Sweeping reforms to Massachusetts’ long-term care industry that would raise providers’ rates while enacting stricter disclosure requirements on facility sales are one step closer to becoming law.
The state Legislature sent the reform bill on Thursday to Gov. Maura T. Healey (D) for her signature. Healey’s office did not respond to an inquiry from McKnight’s Long-Term Care News about whether she planned to sign the measure into law. She has 10 days from the time her office receives the bill to sign or veto it.
At a time when lawmakers nationwide are pressing aggressive consumer-driven reforms, the Massachusetts package is notable because it offers a combination of measures designed to improve quality and increase the resources available to providers.
“This comprehensive and historic legislation represents a profound commitment to the well-being of our seniors and the dedicated professionals who care for them, and it will have a lasting impact on the provision of care in Massachusetts,” Tara Gregorio, president of the Massachusetts Senior Care Association, told McKnight’s on Thursday. “We are deeply appreciative of the Legislature’s efforts to safeguard the dignity and quality of life for our most vulnerable citizens.”
The legislation creates a Long-Term Care Workforce and Capital Fund that would be administered through the state Secretary of Health and Human Services to provide funds for capital loans and also for workforce training programs. The money for the fund will come from a variety of federal and state sources, including half of any amounts the state collects through fines to facilities in which residents are found with bodily injuries or have been sexually assaulted.
Funds for the training programs for CNAs, a CNA-to-LPN pathway, and supervisory training for clinicians can be used for program costs, tuition, books, exam and licensing fees, stipends for enrollees, childcare, and transportation.
The reform bill also creates a requirement that the state’s Department of Public Health, the Division of Medical Assistance, the Executive Office of Elder Affairs and the Health Policy Commission conduct an analysis of cost trends and the financial performance of skilled nursing facilities.
That report will look at, among other things, trends in relative price, payer mix, case mix, utilization and length of stay; general and administrative costs, nursing and other labor costs and salaries, building costs, capital costs and other operating costs; and total spending on direct patient care as a percent of total operating expenses.
“The examination shall aggregate information collected on multiple skilled nursing facilities that are owned and operated by a single owner,” according to the bill’s text.
Reimbursement rates are, as in other places, problematic for Massachusetts providers.
In July, McKnights’ reported that the legislation left a $300 million Medicare shortfall with the state severely underfunding nursing facility care by $47 per resident per day, Gregorio said at the time.
The legislation calls for Medicaid rates for SNFs to be set using a base rate not more than two years prior to the current rate year. 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.
The legislation 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.
Other provisions in the bill 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 Medicaid 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.
