Text of MA H 4193 (2024)

FILED ON: 11/15/2023 HOUSE . . . . . . . . . . . . . . . No. 4193 House bill No. 4178, as amended and passed to be engrossed by the House. November 15, 2023. The Commonwealth of Massachusetts _______________ In the One Hundred and Ninety-Third General Court (2023-2024) _______________ An Act to improve quality and oversight of long-term care. Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows: 1 SECTION 1. Chapter 10 of the General Laws is hereby amended by inserting after 2 section 35SSS the following section:- 3 SECTION 35TTT. (a) There shall be established and set up on the books of the 4 commonwealth a separate fund known as the Long-Term Care Workforce and Capital Fund. The 5 fund shall be administered by the secretary of health and human services in consultation with the 6 advisory committee established pursuant to subsection (c). The secretary may use amounts 7 credited to the fund to pay for: (i) the administration of the capital loan program pursuant to 8 subsection (e); and (ii) the workforce training programs pursuant to subsection (d), including the: 9 (A) program costs, tuition, books and fees related to the cost of education and training for 10 participants in the programs; (B) costs related to obtaining an applicable license, including, but 11 not limited to, examination and licensing fees; (C) stipends for program participants; and (D) 12 stipends for childcare and transportation for program participants. 1 of 35 13 (b) The fund shall consist of: (i) any revenues or other financing sources directed to the 14 fund by appropriation; (ii) 50 per cent of any amount recovered by the commonwealth and 15 credited thereto in connection with civil actions brought pursuant to section 72K of chapter 111; 16 (iii) bond revenues or other money authorized by the general court and specifically designated to 17 be credited to the fund; (iv) any income derived from the investment of amounts credited to the 18 fund or repayment of loans from the fund; (v) funds from public or private sources, including, 19 but not limited to, gifts, federal or private grants, donations, rebates and settlements received by 20 the commonwealth that are specifically designated to be credited to the fund; and (vi) all other 21 amounts credited or transferred into the fund from any other source. The executive office of 22 health and human services shall seek to maximize fund revenues through federal money, 23 matching funds and grants. Any unexpended balances in the fund at the end of the fiscal year 24 shall not revert to the General Fund and shall be available for expenditures in subsequent fiscal 25 years. Any fiscal year-end balance in the fund shall be excluded from the calculation of the 26 consolidated net surplus pursuant to section 5C of chapter 29. The fund shall not be subject to 27 appropriation. 28 (c) There shall be an advisory committee that shall consist of the following members: the 29 assistant secretary for MassHealth, or their designee, who shall serve as chair; the secretary of 30 labor and workforce development, or their designee; the commissioner of public health, or their 31 designee; and 2 persons to be appointed by the governor, 1 of whom shall be a representative of 32 the Massachusetts Senior Care Association, Inc. and 1 of whom shall be a representative of 33 Local 1199 Service Employees International Union. 2 of 35 34 (d) The secretary of health and human services, in consultation with the advisory 35 committee, shall establish, and the executive office of health and human services shall 36 administer, workforce training grant programs to: 37 (i) train new certified nurses’ aides to work in licensed long-term care facilities; 38 (ii) advance the skills of certified nurses’ aides, home health aides, homemakers and 39 other entry-level workers in long-term care facilities to improve quality of care and improve 40 worker access to and participation in a career pathway to become a licensed practical nurse; and 41 (iii) provide long-term care supervisory and leadership training, which shall consist of 42 evidence-based supervisory training for the purposes of improving staff satisfaction, retaining 43 staff and reducing staff turnover. 44 (e) The secretary of health and human services, in consultation with the advisory 45 committee, shall establish a no interest or forgivable capital loan program for skilled nursing 46 facilities to: 47 (i) support the development of specialized care units, including, but not limited to: (A) 48 infectious disease isolation; (B) dementia special care; (C) degenerative neurological units; (D) 49 geriatric psychiatry; (E) traumatic brain injury; (F) in-house dialysis treatment; (G) behavioral 50 health and substance use disorder; and (H) bariatric patient care; 51 (ii) enable facilities to offset the costs of pay-go capital; and 52 (iii) support innovative projects, including, but not limited to: (A) converting of sections 53 within skilled nursing facilities into affordable housing, veterans housing or assisted living units 54 to accommodate individual needs of residents; (B) converting multi-bed rooms to single 3 of 35 55 occupancy to enhance privacy and dignity; and (C) establishing voluntary skilled nursing facility 56 reconfigurations, including, but not limited to, providing financial incentives to reduce capacity 57 and balance supply and demand based on regional needs. 58 (f) Annually, not later than December 1, the secretary of health and human services shall 59 report on the activities of the fund to the clerks of the house of representatives and the senate and 60 to the house and senate committees on ways and means. The report shall include: (i) an 61 accounting of expenditures made from the fund with a description of the authorized purpose of 62 each expenditure; (ii) an accounting of amounts credited to the fund; and (iii) any unexpended 63 balance remaining in the fund. 64 SECTION 2. Chapter 111 of the General Laws is hereby amended by striking out section 65 71 and inserting in place thereof the following section:- 66 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the 67 following words shall, unless the context clearly requires otherwise, have the following 68 meanings: 69 “Applicant”, any person who applies to the department for a license to establish or 70 maintain and operate a long-term care facility. 71 “Charitable home for the aged”, any institution, however named, conducted for charitable 72 purposes and maintained for the purpose of providing a retirement home for elderly persons and 73 which may provide nursing care within the home for its residents. 74 “Cohorting”, the practice of grouping patients who: (i) are colonized or infected with the 75 same organism in order to confine their care to 1 area and prevent contact with other patients; or 4 of 35 76 (ii) are not colonized or infected with the same organism in order to confine their care to 1 area 77 and prevent contact with other patients. 78 “Convalescent or nursing home”, any institution, however named, including a skilled 79 nursing facility, whether conducted for profit or not for profit, which is advertised, announced or 80 maintained for the express or implied purpose of caring for 4 or more persons admitted thereto 81 for the purpose of nursing or convalescent care. 82 “Correct by date”, the date by which a licensee shall remedy or correct any violation 83 discovered after an inspection by the department pursuant to section 72E. 84 “Endemic level”, the usual level of a given disease in a geographic area. 85 “Intermediate care facility for persons with an intellectual disability”, any institution, 86 however named, that: (i) is conducted for charity or not for profit; (ii) is advertised, announced or 87 maintained for the purpose of providing rehabilitative services and active treatment to persons 88 with an intellectual disability or persons with related conditions, as defined in regulations 89 promulgated pursuant to Title XIX of the federal Social Security Act, Public Law 89-97; (iii) is 90 not both owned and operated by a state agency; and (iv) makes application to the department for 91 a license for the purpose of participating in the federal program established by said Title XIX. 92 “Isolating”, the process of separating persons colonized or infected with a communicable 93 disease from those who are not colonized or infected with a communicable disease. 94 “License”, an initial or renewal license issued by the department and which permits the 95 licensee to establish or maintain and operate a long-term care facility. 5 of 35 96 “Licensee”, a person permitted to establish or maintain and operate a long-term care 97 facility through a license. 