents shall be provided access to such transition-related assessments,
750	750	740therapy and treatments as have been recommended by the resident's health care provider,
751	751	741including, but not limited to, transgender-related medical care, including hormone therapy and
752	752	742supportive counseling, subject to availability and third-party medical coverage.
753	753	743 (h) LGBTQI-related programming, such as an LGBTQI Pride Month event or a
754	754	744Transgender Day of Remembrance event, shall be allowed and treated equally to other cultural
755	755	745celebrations or commemorations.
756	756	746 (i) The department shall promulgate regulations relative to discipline and penalties for
757	757	747long-term care facilities that violate the requirements of this section or that employ a staff
758	758	748member who violates the requirements of this section, which shall include, but not be limited to,
759	759	749civil penalties and other administrative action. Nothing in this section shall be construed to limit
760	760	750the ability of any party to bring a civil, criminal or administrative action for conduct constituting
761	761	751a violation of any other provision of law. 36 of 51
762	762	752 (j) (1) A long-term care facility shall ensure that the long-term care facility staff receive
763	763	753training, on at least a biennial basis, concerning: (i) the care of LGBTQI older adults and older
764	764	754adults living with HIV; and (ii) the prevention of discrimination based on sexual orientation,
765	765	755gender identity or expression, intersex status and HIV status.
766	766	756 (2) The training required by this section shall include, but not be limited to: (i) the
767	767	757definition of the terms commonly associated with sexual orientation, gender identity and
768	768	758expression, intersex status and HIV status; (ii) best practices for communicating with or about
769	769	759LGBTQI older adults and older adults living with HIV and others who are LGBTQI or living
770	770	760with HIV, including the use of any name and pronouns by which residents may express the
771	771	761desire to be identified; (iii) a description of the health and social challenges historically
772	772	762experienced by LGBTQI older adults and older adults living with HIV and others who are
773	773	763LGBTQI or living with HIV, including discrimination when seeking or receiving care at long-
774	774	764term care facilities, and the demonstrated physical and mental health effects within the LGBTQI
775	775	765community associated with such discrimination; (iv) strategies to create a safe and affirming
776	776	766environment for LGBTQI seniors and residents living with HIV, including suggested changes to
777	777	767facility policies and procedures, forms, signage, communication between residents and their
778	778	768families, activities and staff training and in-services; and (v) an overview of the provisions of this
779	779	769section.
780	780	770 (3) The department shall select an entity that has demonstrated expertise in creating safe
781	781	771and affirming environments and identifying the legal, social and medical challenges faced by
782	782	772LGBTQI older adults and older adults living with HIV and others who are LGBTQI or living
783	783	773with HIV, who reside in long-term care facilities, to provide the training required by this section. 37 of 51
784	784	774 (4) Long-term care facility staff shall complete all training required by this section within
785	785	7751 year of their date of hire unless the new hire provides the long-term care facility with
786	786	776documentation demonstrating that they have completed equivalent training within the past 2
787	787	777years.
788	788	778 (5) Each long-term care facility shall retain records documenting the completion of the
789	789	779training required pursuant to this section by each administrator and staff member at the long-term
790	790	780care facility. Compliance records shall be made available, upon request, to the department, the
791	791	781executive office of health and human services and the office of the statewide long-term care
792	792	782ombudsman.
793	793	783 (6) Each long-term care facility shall assume the cost of providing the training required
794	794	784pursuant to this section.
795	795	785 (k) The commissioner and the secretary of health and human services shall adopt rules
796	796	786and regulations as may be necessary to implement this section.
