Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S2085 Compare Versions

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22 SENATE DOCKET, NO. 212 FILED ON: 1/9/2025
33 SENATE . . . . . . . . . . . . . . No. 2085
44 The Commonwealth of Massachusetts
55 _________________
66 PRESENTED BY:
77 Bruce E. Tarr
88 _________________
99 To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
1010 Court assembled:
1111 The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
1212 An Act to improve long-term care staffing and dignity for caregivers.
1313 _______________
1414 PETITION OF:
1515 NAME:DISTRICT/ADDRESS :Bruce E. TarrFirst Essex and Middlesex 1 of 15
1616 SENATE DOCKET, NO. 212 FILED ON: 1/9/2025
1717 SENATE . . . . . . . . . . . . . . No. 2085
1818 By Mr. Tarr, a petition (accompanied by bill, Senate, No. 2085) of Bruce E. Tarr for legislation
1919 to improve long-term care staffing and dignity for caregivers through training, tuition
2020 reimbursements, tax credits and other programs. Revenue.
2121 [SIMILAR MATTER FILED IN PREVIOUS SESSION
2222 SEE SENATE, NO. 1952 OF 2023-2024.]
2323 The Commonwealth of Massachusetts
2424 _______________
2525 In the One Hundred and Ninety-Fourth General Court
2626 (2025-2026)
2727 _______________
2828 An Act to improve long-term care staffing and dignity for caregivers.
2929 Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
3030 of the same, as follows:
3131 1 SECTION 1. Chapter 23 of the General Laws, as appearing in the 2022 Official Edition,
3232 2is hereby amended by inserting after section 9U the following 2 sections:-
3333 3 Section 9V. The executive office of labor and workforce development, through the
3434 4Commonwealth Corporation, shall establish a grant program for nursing facility supervisory and
3535 5leadership training. The program shall include, but not be limited to, covering the cost of nursing
3636 6facility worker participation in evidence-based supervisory training for the express purpose of
3737 7improving staff satisfaction, retaining staff and reducing turnover.
3838 8 Section 9W. The Commonwealth Corporation shall, subject to appropriation, establish an
3939 9extended care career ladder grant program, consistent with section 410 of chapter 159 of the acts 2 of 15
4040 10of 2000. The Commonwealth Corporation shall make grants available for certified nurses' aides,
4141 11home health aides, homemakers, personal care attendants, and other entry-level workers in long-
4242 12term care. The grants may include English language training, training in other languages and
4343 13adult basic education programs to improve quality of care and improve direct care worker access
4444 14to and participation in career ladder training. The length of such grants shall not exceed a period
4545 15of 3 years. The Commonwealth Corporation shall submit quarterly reports to the house and
4646 16senate committees on ways and means on said grant program including, but not limited to, the
4747 17number of grants awarded, the amount of each grant, a description of the career ladder programs,
4848 18changes in care-giving and workplace practices that have occurred and their impact on quality of
4949 19care and worker retention and the certificates, degrees or professional status attained by each
5050 20participating employee. The administrative and program-management costs for the
5151 21implementation of said grant program shall not exceed 4 per cent of the amount of the grant
5252 22program, including funding for technical assistance and evaluation.
5353 23 SECTION 2. Chapter 111 of the General Laws, as so appearing, is hereby amended by
5454 24inserting after section 4O the following section:-
5555 25 Section 4P. The department shall, subject to appropriation, establish a tuition
5656 26reimbursement program for certified nursing assistant training. The department shall reimburse
5757 27for the costs of certified nursing assistant training or competency, provided that: (i) the costs
5858 28have been incurred for an approved certified nursing assistant training program; (ii) the costs
5959 29have been actually paid by the certified nursing assistant from their own personal funds; and (iii)
6060 30individuals have begun employment as a certified nursing assistant in a licensed nursing facility
6161 31within 12 months of completing the training program, including passing the competency testing. 3 of 15
6262 32 SECTION 3. Section 6 of Chapter 62 of the General Laws, as appearing in the 2022
6363 33Official Edition, is hereby amended by inserting after subsection (t) the following new
6464 34subsection:- (u)(1) As used in this subsection, the following words shall have the following
6565 35meanings unless the context clearly requires otherwise:
6666 36 "Activities of daily living", everyday functions and activities, which individuals usually
6767 37do without help, including, but not limited to, bathing, continence, dressing, eating, toileting and
6868 38transferring.
