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HOUSE DOCKET, NO. 1449 FILED ON: 1/15/2025
HOUSE . . . . . . . . . . . . . . . No. 789
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Thomas M. Stanley
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act to improve Massachusetts home care.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Thomas M. Stanley9th Middlesex1/15/2025Brian W. Murray10th Worcester1/28/2025Lindsay N. Sabadosa1st Hampshire1/28/2025Paul K. Frost7th Worcester1/28/2025Rodney M. Elliott16th Middlesex2/4/2025Rebecca L. RauschNorfolk, Worcester and Middlesex2/4/2025Danillo A. Sena37th Middlesex2/4/2025Paul McMurtry11th Norfolk2/5/2025Samantha Montaño15th Suffolk2/5/2025Erika Uyterhoeven27th Middlesex2/7/2025James B. EldridgeMiddlesex and Worcester2/11/2025James C. Arena-DeRosa8th Middlesex2/12/2025Bruce J. Ayers1st Norfolk2/13/2025Jason M. LewisFifth Middlesex2/13/2025Patricia D. JehlenSecond Middlesex2/14/2025Carmine Lawrence Gentile13th Middlesex2/19/2025Carlos González10th Hampden2/24/2025Natalie M. Higgins4th Worcester2/24/2025 2 of 2
Manny Cruz7th Essex2/28/2025James Arciero2nd Middlesex2/28/2025Adam J. Scanlon14th Bristol2/28/2025Michael D. BradySecond Plymouth and Norfolk3/3/2025Mary S. Keefe15th Worcester3/5/2025Adrianne Pusateri Ramos14th Essex3/12/2025Kevin G. Honan17th Suffolk3/12/2025 1 of 13
HOUSE DOCKET, NO. 1449 FILED ON: 1/15/2025
HOUSE . . . . . . . . . . . . . . . No. 789
By Representative Stanley of Waltham, a petition (accompanied by bill, House, No. 789) of
Thomas M. Stanley and others for legislation to create safe environments for home care workers
and consumers. Elder Affairs.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act to improve Massachusetts home care.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 111 of the General Laws, as appearing in the 2022 Official Edition,
2is hereby amended by inserting after section 51K the following 3 sections:-
3 Section 51L. (a) For the purposes of this section and sections 51M and 51N, the
4following words shall, unless the context clearly requires otherwise, have the following
5meanings,:-
6 “Home care agency", a business, nonprofit organization or other entity engaged in
7providing home care services to consumers in the consumers’ residence for compensation or any
8entity or individual that represents itself as a home care agency by name, advertising or
9presentments to the public or uses the terms “home care agency” or “home care” in the entity or
10individual’s name; provided however, that ''home care agency'' shall not include any of the
11following: (i) an entity operated by either the federal government or the commonwealth
12providing home care services, (ii) an entity that limits its business to the provision of house 2 of 13
13cleaning services, (iii) an Aging Service Access Points entity as defined in section 4B of chapter
1419A, (v) a hospice program licensed under section 57D or (vi) a home health agency as defined
15in section 51K.
16 “Home care consumers”, an individual receiving home care services or any legal
17representative of such individual.
18 “Home care services", supportive services provided to an individual in their residence to
19enable that individual to remain in their residence safely and comfortably, including, but not
20limited to, assistance with eating, toileting, dressing, bathing, transferring, ambulation and other
21activities of daily living, housekeeping, personal laundry and companionship. Home care
22services shall not include hospice services provided by an entity subject to licensure under
23section 57D or home health services provided by an entity subject to licensure under section
2451K, services provided by a personal care attendant in the commonwealth’s personal care
25attendant program as defined in 130 CMR 422.000 or services provided under the MassHealth
26adult foster care program as defined in 101 CMR 351.00.
27 “Home care worker”, an individual employed by a home care agency who provides home
28care services to a consumer in the consumer’s residence.
29 “Personal care attendant”, an individual who provides consumer-directed personal care
30services to a consumer in the consumer’s residence, including, but not limited to, a person
31providing such services as defined under section 70 of chapter 118E.
32 “Secretary”, the secretary of health and human services. 3 of 13
33 (b) Unless otherwise expressly authorized by the secretary, no person shall establish,
34maintain, operate or hold oneself out as a home care agency without a home care agency license
35issued by the secretary and no organization or entity shall provide home care services, use the
36words "home care" to describe its services or establish, maintain, operate or hold itself out as a
37home care agency without a home care agency license issued by the secretary; provided, that
38licensure shall be required for home care agencies that directly employ home care workers or
39directly contract with a company who employs home care workers.
