Text of MA H 5033 (2024)

HOUSE . . . . . . . . . . . . . . No. 5033 The Commonwealth of Massachusetts _______________ The committee of conference on the disagreeing votes of the two branches with reference to the Senate amendment (striking out all after the enacting clause and inserting in place thereof the text contained in Senate document numbered 2900) of the House Bill to improve quality and oversight of long-term care (House, No. 4193), reports recommending passage of the accompanying bill (House, No. 5033). August 28, 2024. Thomas M. Stanley Michael J. Rodrigues Alice Hanlon Peisch Patricia D. Jehlen Hannah Kane Patrick O’Connor 1 of 65 FILED ON: 8/28/2024 HOUSE . . . . . . . . . . . . . . . No. 5033 The Commonwealth of Massachusetts _______________ In the One Hundred and Ninety-Third General Court (2023-2024) _______________ 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. 2 of 65 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. 3 of 65 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 units; (B) dementia special care units; (C) degenerative neurological 49 units; (D) geriatric psychiatry units; (E) traumatic brain injury units; (F) in-house dialysis 50 treatment units; (G) behavioral health and substance use disorder units; and (H) bariatric patient 51 care units; 52 (ii) enable facilities to offset the costs of pay-go capital; and 53 (iii) support innovative projects, including, but not limited to: (A) converting of sections 54 within skilled nursing facilities into affordable housing, veterans housing or assisted living units 4 of 65 55 to accommodate individual needs of residents; (B) converting multi-bed rooms to single 56 occupancy to enhance privacy and dignity; and (C) establishing voluntary skilled nursing facility 57 reconfigurations, including, but not limited to, providing financial incentives to reduce capacity 58 and balance supply and demand based on regional needs. 59 (f) Annually, not later than December 1, the secretary of health and human services shall 60 report on the activities of the fund to the clerks of the house of representatives and the senate and 61 to the house and senate committees on ways and means. The report shall include: (i) an 62 accounting of expenditures made from the fund with a description of the authorized purpose of 63 each expenditure; (ii) an accounting of amounts credited to the fund; and (iii) any unexpended 64 balance remaining in the fund. 65 SECTION 2. Section 1 of chapter 19D of the General Laws, as appearing in the 2022 66 Official Edition, is hereby amended by inserting after the definition of “Assisted living 67 residence” or “Residence” the following 3 definitions:- 68 “Authorized medical professional”, an advanced practice registered nurse with 69 prescriptive authority, a physician assistant or a physician; provided, however, that an authorized 70 medical professional shall have been granted authority by a resident to issue care orders for the 71 resident. 72 “Basic health services”, certain services provided at an assisted living residence by 73 employees of the residence that are qualified to administer such services or a qualified third party 74 in accordance with a care order issued by an authorized medical professional; provided, 75 however, that such services shall include all of the following: (i) injections; (ii) the application or 76 replacement of simple non-sterile dressings; (iii) the management of oxygen on a regular and 5 of 65 77 continuing basis; (iv) specimen collection and the completion of a home diagnostic test, 78 including, but not limited to, warfarin, prothrombin or international normalized ratio testing and 79 glucose testing; provided, that such home diagnostic test or monitoring is approved by the United 80 States Food and Drug Administration for home use; and (v) application of ointments or drops. 81 “Care order”, a written order for basic health services issued by an authorized medical 82 professional. 83 SECTION 3. Said section 1 of said chapter 19D, as so appearing, is hereby further 84 amended by striking out the definition of “Elderly housing”. 85 SECTION 4. Said section 1 of said chapter 19D, as so appearing, is hereby further 86 amended by striking out the definition of “Skilled nursing care” and inserting in place thereof the 87 following definition:- 88 "Skilled nursing care", skilled services described in 130 CMR 456.409 or any successor 89 regulation. 90 SECTION 5. Section 2 of said chapter 19D, as so appearing, is hereby amended by 91 striking out clauses (v) and (vi) and inserting in place thereof the following 2 clauses:- 92 (v) provide services to residents in accordance with service plans developed through a 93 process by which employees of the residence discuss the service plan and the needs of the 94 resident with the resident and their representative or designee and ensure the consequences of a 95 decision, including any inherent risk, are understood by all parties; provided, however, that such 96 parties shall review the service plan periodically and consider changes in the resident's status and 97 the ability of the residence to respond accordingly and as set forth in section 12; provided 6 of 65 98 further, that if a resident is receiving basic health services, the staff of the residence shall consult 99 the resident’s authorized medical professional when developing the resident’s service plan; 100 (vi) coordinate and provide personal services, basic health services, where applicable, and 101 other services required under service plans as set forth in section 12;. 102 SECTION 6. Said chapter 19D is hereby further amended by striking out sections 3 to 6, 103 inclusive, as so appearing, and inserting in place thereof the following 4 sections:- 104 Section 3. (a) No person shall advertise, operate or maintain an assisted living residence 105 without the certification required under this chapter, including assisted living residences 106 sponsored by the following entities; provided, however, that the provisions of this chapter shall 107 not apply to entities for the original facilities and services for which said entities were originally 108 licensed or organized to provide: (i) convalescent homes, licensed nursing homes, licensed rest 109 homes, charitable homes for the aged or intermediate care facilities for persons with an 110 intellectual disability licensed pursuant to section 71 of chapter 111; (ii) hospices licensed 111 pursuant to the provisions of section 57D of said chapter 111; (iii) facilities providing continuing 112 care to residents, as those terms are defined by section 76 of chapter 93; (iv) congregate housing 113 authorized by section 39 of chapter 121B; (v) group homes or supported living programs 114 operating under contract with the department of mental health, the rehabilitation commission or 115 the department of developmental services; or (vi) housing operated for only those duly ordained 116 priests or for the members of the religious orders of the Roman Catholic church in their own 117 locations, buildings, residences or headquarters to provide care, shelter, treatment and medical 118 assistance for any of the said duly ordained priests or members of the said religious order. 7 of 65 119 (b) The provisions of this chapter shall not apply to any residential premises available for 120 lease by elderly or disabled individuals that is financed or subsidized in whole or in part by local, 121 state or federal housing programs established primarily to develop or operate housing rather than 122 to provide housing and personal services in combination; provided, however, that such premises 123 are not currently licensed under chapter 111. 124 Section 4. (a) The department shall issue a certification for a term of 2 years, and shall 125 renew for like terms, to any applicant whom the department determines meets the regulatory 126 requirements promulgated by the department in accordance with this chapter; provided, however, 127 that a certification shall be subject to corrective action, modification, suspension or revocation 128 for cause, as determined by the department. Such certification shall: (i) not be transferable or 129 assignable; (ii) be issued only to the person and for the premises named in the application; (iii) 130 indicate whether the residence has been approved to provide basic health services; and (iv) 131 indicate the certification’s expiration date. The department shall issue a certificate, which shall 132 be posted by the residence in a conspicuous place on the approved premises and on the 133 residence’s website. 134 (b) Upon applying for initial certification or renewal, an applicant shall pay the 135 department a fee based on the number of units at the assisted living residence, established by the 136 secretary of administration and finance pursuant to the provisions of section 3B of chapter 7; 137 provided, however, that a minimum fee shall be established notwithstanding the number of units 138 at the residence. No fees for initial certification or renewal shall be due from any provider for 139 assisted living units created under the United States Department of Housing and Urban 140 Development Assisted Living Conversion Program. 8 of 65 141 (c) If an application for renewal of a certification is filed not less than 30 days before the 142 expiration date, such certification shall not expire until the department notifies the sponsor that 143 the application for renewal has been denied. 144 (d) Applicants for initial certification shall file with the department an operating plan that 145 includes: (i) the number of units; (ii) the number of residents allowed per unit; (iii) the location 146 of resident units, common spaces and egresses by floor; (iv) the base fee to be charged for each 147 such unit; (v) the services to be offered, including basic health services, if applicable, and 148 arrangements for providing such services, including linkages with hospitals and nursing 149 facilities, if any; (vi) the number of staff to be employed; and (vii) other information the 150 department deems necessary. 151 (e) Residences may seek certification by the department to provide basic health services; 152 provided, however, that such residences shall offer all such basic health services defined in 153 section 1; and provided further, that residences offering basic health services shall not restrict 154 resident choice in the delivery of said services by third party providers. The residence shall 155 submit a revised operating plan to the department in the event of a change in the scope of basic 156 health services offered to residents. A residence seeking to provide basic health services shall 157 include in its operating plan: (i) a proposed administrative and operational structure to ensure the 158 safe and effective use of basic health services and meet the needs of its residents; and (ii) a 159 compliance plan to meet the requirements established under this chapter and promulgated 160 regulations, which shall include, but not be limited to: (A) staff qualifications and training; and 161 (B) effective policies and procedures to ensure the availability of adequate supplies necessary for 162 basic health services and the safe administration and secure storage of medications. 9 of 65 163 (f) Applicants and sponsors shall file material changes to the assisted living residence’s 164 operating plan prior to the change’s effective date and as may otherwise be required by the 165 department. A sponsor shall file annually on a date established by and on a form prescribed by 166 the department, a statement and a professional opinion prepared by a certified public accountant 167 or comparable reviewer indicating whether the assisted living residence is in sound fiscal 168 condition and is maintaining sufficient cash flow and reserves to meet the requirements of the 169 service plans established for its residents. 170 (g) Applicants for initial certification or renewal shall disclose the name and address of 171 each officer, director, trustee and limited partner or shareholder with not less than 5 per cent 172 interest in the assisted living residence and shall provide to the department documentation of the 173 history of each such individual or entity, including, but not limited to: (i) all multifamily housing, 174 assisted living residences or health care facilities in which the individual or entity has been an 175 officer, director, trustee or partner and, if applicable, evidence from the relevant regulatory 176 authority that said applicant has met criteria for licensure or certification; (ii) documentation of 177 any enforcement action against the applicant and, if applicable, evidence that the applicant has 178 corrected all cited deficiencies without revocation of licensure or certification; and (iii) any other 179 evidence, as determined by the department. 180 (h) The department may deny certification to an applicant who had an ownership interest 181 in an entity licensed under chapter 111, a licensed medical provider or a home health agency 182 certified under Title XVIII of the Social Security Act, as amended, that: (i) has been subject to a 183 patient care receivership action; (ii) has ceased to operate such an entity as a result of: (A) 184 suspension or revocation of license or certification; (B) receivership; or (C) a settlement 185 agreement arising from suspension or revocation of a license or certification; (iii) has a 10 of 65 186 settlement agreement in lieu of or as a result of subclause (B) of clause (ii); (iv) has been the 187 subject of a substantiated case of patient abuse or neglect involving material failure to provide 188 adequate protection or services for the resident in order to prevent such abuse or neglect; or (v) 189 has over the course of its operation been cited for repeated, serious and willful violations of rules 190 and regulations governing the operation of said entity that indicate a disregard for resident safety 191 and an inability to responsibly operate an assisted living residence. 192 Section 5. (a) The department or its authorized designee shall biennially review all 193 assisted living residences; provided, however, that an authorized designee shall not include 194 sponsors of assisted living residences. 195 (b) Prior to the issuance of the sponsor's initial certification, the department shall conduct 196 a review to determine whether an assisted living residence is compliant with this chapter; 197 provided, however, that the department may conduct such review of an assisted living residence 198 at any time the department has probable cause to believe that such assisted living residence is in 199 violation of a provision of this chapter or any regulation promulgated thereunder. Such review 200 shall include: (i) an inspection of every part of the common areas of the assisted living residence 201 and the living quarters of a resident with the resident's prior consent; (ii) an examination of the 202 operating plan; (iii) an examination of a resident's service plan and written progress reports with 203 the resident’s consent; and (iv) resident satisfaction surveys. An inspector shall have authority to 204 confidentially and privately interview the sponsor, manager, staff and residents. 