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Massachusetts House bill could help long-term care providers

House Speaker Ronald Mariano talks to reporters at a gun bill press conference on Thursday, Oct. 5, 2023.
Sam Doran
State House News Service
House Speaker Ronald Mariano talks to reporters at a gun bill press conference on Thursday, Oct. 5, 2023.

House Democrats on Tuesday teed up a bevy of reforms to the long-term care sector, scheduling a vote on a package whose roots predate the COVID-19 pandemic that cast a harsh spotlight on lackluster infection controls, staffing shortages and other pitfalls in the senior care system.

The House Ways and Means Committee began moving a 35-page industry overhaul bill and Speaker Ron Mariano's office said the measure will hit the House floor for a vote on Wednesday, the final day for scheduled formal business in 2023.

Since early in the two-year term, Mariano has signaled an interest in transforming oversight, staffing supports and disease management in nursing homes and similar facilities, where issues were already apparent before the devastation of the public health emergency.

The legislation would implement several changes a nursing facility task force recommended in January 2020, such as empowering the Department of Public Health with more regulatory muscle and creating career ladder and grant programs to support the industry's stretched-thin workforce.

All long-term care facilities would be required under the bill to develop individualized infection outbreak response plans, which would need to be submitted to DPH for review every year, according to a bill summary provided by Mariano's office.

"The nursing home sector has long faced workforce and financial challenges that have only been exacerbated by the pandemic. Addressing persistent challenges within this important sector will not only improve the quality of care that residents receive, it will increase capacity and help acute care hospitals more efficiently discharge patients to the appropriate post-acute care settings," Mariano said in a statement on Tuesday. "Building off of key investments in the industry in recent budgets, this comprehensive legislation will bolster the long-term care workforce, enhance oversight of facilities, and ensure greater access, all while prioritizing quality of care."

The legislation lays out new licensing regulations, subjecting long-term care facility management companies to additional oversight and allowing regulators to examine an applicant's "criminal and civil litigation history, financial capacity, and history providing long-term care both in and outside the Commonwealth," according to Mariano's office.

To give state enforcement more teeth, the bill would quintuple penalties the attorney general can seek for abuse and neglect of patients and double the statute of limitations to four years. It would also increase fines for offenses such as operating a facility without a license.

Attorney General Andrea Campbell this year supported the proposed abuse and neglect penalty hikes, telling lawmakers, "If we want to really get accountability when there's wrongdoing, the penalty must be strengthened so that they reflect the severity of the offenses."

Much of the bill reflects earlier versions that won the support of two joint committees — Elder Affairs Committee and Health Care Financing — and the House Ways and Means Committee added new sections as well, including one creating a "long-term care workforce and capital fund."

That fund would be used for capital improvements at nursing homes and similar facilities, and it would help pay for a wide range of worker training programs including certified nursing assistant career ladders. Half of the revenue the attorney general secures from abuse or neglect civil penalties would be deposited into the fund.

Another set of changes the House Ways and Means Committee made aims to address "chokepoints" that slow the discharge of patients in acute care hospitals to appropriate other settings.

The revised bill would stand up a two-year pilot program requiring insurance carriers, including MassHealth, to respond within one business day to a prior authorization request for post-acute care facilities, or waive prior authorization requirements if a patient can be admitted over a weekend, according to the bill summary.

Additional reforms include creation of a task force to study "acute care hospital throughput challenges," a MassHealth study of changing eligibility to reduce the amount of time applicants wait in acute-care hospitals to find out if they can get into long-term care, and allowing some patients to retain more of their income to pay fees for appointing a medical guardian.

Mariano publicly set his sights on the long-term care sector in February, less than two months into the session, when he dubbed an earlier version of the bill one of his first priorities.

Like other sectors, the industry has long been grappling with staffing shortages, particularly during and after the pandemic. In April, the Massachusetts Senior Care Association published results of a survey that found most facilities were near capacity with an average occupancy rate of 93 percent, coupled with thousands of job vacancies.

After light fall sessions, the Legislature is scheduled this week to take a seven-week holiday break from major business. Senate Democrats have not signaled any concrete plans to tackle long-term care reforms and legislative leaders appear to remain on different pages when it comes to health care policymaking, an approach that resulted in priority bills dying in recent years.

The Senate on Wednesday will vote on the latest version of a prescription drug pricing bill, which the chamber has advanced in each of the past two sessions without it receiving a House vote.

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