6969 39 "Eligible family member", an individual who (1) is at least 18 years of age during a
7070 40taxable year, (2) requires assistance with at least one activity of daily living and (3) qualifies as a
7171 41dependent, spouse, parent or other relation by blood or marriage, including an in-law,
7272 42grandparent, grandchild, stepparent, aunt, uncle, niece or nephew of the family caregiver.
7373 43 “Evaluation year”, the year in which an evaluation of the tax credit is to be complete. The
7474 44evaluation year shall be every 5 years after the effective date of this subsection.
7575 45 "Family caregiver", an individual who is a resident taxpayer for the taxable year and had
7676 46eligible expenditures, as described in paragraph (3) of this subsection, with respect to 1 or more
7777 47eligible family members during the taxable year. In the case of a joint return, the term includes
7878 48the individual and the individual's spouse. The family caregiver claiming the credit must have a
7979 49Massachusetts adjusted gross income of less than $75,000 for an individual and $150,000 for a
8080 50couple and incur uncompensated expenses directly related to the care of an eligible family
8181 51member who is an adult.
8282 52 (2) A taxpayer who is a family caregiver is eligible to receive for a taxable year is equal
8383 53to a refundable credit against the taxes imposed by this chapter. The credit shall be equal to 100 4 of 15
8484 54per cent of the eligible expenditures incurred by the taxpayer during the taxable year, with a
8585 55maximum allowable credit of $1,500.
8686 56 (3) Expenditures eligible to be claimed for the tax credit include the costs associated
8787 57with: (i) the improvement or alteration to the family caregiver's primary residence to permit the
8888 58eligible family member to remain mobile, safe, and independent; (ii) the purchase or lease of
8989 59equipment that is necessary to assist an eligible family member in 2 carrying out one or more
9090 60activities of daily living; and (iii) other goods, services or supports that assist the family
9191 61caregiver in providing care to an eligible family member, such as expenditures related to hiring a
9292 62home care aide or personal care attendant, respite care, adult day health, transportation, legal and
9393 63financial services and assistive technology.
9494 64 (4) No taxpayer shall be entitled to claim a tax credit under this subsection for the same
9595 65eligible expenditures claimed by another taxpayer. The total amount of tax credits claimed by
9696 66family caregivers shall not exceed $1,500 for the same eligible family member. If two or more
9797 67family caregivers claim tax credits for the same eligible family member, the total of which
9898 68exceeds $1,500, the total amount of the credit allowed shall be allocated in amounts
9999 69proportionate to each eligible taxpayer’s share of the total amount of the eligible expenditures for
100100 70the eligible family member.
101101 71 (5) A taxpayer may not claim a tax credit under this section for expenses incurred in
102102 72carrying out general household maintenance activities, including painting, plumbing, electrical
103103 73repairs or exterior maintenance, provided, however, that home modifications to accommodate
104104 74that person receiving care and such expenses must be directly related to assisting the family
105105 75caregiver in providing care to an eligible family member are allowable. 5 of 15
106106 76 (6) The commissioner of the department of revenue shall promulgate rules and
107107 77regulations relative to the administration and enforcement of this subsection.
108108 78 (7) The commissioner shall annually, not later than September 1, file a report with the
109109 79house and senate committees on ways and means, the chairs of the joint committee on revenue
110110 80and the chairs of the joint committee on elder affairs identifying, by community, the total amount
111111 81of tax credits claimed and the total number of tax filers who received the tax credit for the
112112 82preceding fiscal year.
113113 83 (8) On or before May 31 of the year before the evaluation year, there shall be established
114114 84a committee entitled the Caregiver Tax Credit Evaluation Committee to conduct a review of the
115115 85tax credit. The committee shall be comprised of 7 members: 2 of whom shall be appointed by the
116116 86secretary of the executive office of health and human services; 2 of whom shall be appointed by
117117 87the secretary of the executive office of elder affairs; 1 of whom shall be appointed by the
118118 88secretary of the executive office for administration and finance; 1 of whom shall be appointed by
119119 89the president of the senate; and 1 of whom shall be appointed by the speaker of the house of
120120 90representatives.