797	797	787 SECTION 16. Said chapter 111 is hereby further amended by striking out section 73, as
798	798	788so appearing, and inserting in place thereof the following section:-
799	799	789 Section 73. (a) Whoever advertises, announces, establishes or maintains, or is otherwise
800	800	790engaged in any business with or is concerned in establishing or maintaining a long-term care
801	801	791facility without a license granted pursuant to section 71 or violates any provision of sections 71
802	802	792to 73, inclusive, shall for a first offense be punished by a fine of not more than $1,000, and for a
803	803	793subsequent offense by a fine of not more than $2,000 or by imprisonment for not more than 2
804	804	794years. 38 of 51
805	805	795 (b) Whoever violates any rule or regulation promulgated pursuant to sections 71, 72, 72C
806	806	796and 72FF shall be punished by a fine not to exceed $500, unless the department determines a
807	807	797higher amount is appropriate in accordance with 42 CFR 488.438. If any person violates any
808	808	798such rule or regulation by allowing a condition to exist which may be corrected or remedied, the
809	809	799department shall order such person, in writing, to correct or remedy such condition. If such
810	810	800person fails or refuses to comply with such order by the correct by date, each day after the
811	811	801correct by date during which such failure or refusal to comply continues shall constitute a
812	812	802separate offense. A failure to pay the fine imposed by this section shall be a violation of this
813	813	803subsection.
814	814	804 SECTION 17. Section 28 of chapter 118E of the General Laws, as so appearing, is
815	815	805hereby amended by adding the following paragraph:-
816	816	806 The division shall consider a transfer of assets by an individual age 65 or older or a
817	817	807transfer made for the sole benefit of an individual age 65 or older into a trust pursuant to 42
818	818	808U.S.C. 1396p(d)(4)(C), established for the sole benefit of said individual, to be a disposal of
819	819	809resources for fair market value, to the extent that such resources shall be available, under any
820	820	810circumstances, to be used by the trustee to provide goods and services to the individual, or to
821	821	811reimburse such costs, at fair market value.
822	822	812 SECTION 18. Section 31 of said chapter 118E, as so appearing, is hereby amended by
823	823	813inserting after subsection (b) the following subsection:-
824	824	814 (b½) This subsection shall apply to estates of individuals dying on or after August 1,
825	825	8152024. There shall be no adjustments or recovery of medical assistance correctly paid except for
826	826	816recovery from the estate of an individual who was: 39 of 51
827	827	817 (i) regardless of age, a resident in a nursing facility or other medical institution within the
828	828	818meaning of 42 U.S.C. 1396p(a)(1)(B)(i) when the individual received such assistance; provided,
829	829	819however, that recovery of such assistance shall be limited to assistance provided on or after
830	830	820March 22, 1991; or
831	831	821 (ii) 55 years of age or older when the individual received such assistance, where such
832	832	822assistance was for services provided on or after October 1, 1993, but only for medical assistance
833	833	823consisting of nursing facility services, home and community-based services and related hospital
834	834	824and prescription drug services for which estate recovery is mandated under 42 U.S.C.
835	835	8251396p(b)(1)(B)(i) or other federal law.
836	836	826 Any recovery may be made only after the death of the surviving spouse, if any, and only
837	837	827at a time when the individual has no surviving child who is: (i) under the age of 21; or (ii) an
838	838	828individual who is blind or an individual with a disability.
839	839	829 SECTION 19. Said section 31 of said chapter 118E, as so appearing, is hereby further
840	840	830amended by adding the following subsection:-
841	841	831 (e) Notwithstanding subsection (b½), there shall be no adjustment or recovery of medical
842	842	832assistance correctly paid from the estate of an individual who was receiving such assistance
843	843	833under the CommonHealth program for adults with disabilities or for payment of personal care
844	844	834attendant services; provided, however, that the executive office shall seek federal authority, if
845	845	835required, to implement this subsection.
846	846	836 SECTION 20. Said chapter 118E is hereby further amended by adding the following 2
847	847	837sections:- 40 of 51
848	848	838 Section 83. To establish Medicaid rates for skilled nursing facilities licensed pursuant to
849	849	839section 71 of chapter 111, the division of medical assistance shall use as base year costs for rate
850	850	840determination purposes the reported costs of the calendar year not more than 2 years prior to the
851	851	841current rate year.