40 (c) The secretary shall issue for a term to be determined, and may renew for like terms, a
41home care agency license to any person or entity of any kind, other than a department, agency or
42institution of the federal government, the commonwealth or any political subdivision thereof,
43that: (i) the secretary deems responsible and suitable to establish or operate a home care agency,
44and (ii) meets the requirements of the executive office of health and human services established
45in accordance with the office’s rules and regulations developed in consultation with the
46executive office of elder affairs and the department of public health as provided in subsection (e).
47 A home care agency license shall be subject to suspension, revocation or refusal to renew
48for cause. License application and renewal fees shall be established pursuant to section 3B of
49chapter 7.
50 The secretary may issue a provisional license for a term not to exceed 120 days to an
51applicant that has not previously operated home care services, or to a home care agency that is
52operating but is temporarily unable to meet applicable standards and requirements. If a
53provisional licensee has made significant progress towards meeting such requirements, the 4 of 13
54secretary may renew the provisional license once for a period not to exceed 120 days from the
55expiration of the initial provisional license.
56 (d) The secretary may impose a fine on a person or entity that advertises, announces,
57establishes, or operates a home care agency without a license granted by the secretary. The
58secretary may impose a fine on a licensed home care agency that violates this section, or any rule
59or regulation promulgated hereunder. Each day during which a violation continues shall
60constitute a separate offense.
61 The secretary, in collaboration with the executive office of elder affairs and the
62department of public health, may conduct surveys and investigations to enforce compliance with
63this section.
64 (e) The secretary shall, in consultation with the executive office of elder affairs and the
65department of public health, promulgate rules and regulations for the licensing and conduct of a
66home care agency. In developing these rules and regulations, the secretary shall review all
67existing licensure, reporting and oversight requirements across the long-term care services and
68support system and other relevant state agencies, including the provider monitoring conducted by
69the Aging Services Access Points, to avoid duplication or conflicting requirements and to ensure
70that home care agency licensure processes align with the current licensure for home health
71agencies and with state oversight process already in place through the Aging Services Access
72Points and the nurse aide registry.
73 The regulations shall include, but shall not be limited to:
74 (i) background screening check requirements for all home care workers which may
75include: (1) Massachusetts criminal background checks, (2) state or county criminal history 5 of 13
76screenings for each location outside of the commonwealth in which the home care professional is
77known to have lived or worked during the previous 5 years, (3) review of the federal Office of
78Inspector General List of Excluded Individuals/Entities, (4) review of the nurse aide registry, (5)
79applicable professional licensing board check and (6) for all home care professionals who will
80transport consumers, verification of auto insurance and driving records for a minimum of the
81previous 5 years;
82 (ii) minimum standards for consumer-specific service plans and contracts; provided, that
83the plans shall include: (1) a detailed description of services, including services the primary
84agency is subcontracting to another agency or provider, (2) a written unit rate and total cost of
85services, inclusive of any additional fees or deposits, and (3) contact information for consumer
86questions;
87 (iii) minimum coverage requirements for workers’ compensation insurance and liability
88insurance;
89 (iv) maintenance of a payroll process that follows all state and federal labor and wage
90laws;
91 (v) annual and ongoing training and competency requirements for home care agency staff
92that are in direct contact with home care consumers; provided, that minimum training
93requirements shall include (1) confidentiality and privacy of home care consumer’s rights, (2)
94infection control and communicable diseases, (3) handling of emergencies, including safety and
95falls prevention, (4) observation, reporting and documenting changes in consumer needs and
96environment, (5) identifying and reporting suspected abuse, neglect or theft, (6) understanding
97Alzheimer’s disease and dementia, including person centered care, activities of daily living, 6 of 13
98safety and dementia-related behaviors and communication and (7) wage theft. The trainings shall
99be culturally and linguistically competent for the trainee;
100 (vi) policies and procedures to ensure home care workers have safe working conditions,
101adequate training and a process for submitting complaints;
102 (vii) maintenance of an emergency preparedness plan;
103 (viii) meeting of quality metrics and standards to be set forth in the licensing regulations;
104 (ix) requirements and written processes for the timely reporting of home care consumer
105complaints;
106 (x) a suitability determination process; provided, that the process shall include, but not be
107limited to, requiring all applicants to attest to having sufficient financial capacity to provide
108ongoing care and services in compliance with state law and regulation; and
109 (xi) providing adequate equipment and supplies for home care workers.