121121 91 The committee shall:
122122 92 (1) examine the purpose for which the tax credit was established;
123123 93 (2) determine whether the original intent of the tax credit is still appropriate;
124124 94 (3) examine whether the tax credit is meeting its objectives;
125125 95 (4) examine whether the purposes of the tax credit could be more efficiently and
126126 96effectively carried out through alternative methods; and 6 of 15
127127 97 (5) calculate the costs of providing the tax credit, including the administrative cost and
128128 98lost revenues to the commonwealth as well as any estimated saving to the Commonwealth by
129129 99helping the person to avoid nursing home care. The committee shall file a report of its findings
130130 100with the senate and house clerks and with the governor, which shall include a recommendation as
131131 101to whether the tax credit should be continued, with or without changes, or be terminated. The
132132 102report shall be accompanied by any legislation that is needed to accomplish the
133133 103recommendations of the report. The report shall be filed no later than 3 December 31 of the
134134 104evaluation year.
135135 105 SECTION 4. Section 9 of chapter 118E of the General Laws, as appearing in the 2022
136136 106Official Edition, is hereby amended by inserting in line 16, after the words "requirements of Title
137137 107XIX;", the following words:- provided further, that spouses shall be permitted to serve as
138138 108caregivers in the adult foster care and personal care attendant programs.
139139 109 SECTION 5. Notwithstanding any general or special law to the contrary, the executive
140140 110office of health and human services, in consultation with the department of elder affairs and the
141141 111office of Medicaid, shall develop metrics, standards, and procedures that trigger emergency long-
142142 112term care provider rates of payment that include hazard pay wage add-ons for employees of
143143 113home health agencies, personal care agencies, and home care agencies that shall be implemented
144144 114in response to any COVID19 resurgence, statewide public health emergency, severe statewide
145145 115weather emergency, or other statewide emergency incident. The executive office of health and
146146 116human services shall also develop standard, comprehensive, timely and publicly accessible
147147 117processes for provider reporting and state audits of the use of emergency rate increases for wage
148148 118increases. 7 of 15
149149 119 SECTION 6. Notwithstanding any general or special law to the contrary, the executive
150150 120office of health and human services, in consultation with all appropriate state agencies and all
151151 121relevant public stakeholders, shall develop and implement a mandatory infection control and
152152 122public health training program that all new and incumbent direct care employees of home health
153153 123agencies and home care agencies shall complete as a condition of employment. The executive
154154 124office shall establish contracts with labor-management training funds, community colleges, and
155155 125other entities capable of conducting the training program and shall ensure the training program is
156156 126implemented in a manner that is coordinated with the work of other state agencies and public and
157157 127private entities involved in health care workforce training, recruitment, and retention.
158158 128 SECTION 7. Notwithstanding any general or special law to the contrary, the executive
159159 129office of health and human services shall establish an online personal protective equipment
160160 130exchange for the purpose of identifying, aggregating, and making available for private purchase
161161 131and procurement necessary personal protective equipment to be utilized by long-term care
162162 132workers, including, but not limited to, personal care attendants and all employees of nursing
163163 133facilities, resident care facilities, assisted living residences, adult day programs, home health
164164 134agencies, and home care agencies in the Commonwealth. The executive office shall: (i) identify
165165 135and offer qualified private wholesalers, manufacturers, and suppliers the opportunity to
166166 136participate on the exchange; (ii) ensure that the personal protective equipment offered on the
167167 137exchange complies with all federal and state requirements and specifications; and (iii) establish
168168 138and implement a 2 comprehensive process to receive, negotiate, and finalize competitive pricing
169169 139to be offered for the personal protective equipment placed on the exchange. 2 All sales of the
170170 140personal protective equipment from the exchange shall be private transactions by and between
171171 141the private purchaser and private seller. The executive office shall operate the exchange and 8 of 15
172172 142therefore facilitate such transactions but shall have no legal responsibility to offer payment for or
173173 143the delivery of the personal protective equipment. The executive office may establish processes
174174 144to subsidize or to discount the cost of personal protective equipment that is purchased through
175175 145the exchange for certain purchasers. In developing the exchange, the executive office shall
176176 146establish a stakeholder group, which shall be comprised of representatives from 1199SEIU, the
177177 147Massachusetts Senior Care Association, the Massachusetts Assisted Living Association, Leading
178178 148Age of Massachusetts, the Hospice Federation of Massachusetts, the Home Care Alliance of
179179 149Massachusetts, manufacturers and suppliers of personal protective equipment, and other
180180 150stakeholders that the executive office deem necessary to organize and establish the exchange.