205 (c) Reviews of assisted living residences certified to provide basic health services shall 206 include an inspection of records associated with the provision of basic health services, a review 207 of residence employee qualifications and the residence’s operating plan. 11 of 65 208 (d) Upon the completion of an annual or biennial review, the department shall prepare a 209 written report summarizing all pertinent information obtained during the review and shall not 210 disclose confidential or privileged information obtained in connection with such review. The 211 department shall promulgate rules and regulations necessary to ensure the sponsor receives such 212 report and, if applicable, has the opportunity to respond to and resolve any findings of 213 noncompliance prior to departmental enforcement action. Completed reports, responses and 214 notices of final action shall be made available to the public at the department during business 215 hours together with the responses of the applicants or the sponsors and said reports, responses 216 and notices of final action shall be posted on the website of the department. 217 Section 6. (a) If the department determines a sponsor or applicant has failed or refused to 218 comply with requirements established under this chapter or the regulations promulgated 219 thereunder, the department may: (i) deny an application for recertification; (ii) modify, suspend 220 or revoke a certification; or (iii) issue a fine of not more than $500 for each day of such failure or 221 refusal to comply. 222 (b) Notice of enforcement action and a sponsor’s right to an adjudicatory proceeding 223 shall be governed by the provisions of chapter 30A. 224 SECTION 7. Section 8 of said chapter 19D, as so appearing, is hereby amended by 225 striking out, in lines 14 and 15, the words “Any person who violates this subsection shall be 226 subject to” and inserting in place thereof the following words:- A violation of this subsection 227 shall constitute a violation of chapter 93A and shall be punishable by. 12 of 65 228 SECTION 8. Section 10 of said chapter 19D, as so appearing, is hereby amended by 229 striking out subsections (b) to (d), inclusive, and inserting in place thereof the following 9 230 subsections:- 231 (b) The sponsor of the assisted living residence may provide or arrange for the provision 232 of additional services, including: (i) barber and beauty services, sundries for personal 233 consumption and other amenities; (ii) local transportation for medical and recreational purposes; 234 (iii) assistance with and supervision of instrumental activities of daily living; (iv) assistance to 235 residents with accessing telehealth services; (v) basic health services for residents whose service 236 plan includes basic health services, in accordance with the requirements set forth within this 237 chapter, by personnel who meet standards for professional qualifications and training set forth in 238 regulations promulgated pursuant to this chapter; and (vi) ancillary services for health-related 239 care including, but not limited to, restorative therapies, podiatry, hospice care, home health or 240 other such services; provided, however, that such services shall be delivered by an individual 241 licensed to provide such care. 242 (c) No employee of an assisted living residence shall control or manage the funds or 243 property of an assisted living resident; provided, however, that if a resident is unable to manage 244 their funds or property, the assisted living residence shall arrange money management and other 245 financial arrangements with an independent party. 246 (d) A residence certified to provide basic health services may advertise, market and 247 otherwise promote offered services under this chapter and inform residents of the option to 248 directly procure such services from qualified third parties. 13 of 65 249 (e) The residence shall disclose to each resident through the assisted living residence’s 250 residency agreement the fees associated with basic health services and shall review such fees 251 with the resident upon the implementation of and any revision to a service plan that includes 252 provision of basic health services. The residence shall notify residents of any changes in fees in 253 advance and in a timely manner. Residents who receive basic health services shall receive an 254 additional service plan review on a quarterly basis and shall have the opportunity to discontinue 255 receiving basic health services from the residence upon written notice to the residence and shall 256 not be charged a cancellation fee or a fee for services not provided due to discontinuation of the 257 services. 258 (f) The department, in consultation with the department of public health, shall promulgate 259 regulations governing the application, criteria for approval or disapproval of such application, 260 and ongoing oversight of residences that elect to offer basic health services authorized in this 261 section. The department may impose an annual fee on assisted living residences that offer basic 262 health services. 263 (g) To ensure patient safety and clinical competence in the application of subsections (d) 264 to (f), inclusive, the department and the department of public health shall establish operating plan 265 requirements for residences that opt to provide basic health services, including staff access to a 266 licensed practical nurse or registered nurse for consultation at all times; provided, however, that 267 the nurse shall not be required to be on the premises. The department shall make available 268 electronic copies of the required components of operating plans on the department’s website and 269 shall conduct annual compliance reviews on the documentation created and maintained by 270 assisted living residences for an assisted living resident who received basic health services within 271 the previous 12-month period. 14 of 65 272 (h) No residence shall offer or provide basic health services without first being certified 273 by the department. If the department determines that a residence is offering basic health services 274 without certification, the department shall issue a fine of not more than $1,000 per day. 275 (i) A residence shall report an incident involving basic health services that causes a 276 resident harm at the residence not later than 24 hours of said incident. The department shall 277 investigate said incidents and may, at the department’s discretion, impose a fine or otherwise 278 take an enforcement action if the department determines that the basic health services resulted in 279 injury to a resident. 280 (j) The department shall establish criteria to evaluate the quality of basic health services 281 offered by a residence and shall annually publish its evaluation of residences on the department’s 282 website. Such evaluation shall include history of incidents leading to an enforcement action by 283 the department pursuant to subsection (i). 284 SECTION 9. Section 11 of said chapter 19D, as so appearing, is hereby amended by 285 striking out, in lines 1 to 5, inclusive, the words “No assisted living residence shall admit any 286 resident who requires twenty-four hour skilled nursing supervision. No assisted living residence 287 shall provide, or admit or retain any resident in need of skilled nursing care unless all of the 288 following are the case” and inserting in place thereof the following words:- No assisted living 289 residence shall admit a resident who requires 24-hour skilled nursing supervision unless such 290 resident elects to receive basic health services from residences that are certified to provide such 291 services or from qualified third parties. No assisted living residence shall provide skilled nursing 292 care or admit or retain a resident in need of skilled nursing care unless such resident elects to 293 receive basic health services and the following criteria are met. 15 of 65 294 SECTION 10. Section 15 of said chapter 19D, as so appearing, is hereby amended by 295 striking out subsection (c) and inserting in place thereof the following subsection:- 296 (c) No assisted living residence shall discharge, discipline, discriminate against or 297 otherwise retaliate against an employee or resident who, in good faith, files a complaint with or 298 provides information to the department relative to what the employee or resident reasonably 299 believes is a violation of law, rule or regulation or poses a risk to public health or safety or 300 resident or staff well-being. An assisted living residence in violation of this section shall be liable 301 to the person retaliated against by a civil action for up to treble damages, costs and attorney’s 302 fees in the event such violation shall be determined to be egregious or willful. 303 SECTION 11. Said chapter 19D is hereby further amended by adding the following 304 section:- 305 Section 19. The department shall promulgate regulations necessary to implement the 306 requirements of this chapter. Such regulations shall include the establishment of standards 307 concerning the education, training and experience of the managers and residence employees, 308 including service coordinators. 309 SECTION 12. Chapter 111 of the General Laws is hereby amended by striking out 310 section 71, as appearing in the 2022 Official Edition, and inserting in place thereof the following 311 section: - 312 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the 313 following words shall, unless the context clearly requires otherwise, have the following 314 meanings: 16 of 65 315 “Applicant”, any person who applies to the department for a license to establish or 316 maintain and operate a long-term care facility. 317 “Charitable home for the aged”, any institution, however named, conducted for charitable 318 purposes and maintained for the purpose of providing a retirement home for elderly persons and 319 which may provide nursing care within the home for its residents. 320 “Cohorting”, the practice of grouping patients who: (i) are colonized or infected with the 321 same organism in order to confine their care to 1 area and prevent contact with other patients; or 322 (ii) are not colonized or infected with the same organism in order to confine their care to 1 area 323 and prevent contact with other patients. 324 “Convalescent or nursing home”, any institution, however named, including a skilled 325 nursing facility, whether conducted for profit or not for profit, which is advertised, announced or 326 maintained for the express or implied purpose of caring for 4 or more persons admitted thereto 327 for the purpose of nursing or convalescent care. 328 “Correct by date”, the date by which a licensee shall remedy or correct any violation 329 discovered after an inspection by the department pursuant to section 72E. 330 “Endemic level”, the usual level of a given disease in a geographic area. 331 “Intermediate care facility for persons with an intellectual disability”, any institution, 332 however named, that: (i) is conducted for charity or not for profit; (ii) is advertised, announced or 333 maintained for the purpose of providing rehabilitative services and active treatment to persons 334 with an intellectual disability or persons with related conditions, as defined in regulations 335 promulgated pursuant to Title XIX of the federal Social Security Act, Public Law 89-97; (iii) is 17 of 65 336 not both owned and operated by a state agency; and (iv) makes application to the department for 337 a license for the purpose of participating in the federal program established by said Title XIX. 338 “Isolating”, the process of separating persons colonized or infected with a communicable 339 disease from those who are not colonized or infected with a communicable disease. 340 “License”, an initial or renewal license issued by the department and which permits the 341 licensee to establish or maintain and operate a long-term care facility. 342 “Licensee”, a person permitted to establish or maintain and operate a long-term care 343 facility through a license. 344 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home, 345 skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest 346 home. 347 “Long-term care services”, services including: (i) long-term resident, nursing, 348 convalescent or rehabilitative care; (ii) supervision and care incident to old age for ambulatory 349 persons; or (iii) retirement home care for elderly persons. 350 “Management company”, an organization engaged by a licensee to manage the operations 351 at a long-term care facility. 352 “Outbreak”, any unusual occurrence of disease or any disease above endemic levels. 353 “Owner”, any person with an ownership interest of not less than 5 per cent, or with a 354 controlling interest in an applicant, licensee, potential transferee or the real property on which a 355 long-term care facility is located. 18 of 65 356 “Person”, an individual, trust, partnership, association, corporation or other form of 357 business association. 358 “Potential transferee”, a person who submits to the department a notice of intent to 359 acquire the facility operations of a currently operating long-term care facility. 360 “Religious and recreational activities”, any religious, social or recreational activity that is 361 consistent with the resident’s preferences and choosing, regardless of whether the activity is 362 coordinated, offered, provided or sponsored by facility staff or by an outside activities provider. 363 “Resident”, an individual who resides in a long-term care facility. 364 “Rest home”, any institution, however named, which is advertised, announced or 365 maintained for the express or implied purpose of providing care incident to old age to 4 or more 366 persons who are ambulatory and who do not require a specific level of nursing care or other 367 medically related services on a routine basis. 368 “Skilled nursing facility”, any institution, however named, whether conducted for profit 369 or not for profit, which is certified by the federal Centers for Medicare and Medicaid Services for 370 the purpose of providing continuous skilled nursing care and rehabilitative services for 4 or more 371 persons. 372 “Small house nursing home”, 1 or more units of a convalescent or nursing home designed 373 and modeled as a residential home including a central living space, kitchen, dining area, living 374 area and outdoor space. 