852	852	842 Section 84. (a) The division of medical assistance shall establish a skilled nursing facility
853	853	843rate add-on program for bariatric patient care and a rate add-on program for 1-on-1 staffing of at-
854	854	844risk residents requiring 24-hour monitoring and supervision for their safety and the safety of
855	855	845other residents and staff. The division of medical assistance shall identify at-risk resident
856	856	846populations to include in the rate add-on program for 1-on-1 staffing which may include, but not
857	857	847be limited to, residents that: (i) have demonstrated suicidal ideation; (ii) have demonstrated
858	858	848aggressive behavior toward other residents or staff; (iii) have demonstrated exit-seeking
859	859	849behavior; or (vi) are registered sex offenders. The rate add-ons for said program shall be
860	860	850sufficient to defray the cost of employing the required staff to conduct the 24-hour monitoring
861	861	851and supervision of the at-risk residents.
862	862	852 (b) When determining eligibility for add-on or enhanced rates for specialized care units,
863	863	853as authorized by paragraph (2) of section 72 of chapter 111, the division shall consider whether
864	864	854the facility has complied with standards, as determined and certified by the department of public
865	865	855health, which may include, but not be limited to, clinical expertise, staff licensing, staff training,
866	866	856staff certification, unit accreditation, staff ratios, use of psychotropic medications and non-
867	867	857pharmacological interventions, therapeutic and psychosocial programming to develop and
868	868	858maintain daily living skills and encourage socialization, use of behavior plans and other
869	869	859requirements of care and treatment as determined by the department. 41 of 51
870	870	860 (c) The division of medical assistance may develop an add-on rate of payment for skilled
871	871	861nursing facilities that develop small house nursing homes and meet criteria established by the
872	872	862executive office.
873	873	863 SECTION 21. Subsection (c) of section 25 of chapter 176O of the General Laws, as
874	874	864appearing in the 2022 Official Edition, is hereby amended by inserting after the second sentence
875	875	865the following sentence:- The division shall develop and implement a uniform prior authorization
876	876	866form for the admission of patients from an acute care hospital to a post-acute care facility or
877	877	867transitioned to a home health agency certified by the federal Centers for Medicare and Medicaid
878	878	868Services for covered post-acute care services.
879	879	869 SECTION 22. Section 23 of chapter 20 of the acts of 2021 is hereby repealed.
880	880	870 SECTION 23. (a) For the purposes of this section, the following words shall have the
881	881	871following meanings unless the context clearly requires otherwise:
882	882	872 “Enrollee”, shall have the same meaning as in section 8A of chapter 118E of the General
883	883	873Laws; provided, however, that “enrollee” shall include “insured” as defined in section 1 of
884	884	874chapter 176O of the General Laws.
885	885	875 “Payer”, the group insurance commission under chapter 32A of the General Laws, the
886	886	876division of medical assistance under chapter 118E of the General Laws, insurance companies
887	887	877organized under chapter 175 of the General Laws, non-profit hospital service corporations
888	888	878organized under chapter 176A of the General Laws, medical service corporations organized
889	889	879under chapter 176B of the General Laws, health maintenance organizations organized under
890	890	880chapter 176G of the General Laws and preferred provider organizations organized under chapter 42 of 51
891	891	881176I of the General Laws, or a utilization review organization acting under contract with the
892	892	882aforementioned entities.
893	893	883 “Post-acute care facility or agency”, (i) a facility licensed under chapter 111 to provide
894	894	884inpatient post-acute care services, including, but not limited to, skilled nursing facilities, long-
895	895	885term care hospitals, intermediate care facilities or rehabilitation facilities; or (ii) a home health
896	896	886agency certified by the federal Centers for Medicare and Medicaid Services.