98 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home, 99 skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest 100 home. 101 “Long-term care services”, include: (i) long-term resident, nursing, convalescent or 102 rehabilitative care; (ii) supervision and care incident to old age for ambulatory persons; or (iii) 103 retirement home care for elderly persons. 104 “Management company”, an organization engaged by a licensee to manage the operations 105 at a long-term care facility. 106 “Outbreak”, any unusual occurrence of disease or any disease above endemic levels. 107 “Owner”, any person with an ownership interest of not less than 5 per cent, or with a 108 controlling interest in an applicant, licensee, potential transferee or the real property on which a 109 long-term care facility is located. 110 “Person”, an individual, trust, partnership, association, corporation or other form of 111 business association. 112 “Potential transferee”, a person who submits to the department a notice of intent to 113 acquire the facility operations of a currently operating long-term care facility. 114 “Religious and recreational activities”, any religious, social or recreational activity that is 115 consistent with the resident’s preferences and choosing, regardless of whether the activity is 116 coordinated, offered, provided or sponsored by facility staff or by an outside activities provider. 6 of 35 117 “Resident”, an individual who resides in a long-term care facility. 118 “Rest home”, any institution, however named, which is advertised, announced or 119 maintained for the express or implied purpose of providing care incident to old age to 4 or more 120 persons who are ambulatory and who do not require a specific level of nursing care or other 121 medically related services on a routine basis. 122 “Skilled nursing facility”, any institution, however named, whether conducted for profit 123 or not for profit, which is certified by the federal Centers for Medicare and Medicaid Services for 124 the purpose of providing continuous skilled nursing care and rehabilitative services for 4 or more 125 persons. 126 “Small house nursing home”, 1 or more units of a convalescent or nursing home designed 127 and modeled as a residential home including a central living space, kitchen, dining area, living 128 area and outdoor space. 129 “Transfer of facility operations”, a transfer of the operations of a long-term care facility 130 from a licensee to a potential transferee. 131 (b)(1) The department shall issue for a term of 2 years, and shall renew for like terms, a 132 license, subject to the restrictions in this section, to each applicant the department deems 133 responsible and suitable to establish or maintain and operate a long-term care facility and which 134 meets all other requirements for long-term care facility licensure pursuant to this chapter. A 135 license issued pursuant to this section shall not be transferable or assignable and shall be issued 136 only for the premises named in the application. 7 of 35 137 (2) Each long-term care facility shall be subject to not less than 1 periodic, resident- 138 centered inspection per year for the purpose of gathering information about the quality of 139 services furnished in the long-term care facility to determine compliance with applicable state 140 and federal requirements. 141 (3) The department may, when public necessity and convenience require, or to prevent 142 undue hardship to an applicant or licensee, pursuant to such rules and regulations as it may 143 adopt, grant a temporary provisional or probationary license pursuant to this section; provided, 144 however, that no such license shall be for a term exceeding 1 year. 145 (4) The fee for a license to establish or maintain and operate a long-term care facility 146 shall be determined annually by the secretary of administration and finance pursuant to section 147 3B of chapter 7. 148 (c) The department shall not issue a license to establish or maintain an intermediate care 149 facility for persons with an intellectual disability unless the department determines that there is a 150 need for such a facility at the designated location; provided, however, that in the case of a facility 151 previously licensed as an intermediate care facility for persons with an intellectual disability in 152 which there is a change in ownership or transfer of operations, no such determination shall be 153 required; and provided further, that in the case of a facility previously licensed as an intermediate 154 care facility for persons with an intellectual disability in which there is a change in location, such 155 determination shall be limited to consideration of the suitability of the new location. 156 (d)(1) In the case of the transfer of facility operations of a long-term care facility, a 157 potential transferee shall submit a notice of intent to acquire to the department not less than 90 158 days prior to the proposed transfer date. The notice of intent to acquire shall be on a form 8 of 35 159 supplied by the department and shall be deemed complete upon submission of all information the 160 department requires on said form. The potential transferee shall be deemed responsible and 161 suitable upon the expiration of the 90-day period, or upon the expiration of said period as 162 extended, if the department fails to notify said potential transferee in writing of its decision 163 within the 90-day period or within the expiration of the extension period, whichever is 164 applicable. 165 (2) A potential transferee shall, concurrently with the submission of an intent to acquire, 166 provide notice to the current staff of the facility, and to any labor organization that represents the 167 facility’s staff at the time the notice of intent to acquire is submitted, of the potential transferee’s 168 plans to retain or not retain the facility staff and to recognize and bargain with any labor 169 organizations currently representing the facility staff. 170 (3) Upon determination by the department that a potential transferee is responsible and 171 suitable for licensure, the potential transferee may file an application for a license. In the case of 172 a potential transfer of facility operations, the filing of an application for a license shall have the 173 effect of a temporary provisional or probationary license until the department takes final action 174 on such application. 175 (4) Upon an approved transfer of facility operations, the department shall not reduce the 176 number of beds it originally approved in granting a license, unless a reduction in the number of 177 beds is in the interest of public health, welfare or safety. 178 (e) Every applicant for a license shall provide on or with its application, and every 179 potential transferee shall provide on or with its notice of intent to acquire, a sworn statement of 180 the names and addresses of any owner of the applicant or the potential transferee. 9 of 35 181 (f) No license shall be issued to an applicant or potential transferee prior to a 182 determination by the department that the applicant or potential transferee is responsible and 183 suitable pursuant to subsection (g). 184 (g) For the purposes of this section, the department’s determination of responsibility and 185 suitability shall include, but shall not be limited to, the following factors: 186 (1) the criminal history of the applicant or the potential transferee, including its respective 187 owners and management companies, and, to the extent possible, the civil litigation history of the 188 applicant or potential transferee, including its respective owners and contracted management 189 companies, including litigation related to the operation of a long-term care facility, such as 190 quality of care, safety of residents or staff, employment and labor issues, fraud, unfair or 191 deceptive business practices and landlord-tenant issues; provided, that such criminal and civil 192 litigation history may include pending or other court proceedings in the commonwealth and in 193 any other state or federal jurisdiction. Any information related to criminal or civil litigation 194 obtained by the department pursuant to this section shall be confidential and exempt from 195 disclosure under clause Twenty-sixth of section 7 of chapter 4 and chapter 66; 196 (2) the financial capacity of the applicant or potential transferee, including its respective 197 owners and management companies, to establish or maintain and operate a long-term care 198 facility; provided, that financial capacity may include, but shall not be limited to, recorded liens 199 or unpaid fees or taxes in the commonwealth or in other states; 200 (3) the history of the applicant or potential transferee, including its respective owners and 201 management companies, in providing quality long-term care in the commonwealth as measured 10 of 35 202 by compliance with applicable quality measures, statutes and regulations governing the operation 203 of long-term care facilities; and 204 (4) the history of the applicant or potential transferee, including its respective owners and 205 management companies, in providing quality long-term care in states other than the 206 commonwealth, if any, as measured by compliance with the applicable quality measures, statutes 207 and regulations governing the operation of long-term care facilities in said states. 