181181 151 SECTION 8. Notwithstanding any general or special law to the contrary, the executive
182182 152office of health and human services, in consultation with the department of elder affairs and the
183183 153office of Medicaid, shall develop and implement new standards and practices that use the worker
184184 154contact information included in the Massachusetts Home Care Worker Registry established in
185185 155Chapter 139 of the Acts of 2017 to ensure robust communication with the home care agency
186186 156workforce during a state public health emergency or other state emergencies. Such
187187 157communication shall include, but not be limited to, informing the home care agency workforce
188188 158about any new provider rates designated for hazard pay, the availability of and standards for
189189 159mandatory infection control trainings, and procedures for accessing personal protective
190190 160equipment from any state-run online exchange.
191191 161 SECTION 9. The personal protective equipment exchange established in Section 3 shall
192192 162be implemented not later than 90 days after the effective date of this act 9 of 15
193193 163 SECTION 10. Chapter 111 of the Massachusetts General Laws, as so appearing, is
194194 164hereby amended by adding the following new section:- For the purposes of this section the
195195 165following words shall, unless the context clearly requires otherwise, have the following
196196 166meanings:
197197 167 "Health Care Workforce", personnel employed by or contracted to work at a skilled
198198 168nursing facility that influence the delivery of quality care to residents, including but not limited
199199 169to registered nurses, licensed practical nurses, certified nursing assistants, unlicensed assistive
200200 170personnel, service, maintenance, clerical, and all other health care workers.
201201 171 "Skilled Nursing Facility" shall mean a Level 1, Level 2, or Level 3 long term care
202202 172facility as defined in Massachusetts standard operations of long-term care facility regulations
203203 173(105 CMR 150). (a) Notwithstanding any special or general law to the contrary, each skilled
204204 174nursing facility shall establish and develop a health care workforce care planning committee
205205 175within 90 days of the effective date of this act. The membership of the planning committee shall
206206 176include at least one nurse, one certified nurse assistant, and one representative for each labor
207207 177organization representing bargaining units at the facility. The membership of the planning
208208 178committee shall include no more than the same number of management representatives relative
209209 179to the number of appointed members of the health care workforce. (b) The committee shall
210210 180participate in at least one meeting of labor management committee training. Such training shall
211211 181be provided by an outside training vendor with demonstrated experience in labor management
212212 182training. The training vendor shall be selected by majority vote of the planning committee and
213213 183the facility shall pay for costs of this training. 2 (c) Each facility’s health care workforce
214214 184planning committee shall develop, implement, monitor and regularly adjust a comprehensive
215215 185care team plan that accounts for each unit or other skilled nursing facility division in which direct 10 of 15
216216 186patient care is provided. The care team plan shall be developed to ensure that the assigned health
217217 187care workforce members are sufficient to ensure a safe working environment and to provide
218218 188quality care to the facility’s residents. Further, the care team plan shall account for all anticipated
219219 189variables that can influence a facility’s delivery of quality patient care. The care team plan shall
220220 190include account for (i) the numbers and skill mix of needed health care workforce members to be
221221 191assigned to residents, (ii) anticipated resident census, (iii) the time needed 2 to complete
222222 192expected care tasks, (iv) the need for specialized equipment and technology, (v) the physical
223223 193environment of the facility; and (vi) the necessity of ensuring a safe working environment. (d) As
224224 194a condition of licensure, each skilled nursing facility shall submit the care team plan developed
225225 195under subsection (b) and (c) to the department of public health on at least an annual basis. Such
226226 196submission shall include a certification from each member of the health care workforce planning
227227 197committee that the care team plan submitted accurately represents the consensus decisions of the
228228 198facility’s planning committee. (e) The department of public health shall develop rules and
229229 199regulations as needed to implement this section.
