On July 25, the Senate approved sweeping reforms to the Commonwealth’s long term care and assisted living sectors.
The legislation, S.2889, An Act relative to long term care and assisted living, substantially strengthens state oversight and enforcement of long term care and assisted living facilities while also requiring facilities to create outbreak plans should a health issue arise.
The bill passed unanimously.
An amendment I filed to extensively scale back the state’s Medicaid estate recovery program to the federally-required minimum was adopted into the bill that passed the Senate.
MassHealth, the state’s Medicaid program, demands repayment after death from the estates or families of low-income people who received Medicaid health care services after age 55. While federal law mandates that some Medicaid costs be reimbursed this way, the MassHealth Estate Recovery program goes way beyond the federally-set floor.
Federal law requires recovery only for long term care, like nursing home care. Yet in Massachusetts, MassHealth demands repayment from the families of deceased recipients who received any Medicaid services over age 55, including hospital care, doctors’ care, prescription drugs, physical therapy and any other service.
Over 90 percent of these repayments to MassHealth come from the forced sale of the family home.
My amendment restricts MassHealth’s estate recovery program to only federally-required recoveries and exempts CommonHealth members and personal care attendant (PCA) services from recovery.
In a comprehensive study, the Blue Cross Blue Shield of Massachusetts Foundation found that the program perpetuates wealth disparities and intergenerational poverty.
Watch my remarks on the amendment here.
Read on for more information on additional provisions included in the legislation:
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Assisted Living Basic Health Services
The bill makes it easier for residents of nursing homes and long term care facilities to get timely and efficient care by allowing Assisted Living Residences (ALRs) to offer basic health services such as helping a resident administer drops, manage their oxygen, or take a home diagnostic test. The legislation requires ALRs to create service plans that demonstrate the residence has the necessary procedures in place, such as staff training and policies, to ensure safe and effective delivery of basic health services.
The legislation enhances oversight and compliance of ALRs by lowering the threshold for ownership interest disclosure from 25 per cent to five per cent. Under the new law, applicants are required to demonstrate that any prior multifamily housing, ALR, or health care facilities in which they had an interest met all the licensure or certification criteria. If any of these facilities were subject to enforcement action, the applicant must provide evidence that they corrected these deficiencies without revocation of licensure or certification.
This bill also gives the Executive Office of Elder Affairs (EOEA) new powers to penalize non-compliance by allowing them to fine ALRs up to $500 per day. This is in addition to existing EOEA powers to modify, suspend, or revoke a certification, or deny a recertification. Finally, it adds whistleblower protections for staff and residents who report anything happening at an ALR that they reasonably believe is a threat to the health or safety of staff or residents.
Long Term Care Facilities
The bill requires the Department of Public Health (DPH) to inspect each long term care facility every nine to 15 months to assess quality of services and compliance. It also requires DPH to review the civil litigation history, in addition to the criminal history, of the long term care facility applicants, including any litigation related to quality of care, patient safety, labor issues, or deceptive business practices.
S.2889 requires DPH to review the financial capacity of an applicant and its history in providing long term care in Massachusetts and other states. It requires applicants to notify DPH if it is undergoing financial distress, such as filing for bankruptcy, defaulting on a lending agreement, or undergoing receivership.
It allows DPH to limit, restrict, or revoke a long term care facility license for cause, such as substantial or sustained failure to provide adequate care, substantial or sustained failure to comply with laws or regulations, or lack of financial capacity to operate a facility. It also gives DPH the power to appoint a temporary manager if a long term care facility owner fails to maintain substantial or sustained compliance with laws and regulations. This manager would be brought on for at least three months, at the facility owner’s expense, to bring the facility into compliance.
The bill requires long term care facilities to submit outbreak response plans to DPH with clear protocols for the isolation of residents, lab testing, visitor screening, preventing spread from staff, and the notification of residents, family, and staff in the event of a contagious disease outbreak.
The bill prohibits long term care facilities from discriminating against residents based on LGBTQ+ identity or HIV status, whether through the denial of admission, medical or non-medical care, access to restrooms, or through room assignments. It also requires staff training on preserving LGBTQ+ rights and care.
Versions of the bill having passed both chambers of the Legislature, the two branches will now reconcile their differences before sending a bill to the Governor’s desk.