897	897	887 (b) Notwithstanding any general or special law to the contrary, all payers shall approve or
898	898	888deny a request for prior authorization for admission to a post-acute care facility or transition to a
899	899	889post-acute care agency for any inpatient of an acute care hospital requiring covered post-acute
900	900	890care services by the next business day following receipt by the payer of all necessary information
901	901	891to establish medical necessity of the requested service; provided, however, that no admission
902	902	892may occur until the pre-admission screening and resident review pursuant to 42 CFR 483 is
903	903	893complete. If the calendar day immediately following the date of submission of the completed
904	904	894request is not a payer’s business day, and the payer cannot otherwise make a determination by
905	905	895the next calendar day, and the receiving post-acute care facility or agency is both open to new
906	906	896admissions and has indicated that said facility or agency will accept the enrollee, then prior
907	907	897authorization shall be waived; provided, however, that the payer shall provide coverage and may
908	908	898begin its concurrent review of the admission on the next business day; provided further, that the
909	909	899payer shall not retrospectively deny coverage for services to an enrollee admitted to a post-acute
910	910	900care facility or transitioned to a post-acute care agency after a waiver of prior authorization
911	911	901pursuant to this section unless the claim was a result of fraud, waste or abuse. An adverse
912	912	902determination of a prior authorization request pursuant to this section may be appealed by an
913	913	903enrollee or the enrollee’s provider and such appeal, in the case of an enrollee of a commercial 43 of 51
914	914	904payer, shall be subject to the expedited grievance process pursuant to clause (iv) of subsection
915	915	905(b) of section 13 of chapter 176O of the General Laws. An enrollee of an insurance program of
916	916	906the division of medical assistance or the enrollee’s provider may request an expedited appeal of
917	917	907an adverse determination of a prior authorization request. Nothing in this section shall be
918	918	908construed to require a payer to reimburse for services that are not a covered benefit.
919	919	909 (c) In the case of non-emergency transportation between an acute care hospital and a
920	920	910post-acute care facility, payers shall approve or deny a request for prior authorization according
921	921	911to the same process provided pursuant to subsection (b); provided, however, that once
922	922	912authorization has been granted, said authorization shall be valid for not less than 7 calendar days
923	923	913following approval.
924	924	914 (d) The division of insurance and the division of medical assistance shall issue sub-
925	925	915regulatory guidance to effectuate the purposes of this subsection.
926	926	916 SECTION 24. For the purposes of this section, “payer” shall mean the group insurance
927	927	917commission under chapter 32A of the General Laws, the division of medical assistance under
928	928	918chapter 118E of the General Laws, insurance companies organized under chapter 175 of the
929	929	919General Laws, non-profit hospital service corporations organized under chapter 176A of the
930	930	920General Laws, medical service corporations organized under chapter 176B of the General Laws,
931	931	921health maintenance organizations organized under chapter 176G of the General Laws and
932	932	922preferred provider organizations organized under chapter 176I of the General Laws, or a
933	933	923utilization review organization acting under contract with the aforementioned entities.
934	934	924 Notwithstanding any general or special law to the contrary, not later than 90 days after
935	935	925the effective date of this act, the division of insurance shall develop the uniform prior 44 of 51
936	936	926authorization form for admission to a post-acute care facility or transition to a home health
937	937	927agency for any inpatient of an acute care hospital requiring covered post-acute care services
938	938	928pursuant to section 25 of chapter 176O of the General Laws. Said uniform prior authorization
939	939	929form shall state that no admission to a nursing facility may occur until the preadmission
940	940	930screening and resident review required under 42 CFR 483 is complete. The division of insurance
941	941	931shall develop said uniform prior authorization form in consultation with the division of medical
942	942	932assistance. The division of medical assistance, or any entity acting for the division of medical
943	943	933assistance under contract, shall accept the uniform prior authorization form as sufficient to
944	944	934request prior authorization for the requested service. All acute care hospitals shall use the
945	945	935uniform prior authorization form to request prior authorization for coverage of post-acute care
946	946	936services at a post-acute care facility or home health agency, and all payers or entities acting for a
947	947	937payer under contract shall accept such form as sufficient to request prior authorization for the
948	948	938requested service not later than 30 days after the form has been developed by the division of
949	949	939insurance.
950	950	940 SECTION 25. (a) For the purposes of this section, the terms “licensee” and “management
951	951	941company” shall have the meanings as defined in section 71 of chapter 111 of the General Laws.