230230 200 SECTION 11. Notwithstanding any general or special law, rule or regulation to the
231231 201contrary, the Department of Public Health shall amend the regulations governing “Nursing
232232 202Services” and the standard operations of long-term care facilities (105 CMR 150.007). Such
233233 203amendments shall establish enhanced operational standards for Level 1, 2, and 3 facilities
234234 204mandating that, on and after October 1, 2022, compliance with sufficient staffing standards must
235235 205include the provision of a minimum number of hours of care per resident per day (PPD) of 4.0
236236 206hours, of which at least 3.5 hours must be care provided to the resident by a certified nursing
237237 207assistant. 11 of 15
238238 208 SECTION 12. SECTION 1. (a) The following terms, as used in this section, shall, unless
239239 209the context requires otherwise, have the following meanings:-
240240 210 “Consumer”, means a person receiving home care services from a home care worker
241241 211employed by a home care agency or from a personal care attendant.
242242 212 “Home care agency”, an entity or organization, however organized and whether
243243 213conducted for profit or not for profit, that is owned, operated, maintained or advertised for the
244244 214purpose of providing home care services in residential settings for compensation, provided,
245245 215however, that home care agency shall not include an entity operated by either the federal
246246 216government or the commonwealth providing home care services; an entity that limits its business
247247 217exclusively to the provision of house cleaning services; an aging service access points or ASAP
248248 218entity as defined in section 4B of chapter 19A; a hospice program licensed under section 57D of
249249 219chapter 111; or an adult foster care program regulated under 130 CMR 408.
250250 220 “Home care services”, supportive services provided to an individual in his or her
251251 221residence to enable that individual to remain in his or her residence safely and comfortably,
252252 222including, but not limited to, assistance with activities of daily living, homemaker services,
253253 223housekeeping, personal laundry, personal care and companionship, provided, however, that
254254 224home care services shall not include hospice services provided by an entity subject to licensure
255255 225under section 57D of chapter 111, the home health services provided by an entity subject to
256256 226licensure under section 51K of chapter 111, services provided by a personal care attendant in the
257257 227commonwealth’s personal care attendant program as defined in 130 CMR 422.000, or services
258258 228provided under the MassHealth adult foster care program as defined in 101 CMR 351.00. 12 of 15
259259 229 “Home care worker”, means an individual employed by a home care agency who
260260 230provides home care services to a consumer in the consumer’s residence.
261261 231 “Personal Care Attendant”, means an individual who provides consumer-directed
262262 232personal care services to a consumer in the consumer’s residence, including, but not limited to, a
263263 233person providing such services as defined under section 70 of chapter 118E.
264264 234 (b) The executive office of health and human services, in consultation with the home care
265265 235worker and consumer abuse stakeholder advisory committee, mass health, the department of
266266 236elder affairs, the department of public health, and the personal care attendant workforce council,
267267 237shall adopt minimum standards and procedures for addressing abusive treatment and bullying of
268268 238Massachusetts home care workers, personal care attendants and consumers. Such standards and
269269 239procedures shall address physical, verbal and mental abuse either of or from individual clients or
270270 240consumers as well as any abusive treatment or bullying from consumer surrogates, family
271271 241members, other caregivers and any others present in the consumers’ household when the home
272272 242care worker is providing care services. Such standards and procedures shall promote appropriate
273273 243worker and consumer training and supports, and a safe and healthy work environment for home
274274 244care workers, while recognizing the privacy rights of home care clients and consumers, the role
275275 245of PCA consumer employers and that home care consumers/clients may have a disruptive
276276 246behavioral disorder underlying abuse behavior.
