Lawmakers approved a slate of sweeping reforms for senior care facilities under which Massachusetts providers would see pay rates increase — but the provisions still leave a $300 million Medicare payment shortfall, said the head of the state’s largest long-term care provider group.
The legislation also creates more guardrails for facility ownership transfers, requiring the Department of Public Health to review financial and legal information from potential new owners and management companies before granting operating licenses.
“While we support many of these provisions and have been advocating for these types of reforms, we are concerned that the Commonwealth continues to severely underfund nursing facility care by $47 per resident per day, totaling more than $300 million annually, according to the federal government,” Massachusetts Senior Care President Tara Gregorio said in an emailed statement to McKnight’s Long-Term Care News Friday.
The most recent version of the legislation passed in the state Senate 39-0, and lawmakers have until Tuesday (July 31) to reconcile the House and Senate versions and send it to Gov. Maura Healey (D) for her signature.
The Senate’s legislation requires insurers to approve admissions requests from hospitals to long-term care facilities within 24 hours and that the approvals be waived over weekends. It also directs the state Department of Public Health to work with the LTC sector to develop and implement best practices for training and education programs that are based on frequently cited deficiencies.
Skilled nursing facilities would be required to create a Certified Medication Aide Role for CNAs that would allow them to dispense non-narcotic medications to residents.
In an effort to address the state’s staffing crisis, the bill creates a Long-Term Workforce and Capital Fund for workforce training programs for new CNAs, a CNA-to-LPN pathway, and supervisory training for clinicians.
Trying to stop a backslide
Beginning Oct. 1, 2025, Medicaid will set nursing facility rates using a base year more than two years from the rate year, per the legislation. Medicaid also will have to establish a series of rate add-ons for one-on-one staffing for at-risk residents who require 24-hour monitoring and supervision. According to Gregorio, 70% of the state’s more than 33,000 nursing facility residents receive state-funded care.
“A nursing facility’s ability to provide quality resident care, invest in our dedicated workforce and comply with thousands of government regulations is dependent on state funding,” Gregorio said.
State records show that between 2018 and 2023, some 56 nursing homes closed while another five long-term care facilities have either closed or told officials they plan to close this year.
A fact sheet from state Sen. President Karen E. Spilka (D) noted that the reform bill requires licensing applicants to notify the Department of Health if they are experiencing any kind of financial hardship such as bankruptcy or being placed in receivership in other states.
Other provisions in the legislation include:
• Requiring the Massachusetts Health Policy Commission to conduct comprehensive Medicare ACO study on patient care outcomes and financial viability of long-term care facilities;
• Requiring MassHealth — the state’s Medicare program — to study changing its eligibility requirements to include guaranteed payment for long-term care services for up to one year and expanding the undue hardship waiver criteria;
• Encouraging the development of “small house” facilities that would house no more than 14 residents in private rooms around a centralized common space; and
• Enshrining into state law that the Department of Health will conduct facility inspections at least once every nine to 15 months.