208 (h)(1) If the department determines that an applicant or potential transferee is not 209 responsible and suitable, the department’s determination shall take effect on the date of the 210 department’s notice to the applicant or potential transferee. In such cases and upon the filing of a 211 written request, the department shall afford the applicant or potential transferee an adjudicatory 212 hearing pursuant to chapter 30A. 213 (2) During the pendency of an adjudicatory hearing, the applicant or potential transferee 214 shall not operate the facility as a licensee, nor, without prior approval of the department, manage 215 such facility. 216 (i) Each applicant, potential transferee and licensee shall maintain current records of all 217 information provided to the department. After the applicant, potential transferee or licensee 218 becomes aware of any change related to information it has provided or is required to provide to 219 the department, such person shall submit to the department written notice of the change as soon 220 as practicable and without unreasonable delay; provided, that any change in financial status shall 221 be provided to the department and shall include, but shall not be limited to, filing for bankruptcy, 222 any default under a lending agreement or under a lease, the appointment of a receiver or the 11 of 35 223 recording of any lien. Failure to provide timely notice of such change shall be subject to the 224 remedies or sanctions available to the department pursuant to this chapter. 225 (j) An applicant, potential transferee or licensee and its respective owners and 226 management companies shall comply with all applicable federal, state and local laws, rules and 227 regulations. 228 (k)(1) Prior to entering into a contract with a management company, an applicant, 229 potential transferee or licensee shall notify and receive a determination from the department that 230 the management company is responsible and suitable to manage a long-term care facility. 231 (2) In its notification to the department and to inform the department’s review, the 232 applicant, potential transferee or licensee shall provide the proposed management company’s 233 name, contact information and any other information on the proposed management company and 234 its personnel that may be reasonably requested by the department, including, but not limited to, 235 information required pursuant to subsection (g). Upon a determination by the department that the 236 proposed management company is responsible and suitable to manage a long-term care facility, 237 the applicant, potential transferee or licensee may engage said company to manage the long-term 238 care facility. 239 (3) The applicant, potential transferee or licensee shall memorialize any such engagement 240 in a written agreement with the management company. Such written agreement shall include a 241 requirement that the management company and its personnel comply with all applicable federal, 242 state and local laws, regulations and rules. Promptly after the effective date of any such 243 agreement, the applicant, potential transferee or licensee shall provide to the department a copy 244 of the valid, fully executed agreement. Any payment terms included in the agreement shall be 12 of 35 245 confidential and exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 and 246 chapter 66. 247 (4) If the department determines that a management company is not responsible and 248 suitable, the department’s determination shall take effect on the date of the department’s notice 249 to the applicant, potential transferee or licensee. In such cases and upon the filing of a written 250 request, the department shall afford the applicant, potential transferee, licensee or management 251 company an adjudicatory hearing pursuant to chapter 30A. 252 (l) The department shall not reduce the number of beds it originally approved in granting 253 a license for a convalescent or nursing home or rest home upon the transfer of facility operations 254 of said convalescent or nursing home or rest home from 1 licensee to another, unless a reduction 255 in the number of beds is in the interest of public health, welfare or safety. 256 (m)(1) The department shall not issue a license unless the applicant first submits to the 257 department, with respect to each building occupied by residents: (i) a certificate of inspection of 258 the egresses, the means of preventing the spread of fire and apparatus for extinguishing fire, 259 issued by an inspector of the office of public safety and inspections within the division of 260 professional licensure; and (ii) a certificate of inspection issued by the head of the local fire 261 department certifying compliance with local ordinances; provided, however, that for 262 convalescent or nursing homes, the division of health care quality within the department shall 263 have sole authority to inspect and issue a certificate required pursuant to clause (i) of this 264 paragraph. 265 (2) Any applicant who is aggrieved, on the basis of a written disapproval of a certificate 266 of inspection by the head of the local fire department or by the office of public safety and 13 of 35 267 inspections of the division of professional licensure, may, within 30 days from such disapproval, 268 appeal in writing to the division of professional licensure. Failure to either approve or disapprove 269 within 30 days after a written request by an applicant shall be deemed a disapproval. With 270 respect to certificates of inspection issued to convalescent or nursing homes by the division of 271 health care quality within the department, an applicant may, within 30 days from disapproval of 272 a certificate of inspection, appeal in writing to the department. Failure to either approve or 273 disapprove within 30 days after a written request by an applicant shall be deemed a disapproval. 274 (3) If the division of professional licensure or, where applicable, the department approves 275 the issuance of a certificate of inspection after an appeal, the certificate shall be issued by the 276 issuing agency. If the division of professional licensure or, where applicable, the department 277 does not approve the issuance of a certificate of inspection, the applicant may appeal to the 278 superior court. Failure of said division or said department to either approve or disapprove the 279 issuance of a certificate of inspection within 30 days after receipt of an appeal shall be deemed a 280 disapproval. The department shall not issue a license until issuance of an approved certificate of 281 inspection, as required pursuant to paragraph (1). 282 (4) Nothing in this section or in sections 72 or 73 shall be construed to supersede or 283 otherwise affect any laws, ordinances, by-laws, rules or regulations relating to building, zoning, 284 registration or maintenance of a long-term care facility. 285 (n)(1) For cause, the department may limit, restrict, suspend or revoke a license. 286 (2) Grounds for cause on which the department may take action pursuant to paragraph (1) 287 shall include: (i) substantial or sustained failure or inability to provide adequate care to residents; 288 (ii) substantial or sustained failure to maintain compliance with applicable statutes, rules and 14 of 35 289 regulations; or (iii) the lack of financial capacity to maintain and operate a long-term care 290 facility. 291 (3) The limits or restrictions the department may impose on a licensee include requiring a 292 facility to limit new admissions. 293 (4) Suspension of a license may include suspending the license during a pending license 294 revocation action or suspending the license to permit the licensee a period of time, not less than 295 60 days, to terminate operations, and discharge and transfer all residents, if applicable. 296 (5) With respect to an order by the department to limit, restrict or suspend a license, 297 within 7 days of receipt of the written order, the licensee may file a written request with the 298 department for an adjudicatory proceeding pursuant to chapter 30A. 299 (6) Upon a written request by a licensee who is aggrieved by the revocation or limitation 300 of a license or by an applicant who is aggrieved by the refusal of the department to renew a 301 license, the licensee or applicant so aggrieved shall have all the rights provided in chapter 30A 302 with respect to adjudicatory proceedings. In no case shall the revocation of such a license take 303 effect in less than 30 days after written notification by the department to the licensee. 