110 (f)The secretary shall be responsible for licensing home care agencies. To accomplish the
111objectives set forth in this section, the secretary may coordinate and consult with the offices and
112agencies that are interested in matters pertaining to the delivery of home care services, including
113but not limited to: (1) the department of public health, (2) the executive office of elder affairs, (3)
114the department of consumer affairs and business regulation and (4) the department of public
115health. The responsibilities of the regulating agency shall include:
116 (i) reviewing and processing licensure applications, including a suitability review that
117ensures the applicant can meet the obligations and conditions of licensure, including: 7 of 13
118 (A) a review of the state disbarment list and federal Office of Inspector General List of
119Excluded Individuals/Entities; and
120 (B) a competency review where all individuals with at least a 5 per cent ownership stake
121in the home care agency shall submit the individuals’ names, contact information, companies
122where they have at least a 5 per cent ownership, any civil or criminal findings against said
123individual, and a completed background check;
124 (ii) establishing a process for a change of ownership that includes advanced notice to
125home care consumers and home care workers and a review by the regulating state agency to
126determine if the new licensee can meet the obligations and conditions of licensure, including a
127suitability review; provided, that home care agency licenses shall not be transferable;
128 (iii) working with other regulators to investigate and resolve complaints;
129 (iv) imposing fines on the licensee when determined to be appropriate;
130 (v) suspending or revoking licenses when determined to be appropriate;
131 (vi) posting a listing of licensed home care agencies on a publicly available webpage;
132 (vii) allowing for “deemed status” for licensure of home care agencies if an Aging
133Service Access Points or MassHealth provider contract is in place;
134 (viii) establishing of quality metrics and standards for monitoring the licensed home care
135agency performance, including reporting mechanisms for tracking performance; and
136 (ix) annual reporting by home care agencies, which may include reporting on quality
137metrics and significant changes related to home care agency finances. 8 of 13
138 Section 51M. (a) The secretary, in consultation with the home care worker and consumer
139abuse stakeholder advisory committee establishing in subsection (b), MassHealth, the department
140of elder affairs, the department of public health and the PCA quality home care workforce
141council established pursuant to section 71 of chapter 118E, shall adopt minimum standards and
142procedures for addressing abusive treatment and bullying of Massachusetts home care workers,
143personal care attendants and home care consumers. The standards and procedures shall address
144physical, verbal and mental abuse either of or from individual home care consumers as well as
145any abusive treatment or bullying from home care consumer surrogates, family members, other
146caregivers and any others present in the home care consumers’ household when the home care
147worker is providing home care services. The standards and procedures shall promote appropriate
148home care worker and home care consumer training and support and a safe and healthy work
149environment for home care workers, while recognizing the privacy rights of home care
150consumers, the role of personal care attendant consumer employers and that home care
151consumers may have a disruptive behavioral disorder underlying abuse behavior.
152 (b) There shall be a home care worker and consumer abuse stakeholder advisory
153committee that shall meet, study and make recommendations to the secretary relative to
154standards and procedures for addressing abusive treatment and bullying of home care workers,
155personal care attendants and home care consumers.
156 The advisory committee shall consist of the following 16 members: the secretary or a
157designee, who shall serve as chair; the assistant secretary for MassHealth or a designee; the
158secretary of elder affairs or a designee; the commissioner of public health or a designee; the
159chairs of the joint committee on elder affairs or their designees; and 10 persons to be appointed
160by the governor, 1 of whom shall be a personal care attendant, 1 of whom shall be a home care 9 of 13
161agency direct care worker, 1 of whom shall be a consumer of personal care attendant services
162who shall be a member of the PCA workforce council, 1 of whom shall be a consumer of home
163care agency services, 1 of whom shall be a representative of the statewide independent living
164council, 1 of whom shall be a representative of the Disability Law Center, Inc., 1 of whom shall
165be a representative of the Massachusetts Home Care, Inc., 1 of whom shall be a representative of
166the Home Care Aide Council, 1 of whom shall be a representative of the Home Care Alliance of
167Massachusetts, Inc., and 1 of whom shall be a representative of the Massachusetts division of
1681199SEIU. The members of the advisory committee shall serve without compensation.
169 The advisory committee shall submit a report containing initial findings and
170recommendations, including drafts of proposed legislation or regulatory changes to carry out its
171recommendations, by filing the same with the clerks of the senate and house of representatives,
172the joint committee on elder affairs and the joint committee on public health. The advisory
173committee shall continue to meet quarterly following submission of the report and until the
174advisory committee votes to dissolve itself.
175 (c) The home care worker and consumer abuse stakeholder advisory committee shall
176study and make findings and recommendations relative to the development and implementation
177of minimum standards and procedures for addressing abusive treatment and bullying of
178Massachusetts home care workers, personal care attendants and home care consumers. The
179advisory committee’s study, findings and recommendations shall include, but not be limited to:
180 (1) Reporting and debriefing, including best practices for standards and procedures for
181home care workers and their home care consumers experiencing abusive treatment, bullying or
182neglect to report abuse to the home care workers’ employers or appropriate state entities, 10 of 13
183including the PCA workforce council or MassHealth for personal care assistants, without
184retaliation and while retaining the right to report any criminal activity to law enforcement. The
185standards shall include, but not be limited to, best practices for a debriefing process for affected
186home care workers and home care consumers following violent acts.