952	952	942 (b) Pursuant to section 71 of chapter 111 of the General Laws, a licensee who has entered
953	953	943into a contract with a management company prior to the effective date of this act shall provide
954	954	944the department of public health with the necessary documentation and materials for a
955	955	945determination by the department of the responsibility and suitability of the management
956	956	946company, as described in subsection (g) of said section 71 of said chapter 111, prior to any
957	957	947issuance of a renewed license; provided, however, that the department shall give a licensee
958	958	948reasonable time to provide the department with the necessary documents and materials if the 45 of 51
959	959	949licensee’s renewal date is within 90 days of the effective date of this act. A licensee’s failure to
960	960	950comply with this section shall subject the licensee to the penalties established in section 73 of
961	961	951said chapter 111.
962	962	952 SECTION 26. (a) There shall be a special commission to study oversight of continuing
963	963	953care retirement communities to protect the consumer and financial rights of residents.
964	964	954 (b) The commission shall consist of: the chairs of the joint committee on elder affairs,
965	965	955who shall serve as co-chairs; the attorney general or a designee; the secretary of elder affairs or a
966	966	956designee; the commissioner of public health or a designee; 3 persons to be appointed by the
967	967	957governor, 1 of whom shall be a certified public accountant or an actuary and 2 of whom shall be
968	968	958residents at a continuing care retirement community; a representative of the Massachusetts
969	969	959chapter of National Academy of Elder Law Attorneys; a representative of LeadingAge
970	970	960Massachusetts, Inc.; a representative of Massachusetts Assisted Living Association, Inc.; a
971	971	961representative of AARP Massachusetts; a representative of the Alzheimer’s Association; a
972	972	962representative of Massachusetts Advocates for Nursing Home Reform, Inc.; a representative of
973	973	963the Massachusetts Life Care Residents’ Association, Inc.; a representative of Massachusetts
974	974	964Senior Care Association, Inc.; and a representative of Local 1199 SEIU. The commission shall
975	975	965meet not less than 6 times and shall hold not less than 1 public hearing.
976	976	966 (c) The commission shall study and report on: (i) continuing care retirement
977	977	967communities, their care contracts and their impact on consumers; (ii) the financial viability of
978	978	968such communities; (iii) the payment and return of entrance fees at such communities; (iv)
979	979	969statutory and regulatory oversight of such communities, including any activities by state agencies
980	980	970to enforce regulatory requirements; (v) advertising practices communicated to potential residents 46 of 51
981	981	971and families about such communities; and (vi) regulatory procedures for the closure or change of
982	982	972ownership of such communities.
983	983	973 (d) The commission shall submit a report with recommendations, including legislation or
984	984	974regulations necessary to carry out such recommendations, to the clerks of the house of
985	985	975representatives and the senate, the joint committee on elder affairs and the senate and house
986	986	976committees on ways and means not later than August 1, 2025.
987	987	977 SECTION 27. (a) The department of public health shall study and report on the need and
988	988	978feasibility of qualified professional guardians to give informed medical consent for indigent
989	989	979persons and whether such guardians would reduce hospital discharge issues and increase access
990	990	980to long-term care and preventive care; provided, however, that the report shall include, but not be
991	991	981limited to: (i) the need for qualified professional guardians to assist indigent persons with
992	992	982accessing appropriate medical care, including preventive care; (ii) data on the current number of
993	993	983Rogers guardians and similar guardians and the financial impact of reimbursing such guardians;
994	994	984(iii) the fiscal impact of establishing MassHealth fee-for-service guardians; and (iv) other
995	995	985recommendations deemed necessary by the department.
996	996	986 (b) Not later than July 31, 2025, the department shall submit its report, including any
997	997	987proposed legislation necessary to carry out its recommendations, to the clerks of the senate and
998	998	988house of representatives, the senate and house committees on ways and means and the joint
999	999	989committee on elder affairs.