304 (o) In the case of the new construction of, or major addition, alteration or repair to, any 305 long-term care facility, preliminary and final architectural plans and specifications shall be 306 submitted to a qualified person designated by the commissioner. Written approval of the final 307 architectural plans and specifications shall be obtained from said person prior to said new 308 construction or major addition, alteration or repair. 15 of 35 309 (p) Notwithstanding any of the other provisions of this section, the department shall not 310 issue a license to establish or maintain and operate a long-term care facility to an applicant who 311 applies to the department for said license to establish or maintain and operate a convalescent or 312 nursing home unless the applicant for such license submits to the department a certificate that 313 each building to be occupied by residents of such convalescent or nursing home meets the 314 construction standards of the state building code, and is of at least type 1–B fireproof 315 construction; provided, however, that this subsection shall not apply in the instance of a transfer 316 of facility operations of a convalescent or nursing home whose license has not been revoked as 317 of the time of such transfer; and provided, further, that a public medical institution as defined in 318 section 8 of chapter 118E, which meets the construction standards as defined herein, shall not be 319 denied a license as a long-term care facility pursuant to this section because it was not of new 320 construction and designed for the purpose of operating a long-term care facility at the time of 321 application for a license to operate a long-term care facility. An intermediate care facility for 322 persons with an intellectual disability shall be required to meet the construction standards 323 established for such facilities by Title XIX of the Social Security Act, Public Law 89-97 and any 324 regulations promulgated pursuant thereto, and by regulations promulgated by the department. 325 (q) The department shall notify the secretary of elder affairs of the pendency of any 326 proceeding, public hearing or action to be taken pursuant to this section relating to any 327 convalescent or nursing home, rest home or charitable home for the aged. The department shall 328 notify the commissioner of the department of developmental services of the pendency of any 329 proceeding, public hearing or action to be taken pursuant to this section relating to any 330 intermediate care facility for persons with an intellectual disability. 16 of 35 331 SECTION 3. Said chapter 111 is hereby further amended by striking out section 72 and 332 inserting in place thereof the following section:- 333 Section 72. (a)(1) The department shall classify long-term care facilities and shall, after a 334 public hearing, promulgate rules and regulations for the conduct of such facilities. Rules and 335 regulations for long-term care facilities shall include, but not be limited to, minimum 336 requirements for medical and nursing care, the keeping of proper medical and nursing records, 337 uniform requirements for the handling of patient funds, minimum requirements relative to the 338 prevention and reparation of lost or damaged patient possessions, including personal clothing 339 and minimum requirements relative to facility sanitation. 340 (2) Regulations for intermediate care facilities for persons with an intellectual disability 341 shall, in addition to the requirements pursuant to paragraph (1), include minimum requirements 342 for social services, psychological services and other services appropriate for the care of persons 343 with an intellectual disability and shall limit the size of such facilities to not more than 15 beds. 344 (3) The department in promulgating rules and regulations for long-term care facilities 345 shall consider the ability of long-term care facilities to provide service under rates set pursuant to 346 section 13C of chapter 118E. No such rule or regulation shall apply to a long-term care facility 347 licensed at the time of promulgation of such rule or regulation, or a long-term care facility being 348 constructed at the time of such promulgation under plans approved by the department, unless 349 such rule or regulation has a direct and material relation to patient diet, cleanliness, nursing care 350 or health, or to habilitative services and active treatment for persons with an intellectual 351 disability or persons with related conditions; provided, however, that nothing herein contained 17 of 35 352 shall be interpreted to prevent the department from adopting or interpreting rules and regulations 353 more favorable toward existing long-term care facilities. 354 (b)(1) The department or its agents and the board of health or its agents of the city or 355 town wherein any portion of such long-term care facility is located may visit and inspect such 356 institution at any time; provided, that a board of health or its agents conducting an inspection of a 357 long-term care facility located within its city or town shall notify the department of the results of 358 any inspection conducted pursuant to this paragraph. 359 (2) Any person making an inspection pursuant to paragraph (1) shall record in writing 360 every violation of the applicable rules and regulations of the department that they discover 361 during the course of their inspection. Every record of inspection shall be treated as a public 362 record except to such extent the record or a portion thereof is expressly exempt from such 363 treatment pursuant to clause Twenty-sixth of section 7 of chapter 4. A record of inspection 364 containing violations shall be made public by the department at the same time that a written plan 365 of correction is submitted. If a written plan of correction is not submitted within the allowable 366 time, said violations shall be made public at the expiration of the allowable time. Inspections 367 hereunder shall be unannounced and made at such intervals as the department shall specify in its 368 rules and regulations; provided, that, each long-term care facility shall be subject to not less than 369 1 periodic, resident-centered inspection per year pursuant to subsection (b) of section 71. A visit 370 made to a facility for the purpose of providing consultation shall not be considered to be an 371 inspection. 372 (c) The superior court shall have jurisdiction in equity to enforce the rules and regulations 373 promulgated pursuant to this section. 18 of 35 374 (d)(1) The department shall promulgate regulations for the operation of small house 375 nursing homes. Newly constructed small house nursing homes shall house no more than 14 376 individuals per unit, in resident rooms that accommodate not more than 1 resident per room; 377 provided, however, that if a resident requests to share a room with another resident to 378 accommodate a spouse, partner, family member or friend, such resident room shall have 379 sufficient space and equipment, as established by the department, for 2 residents; provided, 380 further, that determinations to grant such requests shall be determined based on space and 381 availability of rooms. All resident rooms shall contain a full private and accessible bathroom. 382 (2) The department shall promulgate regulations for construction and physical plant 383 standards for small house nursing homes that shall consider environmental standards and 384 sustainability. 385 (3) The department may promulgate regulations for small house nursing homes for a 386 staffing model that: (i) allows for a universal worker approach to resident care that is organized 387 to support and empower all staff to respond to the needs and desires of residents, including, but 388 not limited to, cooking and meal preparation, without exceeding the lawful scope of practice of 389 said employee; and (ii) provides for consistent staff in each small house nursing home. 390 (4) The regulations promulgated pursuant to this subsection shall ensure the convalescent 391 or nursing home meets the requirements necessary to be eligible to participate in both the 392 Medicare and Medicaid programs. 393 SECTION 4. Said chapter 111 is hereby further amended by striking out section 72E and 394 inserting in place thereof the following section:- 19 of 35 395 Section 72E. (a) The department shall, after every inspection by its agent pursuant to 396 section 72, provide the licensee of the inspected long-term care facility notice in writing of every 397 violation of the applicable statutes, rules and regulations found during said inspection. With 398 respect to the date by which the licensee shall remedy or correct each violation, the department 399 in such notice shall specify a reasonable time, not more than 60 days after receipt, by which time 400 the licensee shall remedy or correct each violation cited or, in the case of any violation which in 401 the opinion of the department is not reasonably capable of correction within 60 days, the 402 department shall require only that the licensee submit a written plan for the timely correction of 403 the violation in a reasonable manner. The department may modify any nonconforming plan upon 404 notice, in writing, to the licensee. 