375 “Transfer of facility operations”, a transfer of the operations of a long-term care facility 376 from a licensee to a potential transferee. 19 of 65 377 (b)(1) The department shall issue for a term of 2 years, and shall renew for like terms, a 378 license, subject to the restrictions in this section, to each applicant the department deems 379 responsible and suitable to establish or maintain and operate a long-term care facility and which 380 meets all other requirements for long-term care facility licensure pursuant to this chapter. A 381 license issued pursuant to this section shall not be transferable or assignable and shall be issued 382 only for the premises named in the application. 383 (2) Each long-term care facility shall be subject to not less than 1 periodic, resident- 384 centered inspection per year for the purpose of gathering information about the quality of 385 services furnished in the long-term care facility to determine compliance with applicable state 386 and federal requirements. 387 (3) The department may, when public necessity and convenience require, or to prevent 388 undue hardship to an applicant or licensee, pursuant to such rules and regulations as it may 389 adopt, grant a temporary provisional or probationary license pursuant to this section; provided, 390 however, that no such license shall be for a term exceeding 1 year. 391 (4) The fee for a license to establish or maintain and operate a long-term care facility 392 shall be determined annually by the secretary of administration and finance pursuant to section 393 3B of chapter 7. 394 (c) The department shall not issue a license to establish or maintain an intermediate care 395 facility for persons with an intellectual disability unless the department determines that there is a 396 need for such a facility at the designated location; provided, however, that in the case of a facility 397 previously licensed as an intermediate care facility for persons with an intellectual disability in 398 which there is a change in ownership or transfer of operations, no such determination shall be 20 of 65 399 required; and provided further, that in the case of a facility previously licensed as an intermediate 400 care facility for persons with an intellectual disability in which there is a change in location, such 401 determination shall be limited to consideration of the suitability of the new location. 402 (d)(1) In the case of the transfer of facility operations of a long-term care facility, a 403 potential transferee shall submit a notice of intent to acquire to the department not less than 90 404 days prior to the proposed transfer date. The notice of intent to acquire shall be on a form 405 supplied by the department and shall be deemed complete upon submission of all information the 406 department requires on said form. The potential transferee shall be deemed responsible and 407 suitable upon the expiration of the 90-day period, or upon the expiration of said period as 408 extended, if the department fails to notify said potential transferee in writing of its decision 409 within the 90-day period or within the expiration of the extension period, whichever is 410 applicable. 411 (2) A potential transferee shall, concurrently with the submission of an intent to acquire, 412 provide notice to the current staff of the facility, and to any labor organization that represents the 413 facility’s staff at the time the notice of intent to acquire is submitted, of the potential transferee’s 414 plans to retain or not retain the facility staff and to recognize and bargain with any labor 415 organizations currently representing the facility staff. 416 (3) Upon determination by the department that a potential transferee is responsible and 417 suitable for licensure, the potential transferee may file an application for a license. In the case of 418 a potential transfer of facility operations, the filing of an application for a license shall have the 419 effect of a temporary provisional or probationary license until the department takes final action 420 on such application. 21 of 65 421 (4) Upon an approved transfer of facility operations, the department shall not reduce the 422 number of beds it originally approved in granting a license, unless a reduction in the number of 423 beds is in the interest of public health, welfare or safety. 424 (e) Every applicant for a license shall provide on or with its application, and every 425 potential transferee shall provide on or with its notice of intent to acquire, a sworn statement of 426 the names and addresses of any owner of the applicant or the potential transferee. 427 (f) No license shall be issued to an applicant or potential transferee prior to a 428 determination by the department that the applicant or potential transferee is responsible and 429 suitable pursuant to subsection (g). 430 (g) For the purposes of this section, the department’s determination of responsibility and 431 suitability shall include, but shall not be limited to, the following factors: 432 (1) the criminal history of the applicant or the potential transferee, including its respective 433 owners and management companies, and, to the extent possible, the civil litigation history of the 434 applicant or potential transferee, including its respective owners and contracted management 435 companies, including litigation related to the operation of a long-term care facility, such as 436 quality of care, safety of residents or staff, employment and labor issues, fraud, unfair or 437 deceptive business practices and landlord-tenant issues; provided, however, that such criminal 438 and civil litigation history may include pending or other court proceedings in the commonwealth 439 and in any other state or federal jurisdiction. Any information obtained by the department 440 pursuant to this section that is related to criminal or civil litigation or otherwise protected from 441 public disclosure by federal or state law shall be confidential and exempt from disclosure under 442 clause Twenty-sixth of section 7 of chapter 4 and chapter 66; 22 of 65 443 (2) the financial capacity of the applicant or potential transferee, including its respective 444 owners and management companies, to establish or maintain and operate a long-term care 445 facility; provided, that financial capacity may include, but shall not be limited to, recorded liens 446 or unpaid fees or taxes in the commonwealth or in other states; 447 (3) the history of the applicant or potential transferee, including its respective owners and 448 management companies, and if applicable, the involvement of private equity firms, in providing 449 quality long-term care in the commonwealth as measured by compliance with applicable quality 450 measures, statutes and regulations governing the operation of long-term care facilities; provided, 451 however, that applicable quality measures may include the Centers for Medicare and Medicaid 452 Services Quality Rating System; and 453 (4) the history of the applicant or potential transferee, including its respective owners and 454 management companies, and if applicable, the involvement of private equity firms, in providing 455 quality long-term care in states other than the commonwealth, if any, as measured by compliance 456 with the applicable quality measures, statutes and regulations governing the operation of long- 457 term care facilities in said states; provided, however, that applicable quality measures may 458 include the Centers for Medicare and Medicaid Services Quality Rating System. 459 (h)(1) If the department determines that an applicant or potential transferee is not 460 responsible and suitable, the department’s determination shall take effect on the date of the 461 department’s notice to the applicant or potential transferee. In such cases and upon the filing of a 462 written request, the department shall afford the applicant or potential transferee an adjudicatory 463 hearing pursuant to chapter 30A. 23 of 65 464 (2) During the pendency of an adjudicatory hearing, the applicant or potential transferee 465 shall not operate the facility as a licensee, nor, without prior approval of the department, manage 466 such facility. 467 (i) Each applicant, potential transferee and licensee shall maintain current records of all 468 information provided to the department. After the applicant, potential transferee or licensee 469 becomes aware of any change related to information it has provided or is required to provide to 470 the department, such person shall submit to the department written notice of the change as soon 471 as practicable and without unreasonable delay; provided, that any change in financial status shall 472 be provided to the department and shall include, but shall not be limited to, filing for bankruptcy, 473 any default under a lending agreement or under a lease, the appointment of a receiver or the 474 recording of any lien. Failure to provide timely notice of such change shall be subject to the 475 remedies or sanctions available to the department pursuant to this chapter. 476 (j) An applicant, potential transferee or licensee and its respective owners and 477 management companies shall comply with all applicable federal, state and local laws, rules and 478 regulations. 479 (k)(1) Prior to entering into a contract with a management company, an applicant, 480 potential transferee or licensee shall notify and receive a determination from the department that 481 the management company is responsible and suitable to manage a long-term care facility. 482 (2) In its notification to the department and to inform the department’s review, the 483 applicant, potential transferee or licensee shall provide the proposed management company’s 484 name, contact information and any other information on the proposed management company and 485 its personnel that may be reasonably requested by the department, including, but not limited to, 24 of 65 486 information required pursuant to subsection (g). Upon a determination by the department that the 487 proposed management company is responsible and suitable to manage a long-term care facility, 488 the applicant, potential transferee or licensee may engage said company to manage the long-term 489 care facility. 490 (3) The applicant, potential transferee or licensee shall memorialize any such engagement 491 in a written agreement with the management company. Such written agreement shall include a 492 requirement that the management company and its personnel comply with all applicable federal, 493 state and local laws, regulations and rules. Promptly after the effective date of any such 494 agreement, the applicant, potential transferee or licensee shall provide to the department a copy 495 of the valid, fully executed agreement. Any payment terms included in the agreement shall be 496 confidential and exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 and 497 chapter 66. 498 (4) If the department determines that a management company is not responsible and 499 suitable, the department’s determination shall take effect on the date of the department’s notice 500 to the applicant, potential transferee or licensee. In such cases and upon the filing of a written 501 request, the department shall afford the applicant, potential transferee, licensee or management 502 company an adjudicatory hearing pursuant to chapter 30A. 503 (l) The department shall not reduce the number of beds it originally approved in granting 504 a license for a convalescent or nursing home or rest home upon the transfer of facility operations 505 of said convalescent or nursing home or rest home from 1 licensee to another, unless a reduction 506 in the number of beds is in the interest of public health, welfare or safety. 25 of 65 507 (m)(1) The department shall not issue a license unless the applicant first submits to the 508 department, with respect to each building occupied by residents: (i) a certificate of inspection of 509 the egresses, the means of preventing the spread of fire and apparatus for extinguishing fire, 510 issued by an inspector of the office of public safety and inspections within the division of 511 professional licensure; and (ii) a certificate of inspection issued by the head of the local fire 512 department certifying compliance with local ordinances; provided, however, that for 513 convalescent or nursing homes, the division of health care quality within the department shall 514 have sole authority to inspect and issue a certificate required pursuant to clause (i) of this 515 paragraph. 516 (2) Any applicant who is aggrieved, on the basis of a written disapproval of a certificate 517 of inspection by the head of the local fire department or by the office of public safety and 518 inspections of the division of occupational licensure, may, within 30 days from such disapproval, 519 appeal in writing to the division of occupational licensure. Failure to either approve or 520 disapprove within 30 days after a written request by an applicant shall be deemed a disapproval. 521 For certificates of inspection issued to convalescent or nursing homes by the bureau of health 522 care safety and quality within the department, an applicant may, within 30 days of disapproval of 523 a certificate of inspection, submit a written appeal to the department; provided, however, that 524 failure of the department to either approve or disapprove of a written appeal within 30 days of 525 the submission of such written appeal shall constitute a disapproval. 526 (3) If the division of occupational licensure or, where applicable, the department 527 approves the issuance of a certificate of inspection after an appeal, the certificate shall be issued 528 by the issuing agency. If the division of occupational licensure or, where applicable, the 529 department does not approve the issuance of a certificate of inspection, the applicant may appeal 26 of 65 530 to the superior court. Failure of said division or said department to either approve or disapprove 531 the issuance of a certificate of inspection within 30 days after receipt of an appeal shall be 532 deemed a disapproval. The department shall not issue a license until issuance of an approved 533 certificate of inspection, as required pursuant to paragraph (1). 534 (4) Nothing in this section or in sections 72 or 73 shall be construed to supersede or 535 otherwise affect any laws, ordinances, by-laws, rules or regulations relating to building, zoning, 536 registration or maintenance of a long-term care facility. 537 (n)(1) For cause, the department may limit, restrict, suspend or revoke a license; 538 provided, however, that the department may temporarily suspend a license without a hearing if: 539 (i) the suspension is due to an emergency; and (ii) the department allows for a hearing on the 540 suspension in a reasonable timeframe. 