Guv Signs Long-Term Care Reforms

Gov. Maura Healey on Friday signed into law a package of reforms overhauling the long-term care industry in Massachusetts. The bill included infection control plans, uniform patient transfer forms, heightened scrutiny of private equity and much more.

Nearly a month after legislative leaders ended their formal sessions for the term without an agreement on the bill -- and more than 18 months after House Speaker Ron Mariano dubbed it one of his top priorities -- six negotiators submitted their 65-page accord (H 5033) Wednesday.

The House and Senate accepted the measure and sent it to Gov. Maura Healey on Thursday.

Rep. Thomas Stanley of Waltham, who helped craft the original legislation and co-led the compromise talks on behalf of the House, called it "the first major overhaul in a quarter of a century."

"This will be the path forward for the nursing home industry, and it will change lives, save lives, protect employees from abuse, and also provide career ladder programs as an incentive for people to grow in the industry," Stanley told the News Service after filing the conference report with the House clerk.

Sen. Michael Rodrigues, the lead Senate negotiator, said the final bill "takes the best aspects of both the House and Senate versions to enhance protections for seniors in Massachusetts."

"We establish much-needed safeguards and permanent support services for the long term care and assisted living communities," Rodrigues said in a statement Wednesday. "This legislation also creates a Long Term Care Workforce and Capital Training Fund to administer capital loan and workforce training programs. We substantially increase the penalties for bad actors in the industry, and protect LGBTQ+ seniors from discrimination. This legislation protects and empowers seniors all across the Commonwealth."

Many of the marquee reforms in the underlying House and Senate proposals survived in the final version.

Long-term care facilities, which were ravaged by the COVID-19 pandemic, would need to file outbreak response plans with the state Department of Public Health to ensure they have measures in place ahead of time to prevent the spread of diseases. The bill would create a more rigorous licensure process and suitability reviews for operators, according to a Mariano aide familiar with the bill.

It would also increase scrutiny of the role of private equity and real estate investment trusts in long-term care. Steward Health Care's bankruptcy thrust those actors into the spotlight, but the Mariano aide said they also have a long history of buying land from beneath skilled nursing facilities and then leasing it back.

While a growing backlog of hospital patients await placement into a more appropriate care setting, the bill seeks to speed up discharges by requiring MassHealth and commercial insurers to craft a common transfer form to cut down on the administrative burden.

Another section of the bill calls for a two-year pilot program requiring prior authorization requests related to hospital discharges to be completed by the next business day, even over the weekend, instead of the current two-day timeline, Mariano's office said.

The final bill includes a provision allowing DPH to install a "temporary manager" at a facility that fails to comply with state and federal law, and it also includes Senate-proposed protections for LGBTQ+ older adults.

One idea that originated in the House bill and features in the compromise measure is a new state fund to help the industry invest in both workforce growth and capital improvements. Providers could tap into that source to help invest in specialized care units or other facility improvements, and the fund could also help build up a career ladder.

Mariano's office said the bill would create the fund, but not seed it with any money at the outset. Instead, half of what the state receives in expanded abuse and neglect penalties would be deposited into the fund, and future spending bills could also direct additional appropriations.

Much of the bill responds to the COVID-19 pandemic, which wrought disproportionate impacts on the older, more vulnerable residents who live in skilled nursing facilities and similar locations. But it also incorporates changes that a nursing facility task force recommended in January 2020, before the public health crisis, to support the industry's stretched-thin workforce and expand oversight.

Mariano said in February 2023, just about a month into the two-year term, that the topic was one of his top priorities. It took months longer for a bill to emerge, and the House approved its proposal in November. The Senate then waited until late July, the tail end of formal business, to unveil and advance its own draft.

The late-August agreement checks off one more topic top Democrats in both chambers wanted to address, but failed to complete before they wrapped up the last formal session of the term on the morning of Aug. 1.

Legislative leaders say they are still working toward deals, and could call members back in for a formal session if they find agreement on an economic development bond bill, but they have publicly displayed little urgency and the State House has been largely quiet for weeks.

Seven other conference committees have yet to achieve breakthroughs on House- and Senate-approved bills dealing with clean energy siting, economic development, hospital oversight, prescription drug pricing, investing interest from the state's "rainy day" account, Boston liquor licenses, and substance use disorder.

[Sam Drysdale and Sam Doran contributed reporting.]