405 (b) Failure to remedy or correct a cited violation by the correct by date shall be cause to 406 pursue or impose the remedies or sanctions available to the department pursuant to this chapter, 407 unless the licensee demonstrates to the satisfaction of the department or a court, where 408 applicable, that such failure was not due to any neglect of its duty and occurred despite an 409 attempt in good faith to make correction by the correct by date. An aggrieved licensee may 410 pursue the remedies available to it pursuant to chapter 30A. 411 (c) If the department determines the licensee failed to maintain substantial or sustained 412 compliance with applicable state and federal laws, rules and regulations, in addition to imposing 413 any of the other remedies or sanctions available to it, the department may require the licensee to 414 engage, at the licensee’s own expense, a temporary manager to assist the licensee with bringing 415 the facility into substantial compliance and with sustaining such compliance. Such temporary 416 manager shall be subject to the department’s approval; provided, that such approval shall not be 417 unreasonably withheld. Any such engagement of a temporary manager shall be for a period of 20 of 35 418 not less than 3 months and shall be pursuant to a written agreement between the licensee and the 419 management company. A copy of said agreement shall be provided by the licensee to the 420 department promptly after execution. Any payment terms included in the agreement shall be 421 confidential and exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter 422 4 and chapter 66. 423 (d) Nothing in this section shall be construed to prohibit the department from enforcing a 424 statute, rule or regulation, administratively or in court, without first affording formal opportunity 425 to make correction pursuant to this section, where, in the opinion of the department, the violation 426 of such statute, rule or regulation jeopardizes the health or safety of residents or the public or 427 seriously limits the capacity of a licensee to provide adequate care, or where the violation of such 428 statute, rule or regulation is the second such violation occurring during a period of 12 full 429 months. 430 SECTION 5. Section 72K of said chapter 111, as appearing in the 2022 Official Edition, 431 is hereby amended by striking out subsection (b) and inserting in place thereof the following 2 432 subsections:- 433 (b) The attorney general may file a civil action against a person who: (i) commits abuse, 434 mistreatment or neglect of a patient or resident; (ii) misappropriates patient or resident property; 435 or (iii) wantonly or recklessly permits or causes another to commit abuse, mistreatment or 436 neglect of a patient or resident or misappropriate patient or resident property. The civil penalty 437 for such abuse, mistreatment, neglect or misappropriation shall not exceed: $25,000 if no bodily 438 injury results; $50,000 if bodily injury results; $100,000 if sexual assault or serious bodily injury 439 results; and $250,000 if death results. Section 60B of chapter 231 shall not apply to an action 21 of 35 440 brought by the attorney general pursuant to this section. Nothing in this section shall preclude the 441 filing of any action brought by the attorney general or a private party pursuant to chapter 93A or 442 any action by the department pursuant to this chapter. The comptroller shall deposit not less than 443 50 per cent of any amount secured by the attorney general as a result of a civil action brought 444 pursuant to this section into the Long-Term Care Workforce and Capital Fund established in 445 section 35TTT of chapter 10. 446 (c) Notwithstanding section 5 of chapter 260, the attorney general may file a civil action 447 within 4 years next after an offense is committed. 448 SECTION 5A. Said chapter 111 is hereby further amended by inserting after section 449 72W, the following section:- 450 Section 72W½. (a) For the purposes of this section the following words shall, unless the 451 context clearly requires otherwise, have the following meanings: 452 “Certified medication aide,” an employee of a long-term care facility that satisfies 453 eligibility criteria established by the department and that has successfully completed the required 454 training and competency testing developed by the department to administer medications to 455 residents of long-term care facilities. 456 “Medication”, any non-narcotic, prescription or non-prescription drug that may be 457 administered via oral, sublingual, buccal, inhalation, spray on oral mucosa, topical, nasal, ocular, 458 or otic route. 459 (b) The department shall create a program for the certification, training and oversight of 460 certified medication aides who shall be authorized to administer medications to residents of long- 22 of 35 461 term care facilities. Certified medication aides shall be supervised by a licensed practical nurse, a 462 licensed registered nurse, a licensed advanced practice registered nurse or a licensed physician, 463 and shall be evaluated by their supervisor regularly, but not less than once every 6 months. 464 (c) The department, in consultation with the board of registration in nursing, shall 465 develop and approve training curricula, competency evaluation procedures and standards for 466 qualifications of applicants for certification; provided, that such standards shall include the 467 completion of not less than 60 hours of training on the proper administration of medication. 468 (d) The department shall establish regulations that include (i) provisions for continuing 469 education requirements, (ii) requirements for re-certification on a biennial basis, and (iii) fees for 470 the issuance of certifications. 471 (e) The department shall allow for the creation of apprenticeship programs for resident 472 care assistants and certified nurses’ aides to become certified medication aides. 473 (f) Nothing in this section shall be construed to authorize certified medication aides to 474 engage in prescriptive practice. 475 (g) The department shall promulgate rules and regulations to carry out the provisions of 476 this section. 477 SECTION 6. Said chapter 111 is hereby further amended by inserting after section 72BB 478 the following 4 sections:- 479 Section 72CC. (a) The department shall require long-term care facilities to develop an 480 outbreak response plan which shall be customized to the long-term care facility. Each long-term 481 care facility’s plan shall include, but shall not be limited to: 23 of 35 482 (1) a protocol for isolating and cohorting infected and at-risk patients in the event of an 483 outbreak of a contagious disease until the cessation of the outbreak; 484 (2) clear policies for the notification of residents, residents’ families, visitors and staff in 485 the event of an outbreak of a contagious disease at a long-term care facility; 486 (3) information on the availability of laboratory testing, protocols for screening visitors 487 and staff for the presence of a communicable disease, protocols to require infected staff to not 488 present at the long-term care facility for work duties and processes for implementing evidence- 489 based outbreak response measures; 490 (4) policies to conduct routine monitoring of residents and staff to quickly identify signs 491 of a communicable disease that could develop into an outbreak; 492 (5) policies for reporting outbreaks to public health officials, including the chief 493 executive officer or the chief administrative officer of the municipality in which the facility is 494 located, in accordance with applicable laws and regulations; and 495 (6) policies to meet staffing, training and long-term care facility demands during an 496 infectious disease outbreak and to successfully implement the outbreak response plan. 497 (b) The department shall verify that the outbreak response plans submitted by long-term 498 care facilities are in compliance with the requirements of subsection (a). 499 (c)(1) Every long-term care facility shall review the outbreak response plan it submitted 500 to the department pursuant to subsection (a) on an annual basis. 501 (2) If a long-term care facility makes any material changes to its outbreak response plan, 502 the facility shall submit to the department an updated outbreak response plan within 30 days. The 24 of 35 503 department shall, upon receiving an updated outbreak response plan, verify that the plan is in 504 compliance with the requirements of subsection (a). 