541 (2) Grounds for cause on which the department may take action pursuant to paragraph (1) 542 shall include: (i) substantial or sustained failure or inability to provide adequate care to residents; 543 (ii) substantial or sustained failure to maintain compliance with applicable statutes, rules and 544 regulations; or (iii) the lack of financial capacity to maintain and operate a long-term care 545 facility. 546 (3) The limits or restrictions the department may impose on a licensee include requiring a 547 facility to limit new admissions. 548 (4) Suspension of a license may include suspending the license during a pending license 549 revocation action or suspending the license to permit the licensee a period of time, not less than 550 60 days, to terminate operations, and discharge and transfer all residents, if applicable. 27 of 65 551 (5) With respect to an order by the department to limit, restrict or suspend a license, 552 within 7 days of receipt of the written order, the licensee may file a written request with the 553 department for an adjudicatory proceeding pursuant to chapter 30A. 554 (6) Upon a written request by a licensee who is aggrieved by the revocation or limitation 555 of a license or by an applicant who is aggrieved by the refusal of the department to renew a 556 license, the licensee or applicant so aggrieved shall have all the rights provided in chapter 30A 557 with respect to adjudicatory proceedings. In no case shall the revocation of such a license take 558 effect in less than 30 days after written notification by the department to the licensee. 559 (o) In the case of the new construction of, or major addition, alteration or repair to, any 560 long-term care facility, preliminary and final architectural plans and specifications shall be 561 submitted to a qualified person designated by the commissioner. Written approval of the final 562 architectural plans and specifications shall be obtained from said person prior to said new 563 construction or major addition, alteration or repair. 564 (p) Notwithstanding any of the other provisions of this section, the department shall not 565 issue a license to establish or maintain and operate a long-term care facility to an applicant who 566 applies to the department for said license to establish or maintain and operate a convalescent or 567 nursing home unless the applicant for such license submits to the department a certificate that 568 each building to be occupied by residents of such convalescent or nursing home meets the 569 construction standards of the state building code, and is of at least type 1–B fireproof 570 construction; provided, however, that this subsection shall not apply in the instance of a transfer 571 of facility operations of a convalescent or nursing home whose license has not been revoked as 572 of the time of such transfer; and provided, further, that a public medical institution as defined in 28 of 65 573 section 8 of chapter 118E, which meets the construction standards as defined herein, shall not be 574 denied a license as a long-term care facility pursuant to this section because it was not of new 575 construction and designed for the purpose of operating a long-term care facility at the time of 576 application for a license to operate a long-term care facility. An intermediate care facility for 577 persons with an intellectual disability shall be required to meet the construction standards 578 established for such facilities by Title XIX of the Social Security Act, Public Law 89-97 and any 579 regulations promulgated pursuant thereto, and by regulations promulgated by the department. 580 (q) The department shall notify the secretary of elder affairs of the pendency of any 581 proceeding, public hearing or action to be taken pursuant to this section relating to any 582 convalescent or nursing home, rest home or charitable home for the aged. The department shall 583 notify the commissioner of the department of developmental services of the pendency of any 584 proceeding, public hearing or action to be taken pursuant to this section relating to any 585 intermediate care facility for persons with an intellectual disability. 586 (r) The department shall notify the clerks of the senate and house of representatives, the 587 joint committee on elder affairs and the senate and house committees on ways and means within 588 3 business days of being notified of a long-term care facility’s decision to close pursuant to 589 department regulations. 590 SECTION 13. Said chapter 111 is hereby further amended by striking out section 72, as 591 so appearing, and inserting in place thereof the following section:- 592 Section 72. (a)(1) The department shall classify long-term care facilities and shall, after a 593 public hearing, promulgate rules and regulations for the conduct of such facilities. Rules and 594 regulations for long-term care facilities shall include, but not be limited to, minimum 29 of 65 595 requirements for medical and nursing care, the keeping of proper medical and nursing records, 596 uniform requirements for the handling of patient funds, minimum requirements relative to the 597 prevention and reparation of lost or damaged patient possessions, including personal clothing 598 and minimum requirements relative to facility sanitation. 599 (2) Regulations for intermediate care facilities for persons with an intellectual disability 600 shall, in addition to the requirements pursuant to paragraph (1), include minimum requirements 601 for social services, psychological services and other services appropriate for the care of persons 602 with an intellectual disability and shall limit the size of such facilities to not more than 15 beds. 603 (3) The department in promulgating rules and regulations for long-term care facilities 604 shall consider the ability of long-term care facilities to provide service under rates set pursuant to 605 section 13C of chapter 118E. No such rule or regulation shall apply to a long-term care facility 606 licensed at the time of promulgation of such rule or regulation, or a long-term care facility being 607 constructed at the time of such promulgation under plans approved by the department, unless 608 such rule or regulation has a direct and material relation to patient diet, cleanliness, nursing care 609 or health, or to habilitative services and active treatment for persons with an intellectual 610 disability or persons with related conditions; provided, however, that nothing herein contained 611 shall be interpreted to prevent the department from adopting or interpreting rules and regulations 612 more favorable toward existing long-term care facilities. 613 (4) The department may authorize specialized care units serving persons requiring 614 treatment for infectious diseases, isolation, strokes, degenerative neurological conditions, 615 traumatic brain injuries, in-house dialysis treatments, behavioral health treatments, substance use 616 disorder treatments, bariatric patient care and conditions requiring 24-hour or 1-on-1 patient 30 of 65 617 supervision. The department may promulgate rules and regulations to regulate the conduct of any 618 such specialized care units. 619 (b)(1) The department or its agents and the board of health or its agents of the city or 620 town wherein any portion of such long-term care facility is located may visit and inspect such 621 institution at any time; provided, that a board of health or its agents conducting an inspection of a 622 long-term care facility located within its city or town shall notify the department of the results of 623 any inspection conducted pursuant to this paragraph. 624 (2) Any person making an inspection pursuant to paragraph (1) shall record in writing 625 every violation of the applicable rules and regulations of the department that they discover 626 during the course of their inspection. Every record of inspection shall be treated as a public 627 record except to such extent the record or a portion thereof is expressly exempt from such 628 treatment pursuant to clause Twenty-sixth of section 7 of chapter 4. A record of inspection 629 containing violations shall be made public by the department at the same time that a written plan 630 of correction is submitted. If a written plan of correction is not submitted within the allowable 631 time, said violations shall be made public at the expiration of the allowable time. Inspections 632 hereunder shall be unannounced and made at such intervals as the department shall specify in its 633 rules and regulations; provided, that, each long-term care facility shall be subject to not less than 634 1 periodic, resident-centered inspection per year pursuant to subsection (b) of section 71. A visit 635 made to a facility for the purpose of providing consultation shall not be considered to be an 636 inspection. 637 (c) The superior court shall have jurisdiction in equity to enforce the rules and regulations 638 promulgated pursuant to this section. 31 of 65 639 (d)(1) The department shall promulgate regulations for the construction, physical plant 640 standards and operation of small house nursing homes. Newly constructed small house nursing 641 homes shall house no more than 14 individuals per unit, in resident rooms that accommodate not 642 more than 1 resident per room; provided, however, that if a resident requests to share a room 643 with another resident to accommodate a spouse, partner, family member or friend, such resident 644 room shall have sufficient space and equipment, as established by the department, for 2 645 residents; provided, further, that determinations to grant such requests shall be determined based 646 on space and availability of rooms. All resident rooms shall contain a full private and accessible 647 bathroom. 648 (2) The department shall promulgate regulations for construction and physical plant 649 standards for small house nursing homes that shall consider environmental standards and 650 sustainability. 651 (3) The department may promulgate additional regulations for small house nursing homes 652 for a staffing model that: (i) allows for a universal worker approach to resident care that is 653 organized to support and empower all staff to respond to the needs and desires of residents, 654 including, but not limited to, cooking and meal preparation, without exceeding the lawful scope 655 of practice of said employee; and (ii) provides for consistent staff in each small house nursing 656 home. 657 (4) The regulations promulgated pursuant to this subsection shall ensure the convalescent 658 or nursing home meets the requirements necessary to be eligible to participate in both the 659 Medicare and Medicaid programs. 32 of 65 660 SECTION 14. Said chapter 111 is hereby further amended by striking out section 72E, as 661 so appearing, and inserting in place thereof the following section:- 662 Section 72E. (a) The department shall, after every inspection by its agent pursuant to 663 section 72, provide the licensee of the inspected long-term care facility notice in writing of every 664 violation of the applicable statutes, rules and regulations found during said inspection. With 665 respect to the date by which the licensee shall remedy or correct each violation, the department 666 in such notice shall specify a reasonable time, not more than 60 days after receipt, by which time 667 the licensee shall remedy or correct each violation cited or, in the case of any violation which in 668 the opinion of the department is not reasonably capable of correction within 60 days, the 669 department shall require only that the licensee submit a written plan for the timely correction of 670 the violation in a reasonable manner. The department may modify any nonconforming plan upon 671 notice, in writing, to the licensee. 672 (b) Failure to remedy or correct a cited violation by the correct by date shall be cause to 673 pursue or impose the remedies or sanctions available to the department pursuant to this chapter, 674 unless the licensee demonstrates to the satisfaction of the department or a court, where 675 applicable, that such failure was not due to any neglect of its duty and occurred despite an 676 attempt in good faith to make correction by the correct by date. An aggrieved licensee may 677 pursue the remedies available to it pursuant to chapter 30A. 678 (c) If the department determines the licensee failed to maintain substantial or sustained 679 compliance with applicable state and federal laws, rules and regulations, in addition to imposing 680 any of the other remedies or sanctions available to it, the department may require the licensee to 681 engage, at the licensee’s own expense, a temporary manager to assist the licensee with bringing 33 of 65 682 the facility into substantial compliance and with sustaining such compliance. Such temporary 683 manager shall be subject to the department’s approval; provided, that such approval shall not be 684 unreasonably withheld. Any such engagement of a temporary manager shall be for a period of 685 not less than 3 months and shall be pursuant to a written agreement between the licensee and the 686 management company. A copy of said agreement shall be provided by the licensee to the 687 department promptly after execution. Any payment terms included in the agreement shall be 688 confidential and exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter 689 4 and chapter 66. 690 (d) Nothing in this section shall be construed to prohibit the department from enforcing a 691 statute, rule or regulation, administratively or in court, without first affording formal opportunity 692 to make correction pursuant to this section, where, in the opinion of the department, the violation 693 of such statute, rule or regulation jeopardizes the health or safety of residents or the public or 694 seriously limits the capacity of a licensee to provide adequate care, or where the violation of such 695 statute, rule or regulation is the second such violation occurring during a period of 12 full 696 months. 