1000	1000	990 SECTION 28. (a) There shall be a taskforce to review the viability and sustainability of
1001	1001	991long-term care facilities in the commonwealth. 47 of 51
1002	1002	992 (b) The taskforce shall consist of: the secretary of health and human services, who shall
1003	1003	993serve as chair; the secretary of elder affairs or a designee; commissioner of public health or a
1004	1004	994designee; 4 persons to be appointed by the governor, 1 of whom shall represent long-term care
1005	1005	995facilities, 1 of whom shall operate an assisted living residence, 1 of whom shall represent
1006	1006	996residents of long-term care facilities in the commonwealth and 1 of whom shall be health care
1007	1007	997economist; a representative of LeadingAge Massachusetts, Inc., a representative of 1199SEIU; a
1008	1008	998representative of Massachusetts Association of Residential Care Homes, Inc.; a representative of
1009	1009	999the Massachusetts Senior Action Council, Inc; and a representative of Massachusetts Senior Care
1010	1010	1000Association.
1011	1011	1001 In making appointments, the governor shall, to the maximum extent feasible, ensure that
1012	1012	1002the task force represents a broad distribution of diverse perspectives and geographic regions.
1013	1013	1003 (c) In making recommendations, the task force shall consider issues including, but not
1014	1014	1004limited to: (i) the demand for long-term care facilities over the next 5 and 10 years and the ability
1015	1015	1005to meet that demand in a cost-effective manner; (ii) the geographic accessibility of such
1016	1016	1006facilities; (iii) staffing challenges and workforce initiatives to support such facilities including
1017	1017	1007but not limited to childcare; (iv) the utilization of pharmacists and other health care providers in
1018	1018	1008long-term care; (v) any policy reforms to strengthen long-term care in the commonwealth
1019	1019	1009including but not limited to, maintaining quality of care; (vi) the adequacy of payor rates; (vii)
1020	1020	1010costs and impacts of financing for facility construction and maintenance, including but not
1021	1021	1011limited to, private equity and real estate investment trusts; and (viii) costs associated with
1022	1022	1012transportation options to and from facilities for individuals. 48 of 51
1023	1023	1013 (d) The task force shall submit its report, recommendations and any proposed legislation
1024	1024	1014necessary to carry out its recommendations to the clerks of the senate and house of
1025	1025	1015representatives, the joint committee on health care financing, the joint committee on elder affairs
1026	1026	1016and the senate and house committees on ways and means not later than July 31, 2025.
1027	1027	1017 SECTION 29. (a) Notwithstanding any general or special law to the contrary, there shall
1028	1028	1018be an assisted living residences commission to study and recommend policies to ensure assisted
1029	1029	1019living residences adequately meet the health and safety needs of residents. The areas examined
1030	1030	1020by the commission shall include, but not be limited to: (i) the current statutory and regulatory
1031	1031	1021oversight of assisted living residences; (ii) assisted living best practices in other states; (iii) the
1032	1032	1022impacts of licensing or certifying such residences; (iv) advertising practices of assisted living
1033	1033	1023residences to potential residents and their families; (v) regulatory procedures for opening, closing
1034	1034	1024or changing ownership of a residence, including determination of need processes and clustering
1035	1035	1025of facilities; (vi) trends in incident reports made to the executive office of elder affairs and the
1036	1036	1026long term care ombudsman’s office and resolutions of such incidents; (vii) methods to provide
1037	1037	1027transparency of information for potential consumers and family members researching and
1038	1038	1028comparing residences; (viii) safety standards; (ix) existing consumer protections for residents in
1039	1039	1029statutes and regulations; and (x) basic health services in residences.