505 (d) The department shall promulgate regulations necessary to implement this section. 506 Section 72DD. (a) The division of health care facility licensure and certification shall 507 establish and implement a process and program for providing training and education to staff of 508 long-term care facilities licensed by the department pursuant to section 71. The training and 509 education program may include, but shall not be limited to: (i) infection prevention and control; 510 (ii) development, implementation, adherence and review of comprehensive resident care plans; 511 (iii) falls prevention; (iv) procedures to ensure timely notification of changes in a resident’s 512 condition to the resident’s primary care physician; (v) prevention of abuse and neglect; (vi) 513 development and implementation of a program to ensure staff safety; and (vii) review of the 514 inspection process established in section 72. 515 (b) The training and education program shall be interactive and shall include, but shall 516 not be limited to: (i) an annual training for long-term care facility supervisory and leadership 517 staff on the licensure and certification process, including, but not limited to, the department’s 518 interpretation of the general laws and relevant changes or additions to applicable rules, 519 regulations, procedures and policies concerning the licensure and certification process for long- 520 term care facilities; and a (ii) biannual training of staff of long-term care facilities on the most 521 frequently cited deficiencies, identified deficiency trends, both state and federal, and best 522 practices to ensure resident quality of care. 523 (c) The department may consult with industry trade associations before issuing or 524 promulgating guidance, regulations, interpretations, program letters, memoranda or any other 25 of 35 525 materials used in inspector training for the inspection of long-term care facilities pursuant to 526 section 72. 527 Section 72EE. (a) The department shall promulgate regulations to encourage and enable 528 residents of a long-term care facility to engage in in-person, face-to-face, verbal or auditory- 529 based contact, communications and religious and recreational activities with others to the extent 530 that in-person contact, communication or activities are not prohibited, restricted or limited by 531 federal or state statute, rule or regulation. Said regulations shall include specific protocols and 532 procedures to provide for residents of the facility who have disabilities that impede their ability 533 to communicate, including, but not limited to, residents who are blind, deaf, have Alzheimer’s 534 disease or other dementias and developmental disabilities. 535 (b) The department may distribute federal civil monetary penalty funds, subject to 536 approval by the federal Centers for Medicare and Medicaid Services, and any other available 537 federal and state funds, upon request, to facilities for communicative technologies and 538 accessories pursuant to this section. 539 Section 72FF. (a) The department, in consultation with the center for health information 540 and analysis, the division of medical assistance, the executive office of elder affairs and the 541 health policy commission, shall annually conduct an examination and report on cost trends and 542 financial performance among skilled nursing facilities. The information shall be analyzed on an 543 institution-specific and industry-wide basis. The examination shall aggregate information 544 collected on multiple skilled nursing facilities that are owned and operated by a single owner. 545 (b) The examination and report shall include, but shall not be limited to collection and 546 analysis of: (i) gross and net patient service revenues; (ii) other sources of operating and non- 26 of 35 547 operating revenue; (iii) trends in relative price, payer mix, case mix, utilization and length of 548 stay; (iv) affiliations with other health care providers, including, but not limited to, preferred 549 clinical relationships and partnerships; (v) categories of costs, including, but not limited to, 550 general and administrative costs, nursing and other labor costs and salaries, building costs, 551 capital costs and other operating costs; (vi) total spending on direct patient care as a percent of 552 total operating expenses; (vii) operating and total margin; (viii) occupancy rates and total 553 resident population; and (ix) any other relevant measures of financial performance and service 554 delivery the department deems necessary; provided, that these measures shall distinguish long- 555 term residents from short-stay residents where possible. 556 (c) Annually, not later than December 1, the report and any policy recommendations shall 557 be filed with the clerks of the house of representatives and the senate, the house and senate 558 committees on ways and means and the joint committee on elder affairs. 559 (d) The department shall utilize ownership information submitted as part of the long-term 560 care facility licensure determination process pursuant to section 71 to determine affiliations 561 between skilled nursing facilities and other health care providers as required. 562 SECTION 7. Said chapter 111 is hereby further amended by striking out section 73 and 563 inserting in place thereof the following section:- 564 Section 73. (a) Whoever advertises, announces, establishes or maintains, or is concerned 565 in establishing or maintaining, a long-term care facility, or otherwise is engaged in any such 566 business without a license granted pursuant to section 71, or whoever being licensed pursuant to 567 said section 71 violates any provision of sections 71 to 73, inclusive, shall for a first offense be 27 of 35 568 punished by a fine of not more than $1,000, and for a subsequent offense by a fine of not more 569 than $2,000 or by imprisonment for not more than 2 years. 570 (b) Whoever violates any rule or regulation promulgated pursuant to sections 71, 72 and 571 72C shall be punished by a fine, not to exceed $500. If any person violates any such rule or 572 regulation by allowing a condition to exist which may be corrected or remedied, the department 573 shall order such person, in writing, to correct or remedy such condition. If such person fails or 574 refuses to comply with such order by the correct by date, each day after the correct by date 575 during which such failure or refusal to comply continues shall constitute a separate offense. A 576 failure to pay the fine imposed by this section shall be a violation of this subsection. 577 SECTION 8. Section 25 of chapter 118E of the General Laws, as appearing in the 2022 578 Official Edition, is hereby amended by inserting after the word “provided.”, in line 61, the 579 following 2 sentences:- In the case of an incompetent applicant or member that requires long- 580 term care services, the division shall authorize a deduction from the applicant or member’s 581 income for guardianship fees and related expenses when the appointment of a guardian is 582 essential to enable an incompetent applicant or member to gain access or consent to medical 583 treatment. The division shall authorize a deduction for the reasonable costs, as approved by the 584 probate and family court, associated with: (i) the appointment of a guardian; (ii) the guardian’s 585 services during the application process; and (iii) the guardian’s services during the 586 redetermination process; provided, however, that said deduction shall not exceed, in any case, 587 $1,500. 588 SECTION 9. Said chapter 118E is hereby further amended by adding the following 2 589 sections:- 28 of 35 590 Section 83. To establish Medicaid rates for skilled nursing facilities licensed pursuant to 591 section 71 of chapter 111, the division of medical assistance shall use as base year costs for rate 592 determination purposes the reported costs of the calendar year not more than 2 years prior to the 593 current rate year. 594 Section 84. (a) The division of medical assistance shall establish a skilled nursing facility 595 rate add-on program for bariatric patient care and a rate add-on program for 1-on-1 staffing of at- 596 risk residents requiring 24-hour monitoring and supervision for their safety and the safety of 597 other residents and staff. The division of medical assistance shall identify at-risk resident 598 populations to include in the rate add-on program for 1-on-1 staffing which shall include, but not 599 be limited to, residents that: (i) have demonstrated suicidal ideation; (ii) have demonstrated 600 aggressive behavior toward other residents or staff; (iii) have demonstrated exit-seeking 601 behavior; or (vi) are registered sex offenders. The rate add-ons for said program shall be 602 sufficient to defray the cost of employing the required staff to conduct the 24-hour monitoring 603 and supervision of the at-risk residents. 