697 SECTION 15. Section 72K of said chapter 111, as appearing in the 2022 Official Edition, 698 is hereby amended by striking out subsection (b) and inserting in place thereof the following 2 699 subsections:- 700 (b) The attorney general may file a civil action against a person who: (i) commits abuse, 701 mistreatment or neglect of a patient or resident; (ii) misappropriates patient or resident property; 702 or (iii) wantonly or recklessly permits or causes another to commit abuse, mistreatment or 703 neglect of a patient or resident or misappropriate patient or resident property. The civil penalty 34 of 65 704 for such abuse, mistreatment, neglect or misappropriation shall not exceed: $25,000 if no bodily 705 injury results; $50,000 if bodily injury results; $100,000 if sexual assault or serious bodily injury 706 results; and $250,000 if death results. Section 60B of chapter 231 shall not apply to an action 707 brought by the attorney general pursuant to this section. Nothing in this section shall preclude the 708 filing of any action brought by the attorney general or a private party pursuant to chapter 93A or 709 any action by the department pursuant to this chapter. The comptroller shall deposit not less than 710 50 per cent of any amount secured by the attorney general as a result of a civil action brought 711 pursuant to this section into the Long-Term Care Workforce and Capital Fund established in 712 section 35TTT of chapter 10. 713 (c) Notwithstanding section 5 of chapter 260, the attorney general may file a civil action 714 within 4 years next after an offense is committed. 715 SECTION 16. Said chapter 111 is hereby further amended by inserting after section 716 72W, the following section:- 717 Section 72W½. (a) For the purposes of this section the following words shall, unless the 718 context clearly requires otherwise, have the following meanings: 719 “Certified medication aide”, an employee of a long-term care facility that satisfies 720 eligibility criteria established by the department and that has successfully completed the required 721 training and competency testing developed by the department to administer medications to 722 residents of long-term care facilities. 723 “Medication”, any non-narcotic, prescription or non-prescription drug that may be 724 administered via oral, sublingual, buccal, inhalation, spray on oral mucosa, topical, nasal, ocular, 725 or otic route. 35 of 65 726 (b) The department shall create a program for the certification, training and oversight of 727 certified medication aides who shall be authorized to administer medications to residents of long- 728 term care facilities. Certified medication aides shall be supervised by a licensed practical nurse, a 729 licensed registered nurse, a licensed advanced practice registered nurse or a licensed physician, 730 and shall be evaluated by their supervisor regularly, not less than once every 6 months. 731 (c) The department, in consultation with the board of registration in nursing, shall 732 develop and approve training curricula, competency evaluation procedures and standards for 733 qualifications of applicants for certification; provided, that such standards shall include the 734 completion of not less than 60 hours of training on the proper administration of medication. 735 (d) The department shall establish regulations that include: (i) provisions for continuing 736 education requirements; (ii) requirements for re-certification on a biennial basis; and (iii) fees for 737 the issuance of certifications. 738 (e) The department shall allow for the creation of apprenticeship programs for resident 739 care assistants and certified nurses’ aides to become certified medication aides. 740 (f) Nothing in this section shall be construed to authorize certified medication aides to 741 engage in prescriptive practice. 742 (g) The department shall promulgate rules and regulations to carry out the provisions of 743 this section. 744 SECTION 17. Said chapter 111 is hereby further amended by inserting after section 745 72BB the following 5 sections:- 36 of 65 746 Section 72CC. (a) The department shall require long-term care facilities to develop and 747 submit to the department an outbreak response plan, which shall be customized to the long-term 748 care facility. The department shall review such plan to ensure compliance with the requirements 749 under this section. Each long-term care facility’s plan shall include, but shall not be limited to: 750 (1) a protocol for isolating and cohorting infected and at-risk patients in the event of an 751 outbreak of a contagious disease until the cessation of the outbreak; 752 (2) clear policies for the notification of residents, residents’ families, visitors and staff in 753 the event of an outbreak of a contagious disease at a long-term care facility; 754 (3) information on the availability of laboratory testing, protocols for screening visitors 755 and staff for the presence of a communicable disease, protocols to prohibit infected staff from 756 appearing for work at the long-term care facility and processes for implementing evidence-based 757 outbreak response measures; 758 (4) policies to conduct routine monitoring of residents and staff to quickly identify signs 759 of a communicable disease that could develop into an outbreak; 760 (5) policies for reporting outbreaks to public health officials, including the chief 761 executive officer or the chief administrative officer of the municipality in which the facility is 762 located, in accordance with applicable laws and regulations; and 763 (6) policies to meet staffing, training and long-term care facility demands during an 764 infectious disease outbreak and to successfully implement the outbreak response plan. 765 (b) The department shall verify that the outbreak response plans submitted by long-term 766 care facilities are in compliance with the requirements of subsection (a); provided, however, that 37 of 65 767 a long-term care facility shall review the outbreak response plan it submitted to the department 768 pursuant to subsection (a) on an annual basis and if it makes any material changes to such plan, 769 the facility shall submit to the department an updated outbreak response plan within 30 days of 770 making such change. The department shall, upon receiving an updated outbreak response plan, 771 verify that the plan is in compliance with the requirements of subsection (a). 772 (c)(1) Every long-term care facility shall review the outbreak response plan it submitted 773 to the department pursuant to subsection (a) on an annual basis. 774 (2) If a long-term care facility makes any material changes to its outbreak response plan, 775 the facility shall submit to the department an updated outbreak response plan within 30 days. The 776 department shall, upon receiving an updated outbreak response plan, verify that the plan is in 777 compliance with the requirements of subsection (a). 778 (d) The department shall promulgate regulations necessary to implement this section. 779 Section 72DD. (a) The division of health care facility licensure and certification shall 780 establish and implement a process and program for providing training and education to staff of 781 long-term care facilities licensed by the department pursuant to section 71. The training and 782 education program may include, but shall not be limited to: (i) infection prevention and control; 783 (ii) development, implementation, adherence and review of comprehensive resident care plans; 784 (iii) falls prevention; (iv) procedures to ensure timely notification of changes in a resident’s 785 condition to the resident’s primary care physician; (v) prevention of abuse and neglect; (vi) 786 development and implementation of a program to ensure staff safety; and (vii) review of the 787 inspection process established in section 72. 38 of 65 788 (b) The training and education program shall be interactive and shall include, but shall 789 not be limited to: (i) an annual training for long-term care facility supervisory and leadership 790 staff on the licensure and certification process, including, but not limited to, the department’s 791 interpretation of the General Laws and relevant changes or additions to applicable rules, 792 regulations, procedures and policies concerning the licensure and certification process for long- 793 term care facilities; and (ii) a biannual training of staff of long-term care facilities on the most 794 frequently cited deficiencies, identified deficiency trends, both state and federal, and best 795 practices to ensure resident quality of care. 796 (c) The department may consult with industry trade associations before issuing or 797 promulgating guidance, regulations, interpretations, program letters, memoranda or any other 798 materials used in inspector training for the inspection of long-term care facilities pursuant to 799 section 72. 800 Section 72EE. (a) The department shall promulgate regulations to encourage and enable 801 residents of a long-term care facility to engage in in-person, face-to-face, verbal or auditory- 802 based contact, communications and religious and recreational activities with others to the extent 803 that in-person contact, communication or activities are not prohibited, restricted or limited by 804 federal or state statute, rule or regulation. Said regulations shall include specific protocols and 805 procedures to provide for residents of the facility who have disabilities that impede their ability 806 to communicate, including, but not limited to, residents who are blind, deaf, have Alzheimer’s 807 disease or other dementias and developmental disabilities. 808 (b) The department may distribute federal civil monetary penalty funds, subject to 809 approval by the federal Centers for Medicare and Medicaid Services, and any other available 39 of 65 810 federal and state funds, upon request, to facilities for communicative technologies and 811 accessories pursuant to this section. 812 Section 72FF. (a) The department, in consultation with the center for health information 813 and analysis, the division of medical assistance, the executive office of elder affairs and the 814 health policy commission, shall annually conduct an examination and report on cost trends and 815 financial performance among skilled nursing facilities. The information shall be analyzed on an 816 institution-specific and industry-wide basis. The examination shall aggregate information 817 collected on multiple skilled nursing facilities that are owned and operated by a single owner. 818 (b) The examination and report shall include, but shall not be limited to collection and 819 analysis of: (i) gross and net patient service revenues; (ii) other sources of operating and non- 820 operating revenue; (iii) trends in relative price, payer mix, case mix, utilization and length of 821 stay; (iv) affiliations with other health care providers, including, but not limited to, preferred 822 clinical relationships and partnerships; (v) categories of costs, including, but not limited to, 823 general and administrative costs, nursing and other labor costs and salaries, building costs, 824 capital costs and other operating costs; (vi) total spending on direct patient care as a percent of 825 total operating expenses; (vii) operating and total margin; (viii) occupancy rates and total 826 resident population; and (ix) any other relevant measures of financial performance and service 827 delivery the department deems necessary; provided, that these measures shall distinguish long- 828 term residents from short-stay residents where possible. 829 (c) Annually, not later than December 1, the report and any policy recommendations shall 830 be filed with the clerks of the house of representatives and the senate, the house and senate 831 committees on ways and means and the joint committee on elder affairs. 40 of 65 832 (d) The department shall utilize ownership information submitted as part of the long-term 833 care facility licensure determination process pursuant to section 71 to determine affiliations 834 between skilled nursing facilities and other health care providers as required. 835 Section 72GG. (a) As used in this section the following words shall have the following 836 meanings unless the context clearly requires otherwise: 837 "Gender expression", the manner in which a person represents or expresses gender to 838 others, often through behavior, clothing, hairstyles, activities, voice or mannerisms. 839 "Gender identity" or “gender”, a person’s gender identity, appearance or behavior, 840 whether or not that gender identity, appearance or behavior is different from that traditionally 841 associated with the person’s physiology or birth sex; provided, however, that gender identity 842 may be demonstrated through medical history, care or treatment of the gender identity, consistent 843 and uniform assertion of the gender identity or any other evidence that the gender identity is 844 sincerely held as part of a person’s core identity; and provided further, that gender identity shall 845 not be asserted for any improper purpose. 846 "Gender-nonconforming", gender expression does not conform to stereotypical 847 expectations of such gender. 848 "Gender transition", a process in which a person begins to live according to that person's 849 gender identity, rather than the sex the person was assigned at birth, which may include changing 850 one's clothing, appearance, name or identification documents or undergoing medical treatments. 851 “HIV”, human immunodeficiency virus. 41 of 65 852 "Intersex", a person whose sexual or reproductive anatomy or chromosomal pattern is not 853 consistent with typical definitions of male or female. 854 "LGBTQI", lesbian, gay, bisexual, transgender, questioning, queer and intersex. 855 "Long-term care facility staff", all individuals employed by, or contracted directly with, a 856 long-term care facility. 857 "Non-binary" describes a person whose gender identity falls outside of the traditional 858 gender binary structure of man and woman. 859 "Queer", a person whose gender expression, gender identity or sexual orientation does 860 not conform to dominant expectations or standards. 861 "Questioning", a person who is exploring or unsure about their own sexual orientation or 862 gender identity or expression. 863 "Sexual orientation", a person's romantic or sexual attraction to other people. 864 "Transgender", a person whose gender identity or gender expression differs from the birth 865 sex of that person. 