1040	1040	1030 (b) The commission shall consist of: the secretary of elder affairs, who shall serve as
1041	1041	1031chair; the commissioner of public health or a designee; the assistant secretary of MassHealth or a
1042	1042	1032designee; the long term care ombudsman or a designee; the chairs of the joint committee on elder
1043	1043	1033affairs; 1 member to be appointed by the senate president; 1 member to be appointed by the
1044	1044	1034speaker of the house; 1 member to be appointed by the minority leader of the senate; 1 member
1045	1045	1035to be appointed by the minority leader of the house of representatives; 3 members to be 49 of 51
1046	1046	1036appointed by the governor, 2 of whom shall be residents or family members of residents at an
1047	1047	1037assisted living residence; a representative of the Massachusetts chapter of the National Academy
1048	1048	1038of Elder Law Attorneys; a representative of LeadingAge Massachusetts, Inc.; a representative of
1049	1049	1039the Massachusetts Assisted Living Association, Inc.; a representative of AARP Massachusetts; a
1050	1050	1040representative of the New England chapter of the Gerontological Advanced Practice Nurses
1051	1051	1041Association; a representative of the Massachusetts chapter of the Alzheimer’s Association; a
1052	1052	1042representative of MassPACE, Inc.; and a representative of Greater Boston Legal Services, Inc..
1053	1053	1043The commission shall meet not less than 5 times and shall hold at least 1 public hearing.
1054	1054	1044 (c) The commission shall file its report and recommendations, including any proposed
1055	1055	1045legislation necessary to carry out its recommendations, to the clerks of the senate and house of
1056	1056	1046representatives, the joint committee on elder affairs and the house and senate committees on
1057	1057	1047ways and means not later than August 1, 2025.
1058	1058	1048 SECTION 30. Notwithstanding any general or special law to the contrary, the executive
1059	1059	1049office shall report to the house and senate committees on ways and means, not later than 90 days
1060	1060	1050after the effective date of this act, on the availability of a waiver and, if applicable, the estimated
1061	1061	1051net state cost of a waiver that would allow individuals qualifying for Medicaid and at risk of
1062	1062	1052entering a nursing home to reside in a certified assisted living residence. The executive office of
1063	1063	1053health and human services may request a waiver from the federal Centers for Medicare and
1064	1064	1054Medicaid Services to allow individuals qualifying for Medicaid and at risk of entering a nursing
1065	1065	1055home to reside in a certified assisted living residence. 50 of 51
1066	1066	1056 SECTION 31. Pursuant to section 72CC of chapter 111 of the General Laws, each long-
1067	1067	1057term care facility shall submit its outbreak response plan to the department of public health not
1068	1068	1058later than 180 days after the effective date of this act.
1069	1069	1059 SECTION 32. (a) Each long-term care facility shall designate 2 employees, including 1
1070	1070	1060employee representing management at the facility and 1 employee representing direct care staff
1071	1071	1061at the facility, to receive in-person training required by section 72FF of chapter 111 of the
1072	1072	1062General Laws within 6 months of the effective date of this act. The designated employees shall
1073	1073	1063serve as points of contact for the long-term care facility regarding compliance with the
1074	1074	1064provisions of this act and shall develop a general training plan for the facility. In the event a
1075	1075	1065designated employee ceases to be employed by the facility, the facility shall designate another
1076	1076	1066employee who is representative of the employee group represented by the former designee, who
1077	1077	1067shall complete the in-person training required pursuant to this section, to serve as a point of
1078	1078	1068contact for the facility regarding compliance with the provisions of this act and have joint
1079	1079	1069responsibility for the facility's training plan.
1080	1080	1070 (b) All long-term care facility staff employed by a long-term care facility on the effective
1081	1081	1071date of this act, other than an employee designated pursuant to subsection (a), shall complete the
1082	1082	1072training required by 72FF of chapter 111 of the General Laws within 1 year of the effective date
1083	1083	1073of this act.
1084	1084	1074 SECTION 33. Sections 15 and 32 shall take effect 180 days after the effective date of this
1085	1085	1075act.
1086	1086	1076 SECTION 34. Section 83 of chapter 118E of the General Laws, inserted by section 20,
1087	1087	1077shall take effect on October 1, 2025. 51 of 51
1088	1088	1078 SECTION 35. Section 23 is hereby repealed.
1089	1089	1079 SECTION 36. Section 35 shall take effect 2 years after the effective date of this act.