604 (b) The division of medical assistance may develop an add-on to rate of payment for 605 skilled nursing facilities that develop small house nursing homes and meet criteria established by 606 the executive office. 607 SECTION 10. Subsection (c) of section 25 of chapter 176O of the General Laws, as 608 appearing in the 2022 Official Edition, is hereby amended by inserting after the second sentence 609 the following sentence:- The division shall develop and implement a uniform prior authorization 610 form for the admission of patients from an acute care hospital to a post-acute care facility or 29 of 35 611 transitioned to a home health agency certified by the federal Centers for Medicare and Medicaid 612 Services for covered post-acute care services. 613 SECTION 11. (a) For the purposes of this section, the following words shall have the 614 following meanings unless the context clearly requires otherwise: 615 “Enrollee”, as defined in section 8A of chapter 118E of the General Laws; provided, that 616 “enrollee” shall include “insured” as defined in section 1 of chapter 176O of the General Laws. 617 “Payer”, the group insurance commission under chapter 32A of the General Laws, the 618 division of medical assistance under chapter 118E of the General Laws, insurance companies 619 organized under chapter 175 of the General Laws, non-profit hospital service corporations 620 organized under chapter 176A of the General Laws, medical service corporations organized 621 under chapter 176B of the General Laws, health maintenance organizations organized under 622 chapter 176G of the General Laws and preferred provider organizations organized under chapter 623 176I of the General Laws, or a utilization review organization acting under contract with the 624 aforementioned entities. 625 “Post-acute care facility or agency”, any: (i) facility licensed under chapter 111 of the 626 General Laws to provide inpatient post-acute care services, including, but not limited to skilled 627 nursing facilities, long-term care hospitals, intermediate care facilities, or rehabilitation facilities; 628 or (ii) a home health agency certified by the federal Centers for Medicare and Medicaid Services. 629 (b) Notwithstanding any general or special law to the contrary, all payers shall approve or 630 deny a request for prior authorization for admission to a post-acute care facility or transition to a 631 post-acute care agency for any inpatient of an acute care hospital requiring covered post-acute 632 care services by the next business day following receipt by the payer of all necessary information 30 of 35 633 to establish medical necessity of the requested service. If the calendar day immediately following 634 the date of submission of the completed request is not a payer’s business day, and the payer 635 cannot otherwise make a determination by the next calendar day, and the receiving post-acute 636 care facility or agency is both open to new admissions and has indicated that said facility or 637 agency will accept the enrollee, then prior authorization shall be waived; provided, that the payer 638 shall provide coverage and may begin its concurrent review of the admission on the next 639 business day; provided further, that the payer shall not retrospectively deny coverage for services 640 to an enrollee admitted to a post-acute care facility or transitioned to a post-acute care agency 641 after a waiver of prior authorization pursuant to this section unless the claim was a result of 642 fraud, waste or abuse. An adverse determination of a prior authorization request pursuant to this 643 section may be appealed by an enrollee or the enrollee’s provider and such appeal, in the case of 644 an enrollee of a commercial payer, shall be subject to the expedited grievance process pursuant 645 to clause (iv) of subsection (b) of section 13 of chapter 176O of the General Laws. An enrollee 646 of an insurance program of the division of medical assistance or the enrollee’s provider may 647 request an expedited appeal of an adverse determination of a prior authorization request. Nothing 648 in this section shall be construed to require a payer to reimburse for services that are not a 649 covered benefit. 650 (c) In the case of non-emergency transportation between an acute care hospital and a 651 post-acute care facility, payers shall approve or deny a request for prior authorization according 652 to the same process provided pursuant to subsection (b); provided, that once authorization has 653 been granted, said authorization shall be valid for not less than 7 calendar days following 654 approval. 31 of 35 655 (d) The division of insurance and the division of medical assistance shall issue sub- 656 regulatory guidance to effectuate the purposes of this subsection. 657 SECTION 12. (a) There shall be a task force to study and propose recommendations to 658 address acute care hospital throughput challenges and the impact of persistent delays in 659 discharging patients from acute to post-acute care settings. The task force shall examine: (i) 660 hospital discharge planning and case management practices; (ii) payer administrative barriers to 661 discharge; (iii) legal and regulatory barriers to discharge; (iv) efforts to increase public 662 awareness of health care proxies and the importance of designating a health care agent; (v) post- 663 acute care capacity constraints and additional opportunities to provide financial incentives to 664 increase capacity; (vi) administrative day rates and the cost to hospitals of discharge delays; (vii) 665 enhanced hospital case management practices and reimbursement for wraparound services; (viii) 666 the adequacy of post-acute care facility insurance networks and the establishment of an out-of- 667 network rate for post-acute care facilities; (ix) expanding MassHealth Limited coverage to 668 include post-acute and long-term care services; (x) the effectiveness of interagency coordination 669 to resolve complex case discharges; (xi) the adequacy of reimbursement rates of MassHealth and 670 commercial carriers for nonemergency medical transportation; (xii) opportunities to expand 671 coverage and reimbursement for services delivered by mobile integrated health programs 672 certified by the department of public health and by participating providers in the federal Centers 673 for Medicare and Medicaid Services acute hospital care at home program; (xiii) alternative 674 transportation options for patients being discharged and transferred to post-acute care facilities or 675 home health agencies; and (xiv) the adequacy of state resources and infrastructure to place 676 complex case discharges in appropriate post-acute care settings, including, but not limited to, 677 patients with dementia diagnoses, geriatric patients with psychiatric diagnoses, patients with 32 of 35 678 behavioral health diagnoses, patients with substance use disorder diagnoses, justice-involved 679 patients, and patients who have been unable to find an appropriate placement for post-acute care 680 for 6 months or longer. 681 (b) The task force shall consist of: the secretary of health and human services, or a 682 designee, who shall serve as chair; the assistant secretary for MassHealth, or a designee; the 683 commissioner of mental health, or a designee; the attorney general, or a designee; the 684 commissioner of correction, or a designee; 1 sheriff appointed by the Massachusetts Sheriffs’ 685 Association, Inc.; 1 member representing the division of the probate and family court department 686 of the trial court to be appointed by the chief justice of said division; and 10 members to be 687 appointed by the chair, 1 of whom shall be a representative of the Massachusetts Hospital 688 Association, Inc., 1 of whom shall be a representative of the Massachusetts Senior Care 689 Association, Inc., 1 of whom shall be a representative of the Home Care Alliance of 690 Massachusetts, Inc., 1 of whom shall be a representative of the Massachusetts Academy of Elder 691 Law Attorneys, 1 of whom shall be a representative from the Massachusetts Ambulance 692 Association, Incorporated, 1 of whom shall be a representative from the Massachusetts 693 Association of Health Plans, Inc., 1 of whom shall be a representative from Blue Cross and Blue 694 Shield of Massachusetts, Inc., 1 of whom shall be a representative from an academic medical 695 center located in Worcester county, 1 of whom shall be a representative of an acute care hospital 696 located in Suffolk county and 1 of whom shall be a representative from an acute care hospital 697 designated by the health policy commission as an independent community hospital for the 698 purposes of 105 CMR 100.715(B)(2)(b). 