866 (b) Except as provided in subsection (c), long-term care facilities and long-term care 867 facility staff shall not take any of the following actions based in whole or in part on a person's 868 actual or perceived sexual orientation, gender identity, gender expression, intersex status or HIV 869 status: 42 of 65 870 (i) denying admission to a long-term care facility, transferring or refusing to transfer a 871 resident within a facility or to another facility or discharging or evicting a resident from a 872 facility; 873 (ii) denying a request by residents to share a room; 874 (iii) where rooms are assigned by gender, assigning, reassigning or refusing to assign a 875 room to (A) a transgender resident other than in accordance with the transgender resident's 876 gender identity, unless at the transgender resident's request, or (B) a non-binary resident other 877 than in accordance with the non-binary resident’s preference; 878 (iv) prohibiting a resident from using or harassing a resident for using or seeking to use, a 879 restroom available to other persons of the same gender identity, regardless of whether the 880 resident is making a gender transition, has taken or is taking hormones, has undergone gender 881 affirmation surgery or presents as gender-nonconforming; provided, however, that for the 882 purposes of this clause, harassment shall include, but not be limited to, requiring a resident to 883 show identity documents to gain entrance to a restroom; 884 (v) repeatedly and intentionally failing to use a resident's chosen name or pronouns after 885 being informed of the chosen name or pronouns, in a manner that constitutes discrimination or 886 harassment in violation of any applicable federal, state or local law; 887 (vi) denying a resident the right to wear or be dressed in clothing, accessories or 888 cosmetics or to engage in grooming practices that are permitted to any other resident; 43 of 65 889 (vii) restricting a resident's right to associate with other residents or with visitors, 890 including the right to consensual sexual relations where sexual relations would not be restricted 891 if the participants were heterosexual or married; 892 (viii) denying or restricting medical or nonmedical care that is appropriate to a resident's 893 organs and bodily needs or providing such care that unduly demeans the resident or causes 894 avoidable discomfort or harm; or 895 (ix) refusing or willfully failing to provide any service, care or reasonable 896 accommodation to a resident or an applicant for services or care. 897 (c) The requirements of this section shall not apply to the extent that compliance with the 898 requirement is incompatible with any professionally reasonable clinical judgment or inconsistent 899 with 42 CFR § 483.15(c)(1), 42 CFR § 483.24 and 105 CMR 150.003. 900 (d) Each facility shall distribute a document containing the following notice alongside the 901 informational document required by section 72AA: 902 "[Name of facility] does not discriminate and does not permit discrimination by persons 903 employed by the facility including, but not limited to, abuse or harassment, on the basis of actual 904 or perceived sexual orientation, gender identity, gender expression, intersex status or HIV status 905 or based on association with another individual on account of that individual's actual or 906 perceived sexual orientation, gender identity, gender expression, intersex status or HIV status. 907 You may file a complaint with the office of the long-term care ombudsman, [provide current 908 contact information] if you believe you have experienced this kind of discrimination." 44 of 65 909 (e) Each long-term care facility shall ensure that resident records, including records 910 generated at the time of admission, include the resident's gender and the name and pronouns by 911 which the resident would like to be identified, as indicated by the resident. 912 (f) Unless expressly authorized by the resident or the resident's authorized representative, 913 long-term care facility staff not involved in providing direct care to a resident shall not be present 914 during physical examination of, or the provision of personal care to, that resident if the resident 915 is partially or fully unclothed. 916 (g) Transgender residents shall be provided access to such transition-related assessments, 917 therapy and treatments as have been recommended by the resident's health care provider, 918 including, but not limited to, transgender-related medical care, including hormone therapy and 919 supportive counseling, subject to availability and third-party medical coverage. 920 (h) LGBTQI-related programming, such as an LGBTQI Pride Month event or a 921 Transgender Day of Remembrance event, shall be allowed and treated equally to other cultural 922 celebrations or commemorations. 923 (i) The department shall promulgate regulations relative to discipline and penalties for 924 long-term care facilities that violate the requirements of this section or that employ a staff 925 member who violates the requirements of this section, which shall include, but not be limited to, 926 civil penalties and other administrative action. Nothing in this section shall be construed to limit 927 the ability of any party to bring a civil, criminal or administrative action for conduct constituting 928 a violation of any other provision of law. 929 (j) (1) A long-term care facility shall ensure that the long-term care facility staff receive 930 training, on at least a biennial basis, concerning: 45 of 65 931 (i) the care of LGBTQI older adults and older adults living with HIV; and 932 (ii) the prevention of discrimination based on sexual orientation, gender identity or 933 expression, intersex status and HIV status. 934 (2) The training required by this section shall include, but not be limited to: 935 (i) the definition of the terms commonly associated with sexual orientation, gender 936 identity and expression, intersex status and HIV status; 937 (ii) best practices for communicating with or about LGBTQI older adults and older adults 938 living with HIV and others who are LGBTQI or living with HIV, including the use of any name 939 and pronouns by which residents may express the desire to be identified; 940 (iii) a description of the health and social challenges historically experienced by LGBTQI 941 older adults and older adults living with HIV and others who are LGBTQI or living with HIV, 942 including discrimination when seeking or receiving care at long-term care facilities, and the 943 demonstrated physical and mental health effects within the LGBTQI community associated with 944 such discrimination; 945 (iv) strategies to create a safe and affirming environment for LGBTQI seniors and 946 residents living with HIV, including suggested changes to facility policies and procedures, 947 forms, signage, communication between residents and their families, activities and staff training 948 and in-services; and 949 (v) an overview of the provisions of this section. 950 (3) The department shall select an entity that has demonstrated expertise in creating safe 951 and affirming environments and identifying the legal, social and medical challenges faced by 46 of 65 952 LGBTQI older adults and older adults living with HIV and others who are LGBTQI or living 953 with HIV, who reside in long-term care facilities, to provide the training required by this section. 954 (4) Long-term care facility staff shall complete all training required by this section within 955 1 year of their date of hire unless the new hire provides the long-term care facility with 956 documentation demonstrating that they have completed equivalent training within the past 2 957 years. 958 (5) Each long-term care facility shall retain records documenting the completion of the 959 training required pursuant to this section by each administrator and staff member at the long-term 960 care facility. Compliance records shall be made available, upon request, to the department, the 961 executive office of health and human services and the office of the statewide long-term care 962 ombudsman. 963 (6) Each long-term care facility shall assume the cost of providing the training required 964 pursuant to this section. 965 (k) The commissioner and the secretary of health and human services shall adopt rules 966 and regulations as may be necessary to implement this section. 967 SECTION 18. Said chapter 111 is hereby further amended by striking out section 73, as 968 appearing in the 2022 Official Edition, and inserting in place thereof the following section:- 969 Section 73. (a) Whoever advertises, announces, establishes or maintains, or is concerned 970 in establishing or maintaining, a long-term care facility, or otherwise is engaged in any such 971 business without a license granted pursuant to section 71, or whoever being licensed pursuant to 972 said section 71 violates any provision of sections 71 to 73, inclusive, shall for a first offense be 47 of 65 973 punished by a fine of not more than $1,000, and for a subsequent offense by a fine of not more 974 than $2,000 or by imprisonment for not more than 2 years. 975 (b) Whoever violates any rule or regulation promulgated pursuant to sections 71, 72 and 976 72C shall be punished by a fine, not to exceed $500, unless the department determines a higher 977 amount is appropriate in accordance with 42 CFR 488.438. If any person violates any such rule 978 or regulation by allowing a condition to exist which may be corrected or remedied, the 979 department shall order such person, in writing, to correct or remedy such condition. If such 980 person fails or refuses to comply with such order by the correct by date, each day after the 981 correct by date during which such failure or refusal to comply continues shall constitute a 982 separate offense. A failure to pay the fine imposed by this section shall be a violation of this 983 subsection. 984 SECTION 19. Section 28 of chapter 118E of the General Laws, as so appearing, is 985 hereby amended by adding the following paragraph:- 986 The division shall consider a transfer of assets by an individual age 65 or older or a 987 transfer made for the sole benefit of an individual age 65 or older into a trust pursuant to 42 988 U.S.C. 1396p(d)(4)(C), established for the sole benefit of said individual, to be a disposal of 989 resources for fair market value, to the extent that such resources shall be available, under any 990 circumstances, to be used by the trustee to provide goods and services to the individual, or to 991 reimburse such costs, at fair market value. 992 SECTION 20. Section 31 of said chapter 118E is hereby amended by striking out 993 subsection (b), as so appearing, and inserting in place thereof the following 2 subsections:- 48 of 65 994 (b) This subsection shall apply to estates of individuals dying on or after April 1, 1995 995 but not after July 31, 2024. There shall be no adjustments or recovery of medical assistance 996 correctly paid except as follows: 997 (1) Recovery from the Permanently Institutionalized: From the estate of an individual, 998 regardless of age, who was an inpatient in a nursing facility or other medical institution when 999 said individual received such assistance. Recovery of such assistance shall be limited to 1000 assistance provided on or after March 22, 1991. 1001 (2) Recovery from Persons Age 65 and Over: From the estate of an individual who was 1002 not less than 65 years of age when said individual received such assistance. 1003 (3) Recovery from Persons Age 55 and Over for Post–October 1, 1993 Medicaid: From 1004 the estate of an individual who was not less than 55 years of age when said individual received 1005 such assistance, where such assistance was for services provided on or after October 1, 1993. 1006 Recovery may be made only after the death of the surviving spouse, if any, and only at a 1007 time when such surviving spouse has no surviving child who is under 21 years of age or is blind 1008 or permanently and totally disabled. The division shall waive recovery if such recovery would 1009 work an undue hardship, as defined by the division in its regulations. 1010 (b½) This subsection shall apply to estates of individuals dying on or after August 1, 1011 2024. There shall be no adjustments or recovery of medical assistance correctly paid except for 1012 recovery from the estate of an individual who was: 1013 (i) regardless of age, a resident in a nursing facility or other medical institution within the 1014 meaning of 42 U.S.C. 1396p(a)(1)(B)(i) when the individual received such assistance; provided, 49 of 65 1015 however, that recovery of such assistance shall be limited to assistance provided on or after 1016 March 22, 1991; or 1017 (ii) 55 years of age or older when the individual received such assistance, where such 1018 assistance was for services provided on or after October 1, 1993, but only for medical assistance 1019 consisting of nursing facility services, home and community-based services and related hospital 1020 and prescription drug services for which estate recovery is mandated under 42 U.S.C. 1021 1396p(b)(1)(B)(i) or other federal law. 1022 Any recovery may be made only after the death of the surviving spouse, if any, and only 1023 at a time when the individual has no surviving child who is: (i) under the age of 21; or (ii) an 1024 individual who is blind or an individual with a disability. 1025 SECTION 21. Said section 31 of said chapter 118E, as so appearing, is hereby further 1026 amended by adding the following subsection:- 1027 (e) Notwithstanding subsection (b½), there shall be no adjustment or recovery of medical 1028 assistance correctly paid from the estate of an individual who was receiving such assistance 1029 under the CommonHealth program for adults with disabilities or for payment of personal care 1030 attendant services; provided, however, that the executive office shall seek federal authority, if 1031 required, to implement this subsection. 1032 SECTION 22. Said chapter 118E is hereby further amended by adding the following 2 1033 sections:- 1034 Section 83. To establish Medicaid rates for skilled nursing facilities licensed pursuant to 1035 section 71 of chapter 111, the division of medical assistance shall use as base year costs for rate 50 of 65 1036 determination purposes the reported costs of the calendar year not more than 2 years prior to the 1037 current rate year. 1038 Section 84. (a) The division of medical assistance shall establish a skilled nursing facility 1039 rate add-on program for bariatric patient care and a rate add-on program for 1-on-1 staffing of at- 1040 risk residents requiring 24-hour monitoring and supervision for their safety and the safety of 1041 other residents and staff. The division of medical assistance shall identify at-risk resident 1042 populations to include in the rate add-on program for 1-on-1 staffing which shall include, but not 1043 be limited to, residents that: (i) have demonstrated suicidal ideation; (ii) have demonstrated 1044 aggressive behavior toward other residents or staff; (iii) have demonstrated exit-seeking 1045 behavior; or (vi) are registered sex offenders. The rate add-ons for said program shall be 1046 sufficient to defray the cost of employing the required staff to conduct the 24-hour monitoring 1047 and supervision of the at-risk residents. 1048 (b) The division of medical assistance may develop an add-on to rate of payment for 1049 skilled nursing facilities that develop small house nursing homes and meet criteria established by 1050 the executive office. 