187 (2) Tracking and record retention, including best practices for standards and procedures
188for the secretary to track and monitor reports of both home care worker abuse and reports of
189home care consumer abuse or neglect.
190 (3) Informing workers, including best practices for standards and procedures that would
191require employers of home care workers or other appropriate state entities, including the PCA
192workforce council or MassHealth for personal care assistants, to regularly inform home care
193workers of patterns of consumer or worker abuse or bullying that indicates a potentially unsafe
194working environment. The standards and procedures shall respect home care consumer privacy
195while prioritizing home care worker safety and while ensuring continuity of care.
196 (4) Training and employer policies, including best practices for standards and procedures
197for the secretary, in consultation with home care employers and other stakeholders, to develop
198and implement home care worker and home care consumer orientations and other trainings on:
199(i) worker abuse and bullying, (ii) escalation cycles and effective de-escalation techniques and
200(iii) culturally competent and peer-to-peer trainings and strategies to prevent physical harm with
201hands-on practice or role play. The training and employer policies shall also include best
202practices for home care employers to implement additional internal plans and procedures to: (A)
203reduce workplace violence and abuse, (B) offer resources to employees for coping with the
204effects of violence and (C) develop labor-management workplace safety committees. The 11 of 13
205training and employer policies shall consider and avoid duplication of existing requirements and
206trainings in place through Aging Service Access Points.
207 Section 51N. (a) There is hereby established a home care oversight advisory council
208within the executive office of health and human services.
209 The advisory council shall advise the secretary relating to the regulations described in
210subsection (e) of section 51L. The executive office of health and human services shall consult
211with the advisory council on implementation of the home care agency licensure process outlined
212in section 51L. The advisory council may also conduct a review concurrently with the
213development of the home care agency licensure process to include, but not be limited to:
214 (i) the process of implementing the new home care agency licensure process in the
215commonwealth, including the creation of a provisional license to address identified gaps in home
216care services;
217 (ii) existing licensure, reporting and oversight requirements across the long-term care
218services and support systems and other relevant state agencies, including the provider monitoring
219conducted by the Aging Services Access Points, to avoid duplication and conflicting
220requirements;
221 (iii) home care agency licensure requirements in other states;
222 (iv) processes to ensure that the home care agency licensure process will align with
223licensure for home health agencies and with state oversight process already in place through the
224Aging Services Access Points, the home care worker registry established in section 4D of
225chapter 19A and the nurse aide registry established in section 72J; 12 of 13
226 (v) the development of a process for state government to conduct a statewide home care
227market analysis and report on current available home care services in all regions that may inform
228the regulating agency and the issuance of new home care agency licenses; and
229 (vi) any additional subjects that the home care oversight advisory council and the
230secretary deem necessary and appropriate.
231 (b) The advisory council shall be composed of the secretary or their designee, who shall
232serve as chair; the chairs of the joint committee on elder affairs or their designees; the secretary
233of elder affairs or their designee; the commissioner of public health or their designee; the
234assistant secretary for MassHealth or their designee; 1 person to be appointed by the minority
235leader of the house of representatives; 1 person to be appointed by the minority leader of the
236senate; and 4 persons to be appointed by the governor, 1 of whom shall be a representative of the
237Home Care Aide Council, 1 of whom shall be a representative of the Home Care Alliance of
238Massachusetts, Inc., 1 of whom shall be a representative of Massachusetts Home Care, Inc. and 1
239of whom shall be a representative of the Massachusetts division of 1199SEIU.
240 (c) The council shall meet quarterly. Upon the promulgation of regulations for home care
241agency licensure pursuant to subsection (e) of section 51L, the council may introduce a motion to
242dissolve by a majority vote of its members.
243 SECTION 2. Section 1 of chapter 151B of the General Laws, as so appearing, is hereby
244amended by inserting after the word “thereof”, in line 21, the following words:- and an employer
245of a personal care attendant as defined in section 70 of chapter 118E, including individual
246consumers of a personal care attendant. 13 of 13
247 SECTION 3. The secretary of health and human services shall, in consultation with the
248executive office of elder affairs and the department of public health, promulgate rules and
249regulations for the licensing and conduct of a home care agency, as provided in subsection (e) of
250section 51L of chapter 111 of the General Laws, within 1 year of the effective date of this act.
251 SECTION 4. The home care worker and consumer abuse stakeholder advisory committee
252established in subsection (b) of section 51M of said chapter 111 shall meet at least monthly in
253the first 6 months after the effective date of this act to develop initial findings and
254recommendations. The advisory committee shall submit the report described in said subsection
255(b) of said section 51M of said chapter 111 not later than 6 months after the effective date of this
256act.
257 SECTION 5. Members of the home care oversight advisory council established in section
25851N of said chapter 111 shall be named and the council shall commence its work within 60 days
259of the effective date of this act.