699 (c) Not later than July 31, 2024, the task force shall submit its report, including its 700 recommendations or any proposed legislation necessary to carry out its recommendations, to the 33 of 35 701 clerks of the house of representatives and the senate, the house and senate committees on ways 702 and means and the joint committee on health care financing. 703 SECTION 13. The division of medical assistance shall study the cost and feasibility of 704 changes to the eligibility requirements for Medicaid long-term care services with the goal of 705 reducing the time applicants spend at acute care hospitals awaiting long-term care eligibility 706 determinations. The study shall consider: (i) improvements to the eligibility determination 707 process; (ii) establishing a rebuttable presumption of eligibility; (iii) guaranteeing payment for 708 long-term care services for up to 1 year regardless of eligibility status; and (iv) expanding the 709 undue hardship waiver criteria. The division of medical assistance shall seek input from the 710 Massachusetts Senior Care Association, Inc., the Massachusetts Academy of Elder Law 711 Attorneys and other interested stakeholders. The division of medical assistance shall submit a 712 report with the results of its study and policy recommendations to the clerks of the house of 713 representatives and the senate and the house and senate committees on ways and means, not later 714 than 180 days after the effective date of this act. 715 SECTION 13A. (a) There shall be a task force to evaluate the governance and regulatory 716 structure of rest homes in the commonwealth. The task force shall include, but shall not be 717 limited to, an examination of the following: (i) the licensing, regulatory, and reporting structure 718 for rest homes; (ii) an inventory of licensed rest homes and licensed rest home beds; (iii) the 719 location and service areas of existing rest homes; (iv) a review of rest home closures since 2015; 720 (v) a review of the recommendations implemented from the nursing facility task force report 721 issued pursuant to section 91 of chapter 41 of the acts of 2019; (vi) the feasibility of receiving 722 federal reimbursement for rest home expenses; and (vii) a review of the current rate structure for 723 rest homes compared to the actual cost of care to residents. 34 of 35 724 (b) The task force shall consist of the secretary of health and human services, or their 725 designee, who shall serve as chair; the secretary of elder affairs, or their designee; the 726 commissioner of public health, or their designee; the assistant secretary for MassHealth, or their 727 designee; the commissioner of the department of mental health, or their designee; the 728 commissioner of the department of transitional assistance, or their designee; the chairs of the 729 joint committee on elder affairs, or their designees; 1 person to be appointed by the minority 730 leader of the house of representatives; 1 person to be appointed by the minority leader of the 731 senate; and 5 members to be appointed by the governor, 1 of whom shall be a representative 732 from the Massachusetts Association of Residential Care Homes, Inc., 1 of whom shall be a 733 representative of LeadingAge Massachusetts, Inc., 1 of whom shall be a representative of 734 Massachusetts Senior Action Council, Inc., 1 of whom shall have direct care giver experience, 735 and 1 of whom shall have experience in health care administration and finance. 736 (c) The task force shall submit a report of its findings, including any recommendations or 737 proposed legislation necessary to carry out its recommendations, to the clerks of the house of 738 representatives and the senate and to the house and senate committees on ways and means, not 739 later than April 1, 2025. 740 SECTION 14. (a) The health policy commission shall conduct an analysis and issue a 741 report on the impact of the Medicare shared savings program and participating Medicare 742 accountable care organizations, hereinafter referred to as Medicare ACOs, on the financial 743 viability of long-term care facilities in the commonwealth and continued access to long-term care 744 facility services for Medicare patients. The analysis shall include, but not be limited to, an 745 examination of the following: 35 of 35 746 (i) the impact of Medicare ACOs on clinical eligibility decisions related to initial long- 747 term care facility placement and patient length of stay for Medicare ACO beneficiaries compared 748 to Medicare fee-for-service beneficiaries, including an analysis of the impact of length of stay on 749 quality outcomes including readmissions, functional status and patient experience; 750 (ii) the amount of payments Medicare ACOs have received from the federal government 751 from capitated, shared savings or other related initiatives and how those payments have been 752 utilized, or not, to enhance patient care and outcomes in long-term care facilities; 753 (iii) Medicare ACO practices related to patient care utilization controls and the financial 754 and quality care impact of these controls on beneficiaries in the acute and post-acute care system; 755 and 756 (iv) Medicare ACOs long-term care network adequacy. 757 (b) The health policy commission shall submit the report to the clerks of the house of 758 representatives and the senate, the house and senate committees on ways and means, the joint 759 committee on health care financing and the joint committee on elder affairs not later than 760 December 31, 2024. 761 SECTION 15. Notwithstanding any general or special law to the contrary, the division of 762 insurance shall develop the uniform prior authorization form for admission to a post-acute care 763 facility or transition to a home health agency for any inpatient of an acute care hospital requiring 764 covered post-acute care services pursuant to section 25 of chapter 176O of the General Laws, as 765 amended by section 10, not later than 90 days after the effective date of this act. The division of 766 insurance shall develop said uniform prior authorization form in consultation with the division of 767 medical assistance. The division of medical assistance, or any entity acting for the division of 36 of 35 768 medical assistance under contract, shall accept the uniform prior authorization form as sufficient 769 to request prior authorization for the requested service. All acute care hospitals shall use the 770 uniform prior authorization form to request prior authorization for coverage of post-acute care 771 services at a post-acute care facility or home health agency, and all payers, as defined in section 772 11, or entities acting for a payer under contract shall accept such form as sufficient to request 773 prior authorization for the requested service, not later than 30 days after the form has been 774 developed by the division of insurance. 775 SECTION 16. (a) For the purposes of this section, the terms “licensee” and “management 776 company” shall have the meanings as defined in section 71 of chapter 111 of the General Laws, 777 as amended by section 2. 778 (b) Pursuant to section 71 of chapter 111 of the General Laws, as amended by section 2, a 779 licensee who has entered into a contract with a management company prior to the effective date 780 of this act shall provide the department of public health with the necessary documentation and 781 materials for a determination by the department of the responsibility and suitability as described 782 in subsection (g) of said section 71 of said chapter 111 of the management company, prior to any 783 issuance of a renewed license; provided, however, that the department shall give a licensee 784 reasonable time to provide the department with the necessary documents and materials if the 785 licensee’s renewal date is within 90 days of the effective date of this act. A licensee’s failure to 786 comply with this section shall subject the licensee to the penalties established in section 73 of 787 said chapter 111, as amended by section 7. 37 of 35 788 SECTION 17. Pursuant to section 72CC of chapter 111 of the General Laws, as inserted 789 by section 6, each long-term care facility shall submit its outbreak response plan to the 790 department of public health not later than 180 days after the effective date of this act. 791 SECTION 18. The initial report required by section 72FF of chapter 111 of the General 792 Laws, as inserted by section 6, shall be filed with the clerks of the house of representatives and 793 the senate, the house and senate committees on ways and means and the joint committee on elder 794 affairs not later than 6 months after the effective date of this act. 795 SECTION 19. Section 11 is hereby repealed. 796 SECTION 20. Section 19 shall take effect 2 years after the effective date of this act. 797 SECTION 21. Section 83 of chapter 118E of the General Laws, as inserted by section 9, 798 shall take effect on October 1, 2025.