1051 SECTION 23. Subsection (c) of section 25 of chapter 176O of the General Laws, as 1052 appearing in the 2022 Official Edition, is hereby amended by inserting after the second sentence 1053 the following sentence:- The division shall develop and implement a uniform prior authorization 1054 form for the admission of patients from an acute care hospital to a post-acute care facility or 1055 transitioned to a home health agency certified by the federal Centers for Medicare and Medicaid 1056 Services for covered post-acute care services. 51 of 65 1057 SECTION 24. (a) For the purposes of this section, the following words shall have the 1058 following meanings unless the context clearly requires otherwise: 1059 “Enrollee”, as defined in section 8A of chapter 118E of the General Laws; provided, that 1060 “enrollee” shall include “insured” as defined in section 1 of chapter 176O of the General Laws. 1061 “Payer”, the group insurance commission under chapter 32A of the General Laws, the 1062 division of medical assistance under chapter 118E of the General Laws, insurance companies 1063 organized under chapter 175 of the General Laws, non-profit hospital service corporations 1064 organized under chapter 176A of the General Laws, medical service corporations organized 1065 under chapter 176B of the General Laws, health maintenance organizations organized under 1066 chapter 176G of the General Laws and preferred provider organizations organized under chapter 1067 176I of the General Laws, or a utilization review organization acting under contract with the 1068 aforementioned entities. 1069 “Post-acute care facility or agency”, any: (i) facility licensed under chapter 111 of the 1070 General Laws to provide inpatient post-acute care services, including, but not limited to skilled 1071 nursing facilities, long-term care hospitals, intermediate care facilities, or rehabilitation facilities; 1072 or (ii) a home health agency certified by the federal Centers for Medicare and Medicaid Services. 1073 (b) Notwithstanding any general or special law to the contrary, all payers shall approve or 1074 deny a request for prior authorization for admission to a post-acute care facility or transition to a 1075 post-acute care agency for any inpatient of an acute care hospital requiring covered post-acute 1076 care services by the next business day following receipt by the payer of all necessary information 1077 to establish medical necessity of the requested service; provided, however, that no new 1078 admission may occur until the applicable pre-admission screening and resident review required 52 of 65 1079 pursuant to 42 CFR 483 is complete. If the calendar day immediately following the date of 1080 submission of the completed request is not a payer’s business day, and the payer cannot 1081 otherwise make a determination by the next calendar day, and the receiving post-acute care 1082 facility or agency is both open to new admissions and has indicated that said facility or agency 1083 will accept the enrollee, then prior authorization shall be waived; provided, that the payer shall 1084 provide coverage and may begin its concurrent review of the admission on the next business day; 1085 provided further, that the payer shall not retrospectively deny coverage for services to an enrollee 1086 admitted to a post-acute care facility or transitioned to a post-acute care agency after a waiver of 1087 prior authorization pursuant to this section unless the claim was a result of fraud, waste or abuse. 1088 An adverse determination of a prior authorization request pursuant to this section may be 1089 appealed by an enrollee or the enrollee’s provider and such appeal, in the case of an enrollee of a 1090 commercial payer, shall be subject to the expedited grievance process pursuant to clause (iv) of 1091 subsection (b) of section 13 of chapter 176O of the General Laws. An enrollee of an insurance 1092 program of the division of medical assistance or the enrollee’s provider may request an expedited 1093 appeal of an adverse determination of a prior authorization request. Nothing in this section shall 1094 be construed to require a payer to reimburse for services that are not a covered benefit. 1095 (c) In the case of non-emergency transportation between an acute care hospital and a 1096 post-acute care facility, payers shall approve or deny a request for prior authorization according 1097 to the same process provided pursuant to subsection (b); provided, that once authorization has 1098 been granted, said authorization shall be valid for not less than 7 calendar days following 1099 approval. 1100 (d) The division of insurance and the division of medical assistance shall issue sub- 1101 regulatory guidance to effectuate the purposes of this subsection. 53 of 65 1102 SECTION 25. (a) There shall be a task force to study and propose recommendations to 1103 address acute care hospital throughput challenges and the impact of persistent delays in 1104 discharging patients from acute to post-acute care settings. The task force shall examine: (i) 1105 hospital discharge planning and case management practices; (ii) payer administrative barriers to 1106 discharge; (iii) legal and regulatory barriers to discharge; (iv) efforts to increase public 1107 awareness of health care proxies and the importance of designating a health care agent; (v) post- 1108 acute care capacity constraints and additional opportunities to provide financial incentives to 1109 increase capacity; (vi) administrative day rates and the cost to hospitals of discharge delays; (vii) 1110 enhanced hospital case management practices and reimbursement for wraparound services; (viii) 1111 the adequacy of post-acute care facility insurance networks and the establishment of an out-of- 1112 network rate for post-acute care facilities; (ix) expanding MassHealth Limited coverage to 1113 include post-acute and long-term care services; (x) the effectiveness of interagency coordination 1114 to resolve complex case discharges; (xi) the adequacy of reimbursement rates of MassHealth and 1115 commercial carriers for nonemergency medical transportation; (xii) opportunities to expand 1116 coverage and reimbursement for services delivered by mobile integrated health programs 1117 certified by the department of public health and by participating providers in the federal Centers 1118 for Medicare and Medicaid Services acute hospital care at home program; (xiii) alternative 1119 transportation options for patients being discharged and transferred to post-acute care facilities or 1120 home health agencies; and (xiv) the adequacy of state resources and infrastructure to place 1121 complex case discharges in appropriate post-acute care settings, including, but not limited to, 1122 patients with dementia diagnoses, geriatric patients with psychiatric diagnoses, patients with 1123 behavioral health diagnoses, patients with substance use disorder diagnoses, justice-involved 54 of 65 1124 patients and patients who have been unable to find an appropriate placement for post-acute care 1125 for 6 months or longer. 1126 (b) The task force shall consist of: the secretary of health and human services, or a 1127 designee, who shall serve as chair; the assistant secretary for MassHealth, or a designee; the 1128 commissioner of mental health, or a designee; the attorney general, or a designee; the 1129 commissioner of correction, or a designee; 1 sheriff appointed by the Massachusetts Sheriffs’ 1130 Association, Inc.; 1 member representing the division of the probate and family court department 1131 of the trial court to be appointed by the chief justice of said division; and 10 members to be 1132 appointed by the chair, 1 of whom shall be a representative of the Massachusetts Hospital 1133 Association, Inc., 1 of whom shall be a representative of the Massachusetts Senior Care 1134 Association, Inc., 1 of whom shall be a representative of the Home Care Alliance of 1135 Massachusetts, Inc., 1 of whom shall be a representative of the Massachusetts Academy of Elder 1136 Law Attorneys, 1 of whom shall be a representative from the Massachusetts Ambulance 1137 Association, Incorporated, 1 of whom shall be a representative from the Massachusetts 1138 Association of Health Plans, Inc., 1 of whom shall be a representative from Blue Cross and Blue 1139 Shield of Massachusetts, Inc., 1 of whom shall be a representative from an academic medical 1140 center located in Worcester county, 1 of whom shall be a representative of an acute care hospital 1141 located in Suffolk county and 1 of whom shall be a representative from an acute care hospital 1142 designated by the health policy commission as an independent community hospital for the 1143 purposes of 105 CMR 100.715(B)(2)(b). 1144 (c) Not later than July 31, 2025, the task force shall submit its report, including its 1145 recommendations or any proposed legislation necessary to carry out its recommendations, to the 55 of 65 1146 clerks of the house of representatives and the senate, the house and senate committees on ways 1147 and means and the joint committee on health care financing. 1148 SECTION 26. The division of medical assistance shall study the cost and feasibility of 1149 changes to the eligibility requirements for Medicaid long-term care services with the goal of 1150 reducing the time applicants spend at acute care hospitals awaiting long-term care eligibility 1151 determinations. The study shall consider: (i) improvements to the eligibility determination 1152 process; (ii) establishing a rebuttable presumption of eligibility; (iii) guaranteeing payment for 1153 long-term care services for up to 1 year regardless of eligibility status; and (iv) expanding the 1154 undue hardship waiver criteria. The division of medical assistance shall seek input from the 1155 Massachusetts Senior Care Association, Inc., the Massachusetts Academy of Elder Law 1156 Attorneys and other interested stakeholders. The division of medical assistance shall submit a 1157 report with the results of its study and policy recommendations to the clerks of the house of 1158 representatives and the senate and the house and senate committees on ways and means, not later 1159 than 180 days after the effective date of this act. 1160 SECTION 27. (a) There shall be a task force to evaluate the governance and regulatory 1161 structure of rest homes in the commonwealth. The task force shall include, but shall not be 1162 limited to, an examination of the following: (i) the licensing, regulatory and reporting structure 1163 for rest homes; (ii) an inventory of licensed rest homes and licensed rest home beds; (iii) the 1164 location and service areas of existing rest homes; (iv) a review of rest home closures since 2015; 1165 (v) a review of the recommendations implemented from the nursing facility task force report 1166 issued pursuant to section 91 of chapter 41 of the acts of 2019; (vi) the feasibility of receiving 1167 federal reimbursement for rest home expenses; and (vii) a review of the current rate structure for 1168 rest homes compared to the actual cost of care to residents. 56 of 65 1169 (b) The task force shall consist of the secretary of health and human services, or their 1170 designee, who shall serve as chair; the secretary of elder affairs, or their designee; the 1171 commissioner of public health, or their designee; the assistant secretary for MassHealth, or their 1172 designee; the commissioner of the department of mental health, or their designee; the 1173 commissioner of the department of transitional assistance, or their designee; the chairs of the 1174 joint committee on elder affairs, or their designees; 1 person to be appointed by the minority 1175 leader of the house of representatives; 1 person to be appointed by the minority leader of the 1176 senate; and 5 members to be appointed by the governor, 1 of whom shall be a representative 1177 from the Massachusetts Association of Residential Care Homes, Inc., 1 of whom shall be a 1178 representative of LeadingAge Massachusetts, Inc., 1 of whom shall be a representative of 1179 Massachusetts Senior Action Council, Inc., 1 of whom shall have direct care giver experience 1180 and 1 of whom shall have experience in health care administration and finance. 1181 (c) The task force shall submit a report of its findings, including any recommendations or 1182 proposed legislation necessary to carry out its recommendations, to the clerks of the house of 1183 representatives and the senate and to the house and senate committees on ways and means, not 1184 later than April 1, 2025. 1185 SECTION 28. (a) The health policy commission shall conduct an analysis and issue a 1186 report on the impact of the Medicare shared savings program and participating Medicare 1187 accountable care organizations, hereinafter referred to as Medicare ACOs, on the financial 1188 viability of long-term care facilities in the commonwealth and continued access to long-term care 1189 facility services for Medicare patients. The analysis shall include, but not be limited to, an 1190 examination of the following: 57 of 65 1191 (i) the impact of Medicare ACOs on clinical eligibility decisions related to initial long- 1192 term care facility placement and patient length of stay for Medicare ACO beneficiaries compared 1193 to Medicare fee-for-service beneficiaries, including an analysis of the impact of length of stay on 1194 quality outcomes including readmissions, functional status and patient experience; 1195 (ii) the amount of payments Medicare ACOs have received from the federal government 1196 from capitated, shared savings or other related initiatives and how those payments have been 1197 utilized, or not, to enhance patient care and outcomes in long-term care facilities; 1198 (iii) Medicare ACO practices related to patient care utilization controls and the financial 1199 and quality care impact of these controls on beneficiaries in the acute and post-acute care system; 1200 and 1201 (iv) Medicare ACOs long-term care network adequacy. 1202 (b) The health policy commission shall submit the report to the clerks of the house of 1203 representatives and the senate, the house and senate committees on ways and means, the joint 1204 committee on health care financing and the joint committee on elder affairs not later than June 1, 1205 2025. 1206 SECTION 29. (a) There shall be a special legislative commission established pursuant to 1207 section 2A of chapter 4 of the General Laws to study oversight of continuing care retirement 1208 communities to protect the consumer and financial rights of residents. 