277277 247 (c) There shall be a Home Care Worker and Consumer Abuse Stakeholder Advisory
278278 248Committee that shall meet, study, and make recommendations to the Executive Office of Health
279279 249and Human Services relative to standards and procedures for addressing abusive treatment and
280280 250bullying of home care workers, personal care attendants and consumers. 13 of 15
281281 251 The advisory committee shall consist of the following 15 members: the secretary of
282282 252health and human services or a designee who shall serve as chair; the assistant secretary for
283283 253MassHealth or a designee; the secretary of elder affairs or a designee; the commissioner of
284284 254public health or a designee; the chairs of the joint committee on elder affairs or their designees;
285285 255the chairs of the joint committee on children, families, and disabilities, and 9 persons to be
286286 256appointed by the governor, 1 of whom shall be a personal care attendant, 1 of whom shall be a
287287 257home care agency direct care worker, 1 of whom shall be a consumer of pca services who shall
288288 258be a member of the pca workforce council, 1 of whom shall be a consumer of home care agency
289289 259services, 1 of whom shall be a representative of the Massachusetts statewide independent living
290290 260council, 1 of whom shall be a representative of the disability Law center, 1 of whom shall be a
291291 261representative of the Massachusetts home care, 1 of whom shall be a representative of the
292292 262Massachusetts home care aide council and 1 of whom shall be a representative of the
293293 263Massachusetts division of 1199SEIU-UHE. The members of the advisory committee shall serve
294294 264without compensation.
295295 265 The advisory committee shall meet at least monthly in the first six months after passage
296296 266of this Act to develop initial findings and recommendations. The advisory committee shall
297297 267submit a report containing initial findings and recommendations, including drafts of proposed
298298 268legislation or regulatory changes to carry out its recommendations, by filing the same with the
299299 269clerks of the senate and house of representatives, the joint committee on elder affairs and the
300300 270joint committee on public health not later than six months following the passage of this Act. The
301301 271advisory committee shall continue to meet quarterly thereafter and until the advisory committee
302302 272votes to dissolve itself. 14 of 15
303303 273 (d) The home care worker and consumer abuse stakeholder advisory committee shall
304304 274study and make findings and recommendations relative to the development and implementation
305305 275of minimum standards and procedures for addressing abusive treatment and bullying of
306306 276Massachusetts home care workers, personal care attendants and consumers. The advisory
307307 277committee’s study, findings and recommendations shall include, but not be limited to, each of
308308 278the following matters:
309309 279 1) Reporting and debriefing: best practices for standards and procedures for home care
310310 280workers and their consumers/clients experiencing abusive treatment, bullying or neglect to report
311311 281such abuse to their employers and/or appropriate state entities, including the Personal Care
312312 282Attendant Workforce Council and/or MassHealth for PCAs, without retaliation and while
313313 283retaining the right to report any criminal activity to law enforcement. Such standards shall
314314 284include, but not be limited to, best practices for a debriefing process for affected workers and
315315 285consumers following violent acts.
316316 286 2) Tracking and record retention: Best practices for standards and procedures for the
317317 287Executive Office of Health and Human Services to track and monitor reports of both worker
318318 288abuse and reports of consumer abuse or neglect.
319319 289 3) Informing workers: Best practices for standards and procedures that would require
320320 290employers of home care workers or other appropriate state entities, including the Personal Care
321321 291Attendant Workforce Council and/or MassHealth for PCAs, to regularly inform home care
322322 292workers of patterns of consumer/client worker abuse or bullying that indicates a potentially
323323 293unsafe working environment. Such standards and procedures shall respect home care
324324 294client/consumer privacy while prioritizing worker safety and while ensuring continuity of care. 15 of 15
325325 295 4) Training and employer policies: Best practices for standards and procedures for the
326326 296Executive Office of Health and Human Services, in consultation with home care employers and
327327 297other stakeholders, to develop and implement home care worker and consumer orientations and
328328 298other trainings on worker abuse and bullying, escalation cycles and effective de-escalation
329329 299techniques, culturally competent and peer-to-peer trainings and strategies to prevent physical
330330 300harm with hands-on practice or role play. Best practices for home care employers to implement
331331 301additional internal plans and procedures to reduce workplace violence and abuse, offer resources
332332 302to employees for coping with the effects of violence and develop labor-management workplace
333333 303safety committees.
334334 304 SECTION 13. Section 1 of chapter 151B of the General Laws is hereby amended in line
335335 30521 by inserting after the word “thereof” the following words:-
336336 306 and shall also include an employer of a personal care attendant as defined under section
337337 30770 of chapter 118e of the General Laws including individual consumers of a personal care
338338 308attendant
339339 309 SECTION 14. Section 3 of this act shall apply to taxable years beginning on or after
340340 310January 1 next following the date of enactment.