1209 (b) The commission shall consist of: the chairs of the joint committee on elder affairs, 1210 who shall serve as co-chairs; the attorney general or a designee; the secretary of elder affairs or a 1211 designee; the commissioner of public health or a designee; 3 persons to be appointed by the 58 of 65 1212 governor, 1 of whom shall be a certified public accountant or an actuary and 2 of whom shall be 1213 residents at a continuing care retirement community; a representative of the Massachusetts 1214 chapter of National Academy of Elder Law Attorneys; a representative of LeadingAge 1215 Massachusetts, Inc.; a representative of Massachusetts Assisted Living Association, Inc.; a 1216 representative of AARP Massachusetts; a representative of the Alzheimer’s Association; a 1217 representative of Massachusetts Advocates for Nursing Home Reform, Inc.; a representative of 1218 the Massachusetts Life Care Residents’ Association, Inc.; a representative of Massachusetts 1219 Senior Care Association, Inc.; and a representative of Local 1199 SEIU. The commission shall 1220 meet not less than 6 times and shall hold not less than 1 public hearing. 1221 (c) The commission shall study and report on: (i) continuing care retirement 1222 communities, their care contracts and their impact on consumers; (ii) the financial viability of 1223 such communities; (iii) the payment and return of entrance fees at such communities; (iv) 1224 statutory and regulatory oversight of such communities, including any activities by state agencies 1225 to enforce regulatory requirements; (v) advertising practices communicated to potential residents 1226 and families about such communities; and (vi) regulatory procedures for the closure or change of 1227 ownership of such communities. 1228 (d) The commission shall submit a report with recommendations, including legislation or 1229 regulations necessary to carry out such recommendations, to the clerks of the house of 1230 representatives and the senate, the joint committee on elder affairs and the senate and house 1231 committees on ways and means not later than August 1, 2025. 1232 SECTION 30. (a) The department of public health shall study and report on the need and 1233 feasibility of qualified professional guardians to give informed medical consent for indigent 59 of 65 1234 persons and whether such guardians would reduce hospital discharge issues and increase access 1235 to long-term care and preventive care; provided, however, that the report shall include, but not be 1236 limited to: (i) the need for qualified professional guardians to assist indigent persons with 1237 accessing appropriate medical care, including preventive care; (ii) data on the current number of 1238 Rogers guardians and similar guardians and the financial impact of reimbursing such guardians; 1239 (iii) the fiscal impact of establishing MassHealth fee-for-service guardians; (iv) consideration of 1240 the benefits to an individual and cost to the commonwealth of deducting from an applicant for 1241 MassHealth or a MassHealth member’s income for guardianship fees and related expenses when 1242 the appointment of a guardian is essential to enable an applicant or member to gain access or 1243 consent to medical treatment and an estimation of reasonable costs for such a deduction; and (v) 1244 other recommendations deemed necessary by the department. 1245 (b) Not later than July 31, 2025, the department shall submit its report, including any 1246 proposed legislation necessary to carry out its recommendations, to the clerks of the senate and 1247 house of representatives, the senate and house committees on ways and means and the joint 1248 committee on elder affairs. 1249 SECTION 31. (a) There shall be a task force to review the viability and sustainability of 1250 long-term care facilities in the commonwealth. 1251 (b) The task force shall consist of: the secretary of health and human services, who shall 1252 serve as chair; the secretary of elder affairs or a designee; commissioner of public health or a 1253 designee; 4 persons to be appointed by the governor, 1 of whom shall represent long-term care 1254 facilities, 1 of whom shall operate an assisted living residence, 1 of whom shall represent 1255 residents of long-term care facilities in the commonwealth and 1 of whom shall be health care 60 of 65 1256 economist; a representative of LeadingAge Massachusetts, Inc., a representative of Local 1199 1257 SEIU; a representative of Massachusetts Association of Residential Care Homes, Inc.; a 1258 representative of the Massachusetts Senior Action Council, Inc.; and a representative of 1259 Massachusetts Senior Care Association, Inc. 1260 In making appointments, the governor shall, to the maximum extent feasible, ensure that 1261 the task force represents a broad distribution of diverse perspectives and geographic regions. 1262 (c) In making recommendations, the task force shall consider issues including, but not 1263 limited to: (i) the demand for long-term care facilities over the next 5 and 10 years and the ability 1264 to meet that demand in a cost-effective manner; (ii) the geographic accessibility of such 1265 facilities; (iii) staffing challenges and workforce initiatives to support such facilities including, 1266 but not limited to, childcare; (iv) the utilization of pharmacists and other health care providers in 1267 long-term care; (v) any policy reforms to strengthen long-term care in the commonwealth 1268 including, but not limited to, maintaining quality of care; (vi) the adequacy of payor rates; (vii) 1269 costs and impacts of financing for facility construction and maintenance including, but not 1270 limited to, private equity and real estate investment trusts; and (viii) costs associated with 1271 transportation options to and from facilities for individuals. 1272 (d) The task force shall submit its report, recommendations and any proposed legislation 1273 necessary to carry out its recommendations to the clerks of the senate and house of 1274 representatives, the joint committee on health care financing, the joint committee on elder affairs 1275 and the senate and house committees on ways and means not later than July 31, 2025. 1276 SECTION 32. (a) Notwithstanding any general or special law to the contrary, there shall 1277 be an assisted living residences commission to study and recommend policies to ensure assisted 61 of 65 1278 living residences adequately meet the health and safety needs of residents. The areas examined 1279 by the commission shall include, but not be limited to: (i) the current statutory and regulatory 1280 oversight of assisted living residences; (ii) assisted living best practices in other states; (iii) the 1281 impacts of licensing or certifying such residences; (iv) advertising practices of assisted living 1282 residences to potential residents and their families; (v) regulatory procedures for opening, closing 1283 or changing ownership of a residence, including determination of need processes and clustering 1284 of facilities; (vi) trends in incident reports made to the executive office of elder affairs and the 1285 long term care ombudsman’s office and resolutions of such incidents; (vii) methods to provide 1286 transparency of information for potential consumers and family members researching and 1287 comparing residences; (viii) safety standards; (ix) existing consumer protections for residents in 1288 statutes and regulations; and (x) basic health services in residences. 1289 (b) The commission shall consist of: the secretary of elder affairs, who shall serve as 1290 chair; the commissioner of public health or a designee; the assistant secretary of MassHealth or a 1291 designee; the long term care ombudsman or a designee; the chairs of the joint committee on elder 1292 affairs; 1 member to be appointed by the senate president; 1 member to be appointed by the 1293 speaker of the house of representatives; 1 member to be appointed by the minority leader of the 1294 senate; 1 member to be appointed by the minority leader of the house of representatives; 3 1295 members to be appointed by the governor, 2 of whom shall be residents or family members of 1296 residents at an assisted living residence; a representative of the Massachusetts chapter of the 1297 National Academy of Elder Law Attorneys; a representative of LeadingAge Massachusetts, Inc.; 1298 a representative of the Massachusetts Assisted Living Association, Inc.; a representative of 1299 AARP Massachusetts; a representative of the New England chapter of the Gerontological 1300 Advanced Practice Nurses Association; a representative of the Massachusetts chapter of the 62 of 65 1301 Alzheimer’s Association; a representative of MassPACE, Inc.; and a representative of Greater 1302 Boston Legal Services, Inc. The commission shall meet not less than 5 times and shall hold at 1303 least 1 public hearing. 1304 (c) The commission shall file its report and recommendations, including any proposed 1305 legislation necessary to carry out its recommendations, to the clerks of the senate and house of 1306 representatives, the joint committee on elder affairs and the house and senate committees on 1307 ways and means not later than August 1, 2025. 1308 SECTION 33. (a) Each long-term care facility shall designate 2 employees, including 1 1309 employee representing management at the facility and 1 employee representing direct care staff 1310 at the facility, to receive in-person training required by section 72GG of chapter 111 of the 1311 General Laws within 6 months of the effective date of this section. The designated employees 1312 shall serve as points of contact for the long-term care facility regarding compliance with the 1313 provisions of this act and shall develop a general training plan for the facility. In the event a 1314 designated employee ceases to be employed by the facility, the facility shall designate another 1315 employee who is representative of the employee group represented by the former designee, who 1316 shall complete the in-person training required pursuant to this section, to serve as a point of 1317 contact for the facility regarding compliance with the provisions of this act and have joint 1318 responsibility for the facility's training plan. 1319 (b) All long-term care facility staff employed by a long-term care facility on the effective 1320 date of this act, other than an employee designated pursuant to subsection (a), shall complete the 1321 training required by section 72GG of chapter 111 of the General Laws within 1 year of the 1322 effective date of this section. 63 of 65 1323 SECTION 34. (a) For the purposes of this section, “payer” shall mean the group 1324 insurance commission under chapter 32A of the General Laws, the division of medical assistance 1325 under chapter 118E of the General Laws, insurance companies organized under chapter 175 of 1326 the General Laws, non-profit hospital service corporations organized under chapter 176A of the 1327 General Laws, medical service corporations organized under chapter 176B of the General Laws, 1328 health maintenance organizations organized under chapter 176G of the General Laws and 1329 preferred provider organizations organized under chapter 176I of the General Laws, or a 1330 utilization review organization acting under contract with the aforementioned entities. 1331 (b) Notwithstanding any general or special law to the contrary, the division of insurance 1332 shall develop the uniform prior authorization form for admission to a post-acute care facility or 1333 transition to a home health agency for any inpatient of an acute care hospital requiring covered 1334 post-acute care services pursuant to section 25 of chapter 176O of the General Laws, not later 1335 than 90 days after the effective date of this act. Said uniform prior authorization form shall state 1336 that no new admission to a nursing facility may occur until the applicable preadmission 1337 screening and resident review required under 42 CFR 483 is complete. The division of insurance 1338 shall develop said uniform prior authorization form in consultation with the division of medical 1339 assistance. The division of medical assistance, or any entity acting for the division of medical 1340 assistance under contract, shall accept the uniform prior authorization form as sufficient to 1341 request prior authorization for the requested service. All acute care hospitals shall use the 1342 uniform prior authorization form to request prior authorization for coverage of post-acute care 1343 services at a post-acute care facility or home health agency, and all payers or entities acting for a 1344 payer under contract shall accept such form as sufficient to request prior authorization for the 64 of 65 1345 requested service, not later than 30 days after the form has been developed by the division of 1346 insurance. 1347 SECTION 35. (a) For the purposes of this section, the terms “licensee” and “management 1348 company” shall have the meanings as defined in section 71 of chapter 111 of the General Laws. 1349 (b) Pursuant to section 71 of chapter 111 of the General Laws, a licensee who has entered 1350 into a contract with a management company prior to the effective date of this act shall provide 1351 the department of public health with the necessary documentation and materials for a 1352 determination by the department of the responsibility and suitability as described in subsection 1353 (g) of said section 71 of said chapter 111 of the management company, prior to any issuance of a 1354 renewed license; provided, however, that the department shall give a licensee reasonable time to 1355 provide the department with the necessary documents and materials if the licensee’s renewal date 1356 is within 90 days of the effective date of this act. A licensee’s failure to comply with this section 1357 shall subject the licensee to the penalties established in section 73 of said chapter 111. 1358 SECTION 36. Pursuant to section 72CC of chapter 111 of the General Laws, inserted by 1359 section 17, each long-term care facility shall submit its outbreak response plan to the department 1360 of public health not later than 180 days after the effective date of this act. 1361 SECTION 37. The initial report required by section 72FF of chapter 111 of the General 1362 Laws, inserted by section 17, shall be filed with the clerks of the house of representatives and the 1363 senate, the house and senate committees on ways and means and the joint committee on elder 1364 affairs not later than 6 months after the effective date of this act. 1365 SECTION 38. Section 24 is hereby repealed. 65 of 65 1366 SECTION 39. Section 23 of chapter 20 of the acts of 2021 is hereby repealed. 1367 SECTION 40. Sections 17 and 33 shall take effect 180 days after the effective date of this 1368 act. 1369 SECTION 41. Section 38 shall take effect 2 years after the effective date of this act. 1370 SECTION 42. Section 83 of chapter 118E of the General Laws, inserted by section 22, 1371 shall take effect on October 1, 2025.