HOUSE . . . . . . . . No. 3929
The Commonwealth of Massachusetts
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HOUSE OF REPRESENTATIVES, June 15, 2023.
The committee on Elder Affairs, to whom were referred the petition
(accompanied by bill, Senate, No. 364) of Julian Cyr and Angelo J.
Puppolo, Jr., for legislation relative to promoting the betterment of
resident health and safety in long term care facilities, the petition
(accompanied by bill, Senate, No. 378) of Patricia D. Jehlen for legislation
relative to regulations for small house nursing homes, the petition
(accompanied by bill, Senate, No. 379) of Patricia D. Jehlen, Thomas M.
Stanley, Joanne M. Comerford, Jack Patrick Lewis and other members of
the General Court for legislation to improve quality and oversight of long-
term care, the petition (accompanied by bill, Senate, No. 384) of Jason M.
Lewis and Andrea Joy Campbell for legislation to strengthen the Attorney
General’s tools to protect nursing home residents and other patients from
abuse and neglect, the petition (accompanied by bill, House, No. 616) of
Ruth B. Balser and Andrea Joy Campbell relative to the authority of the
Attorney General to protect nursing home residents and other patients
from abuse and neglect, the petition (accompanied by bill, House, No.
627) of Denise C. Garlick and others that the Division of Health Care
Facility Licensure and Certification be authorized to establish a program
for training and education for certain licensed providers, and the petition
(accompanied by bill, House, No. 648) of Thomas M. Stanley, Kate
Lipper-Garabedian and others for legislation to improve quality and
oversight of long-term care, reports recommending that the accompanying
bill (House, No. 3929) ought to pass.
For the committee,
THOMAS M. STANLEY.
 FILED ON: 6/15/2023
HOUSE . . . . . . . . . . . . . . . No. 3929
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act to improve quality and oversight of long-term care.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 23 of the General Laws, as appearing in the 2020 Official
2 Edition, is hereby amended by inserting after section 9U the following 2 sections:-
3 Section 9V. The executive office of labor and workforce development shall, in
4 consultation with the commonwealth corporation, establish a grant program for nursing facility
5 supervisory and leadership training. The program shall include, but not be limited to, covering
6 the cost of nursing facility worker participation in evidence-based supervisory training for the
7 express purpose of improving staff satisfaction, retaining staff and reducing turnover. Grants for
8 supervisory and leadership training may include the cost of both in-person and online training
9 programs.
10 Section 9W. The commonwealth corporation shall, subject to appropriation, establish
11 extended care career ladder grant programs in long-term care facilities to upgrade skills of
12 certified nurse’s aides and entry-level workers in nursing homes, to improve employee retention
13 rates and to improve the quality of care provided in such facilities. Such programs shall be
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14 developed in consultation with the local workforce investment boards and the department of
15 public health. Such career ladder programs shall include, but not be limited to, programs that
16 establish a three-level career pathway for certified nurses’ aides or that develop employee
17 competencies in specialized areas of care. The commonwealth corporation shall make grants
18 available for certified nurses' aides, home health aides, homemakers and other entry-level
19 workers in long-term care to improve quality of care and improve direct care worker access to
20 and participation in career ladder training. Said corporation shall award such grants, subject to
21 appropriation, on a competitive basis to long-term care facilities or long-term care facilities for
22 the development of career ladder programs, including but not limited to curriculum development,
23 instructors, instructional materials and technical assistance. Said corporation shall establish
24 criteria for the selection of grant recipients to effectuate the purposes of this section. Grant
25 funding may cover tuition, fees, curricular materials, staff wages, stipends for childcare and
26 transportation to enable eligible workers to attend classes and secure practical nursing
27 certificates. Said corporation shall require, as a condition of receipt of such grants, that each
28 participating long-term care facility shall: (1) provide at least 50 per cent paid time for
29 employees participating in training or instruction in connection with said career ladder program;
30 (2) assist each participating employee in developing a career advancement plan; (3) increase
31 employee compensation upon successful completion of each stage of the career ladder program;
32 and (4) report quarterly to said corporation on the progress of the career ladder program
33 implemented including, but not limited to, the number of employees served by the grant and their
34 career progression within the long-term care facility and the certificates, degrees or professional
35 status attained. Coursework may include English language training, training in other languages
36 and adult basic education programs. The length of such grants shall not exceed a period of 3
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37 years. Said corporation shall develop partnerships with local workforce investment boards,
38 community colleges and other community-based education and training providers and
39 organizations to assist long-term care facilities and long-term care facility employees to fulfill
40 training needs, including but not limited to, identifying sources of funding for such training, and
41 to encourage and enhance access to additional and ongoing skill enhancement and career
42 development in long-term care. The commonwealth corporation shall submit quarterly reports to
43 the house and senate committees on ways and means on said grant program including, but not
44 limited to, the number of grants awarded, the amount of each grant, a description of the career
45 ladder programs, changes in care-giving and workplace practices that have occurred as a result of
46 the grant program, the grant program’s impact on quality of care and worker retention and the
47 certificates, degrees or professional status attained by each participating employee.
48 Administrative and program-management costs for the grant program shall not exceed 4 per cent
49 of the amount of the grant program. Each grant may include funding for technical assistance and
50 evaluation.
51 SECTION 2. Chapter 111 of the General Laws, as so appearing, is hereby amended by
52 inserting after section 4O the following section:-
53 Section 4P. The department shall, subject to appropriation, establish a tuition
54 reimbursement program for certified nursing assistant training. The department shall reimburse
55 for the costs of certified nursing assistant training or competency, provided that: (i) the costs
56 have been incurred for enrollment in an approved certified nursing assistant training program;
57 (ii) the costs have been actually paid by the certified nursing assistant from their own personal
58 funds; and (iii) the individual has begun employment as a certified nursing assistant in a licensed
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59 nursing facility within 12 months of completing the training program, including passing the
60 competency testing.
61 SECTION 3. Said chapter 111 of the General Laws is hereby further amended by striking
62 out section 71 and inserting in place thereof the following section:-
63 Section 71. (a) For purposes of this section and sections 71A½ to 73, inclusive, the
64 following terms shall have the following meanings unless the context or subject matter clearly
65 requires otherwise:
66 “Applicant”, any person who applies to the department for a license to establish or
67 maintain and operate a long-term care facility.
68 “Charitable home for the aged”, any institution, however named, conducted for charitable
69 purposes and maintained for the purpose of providing a retirement home for elderly persons and
70 which may provide nursing care within the home for its residents.
71 “Convalescent or nursing home or skilled nursing facility”, any institution, however
72 named, whether conducted for charity or profit, which is advertised, announced or maintained for
73 the express or implied purpose of caring for four or more persons admitted thereto for the
74 purpose of nursing or convalescent care.
75 “Intermediate care facility for persons with an intellectual disability”, any institution,
76 however named, that: (i) is conducted for charity; (ii) is advertised, announced or maintained for
77 the purpose of providing rehabilitative services and active treatment to persons with an
78 intellectual disability or persons with related conditions, as defined in regulations promulgated
79 pursuant to Title XIX of the federal Social Security Act (P.L. 89–97); (iii) is not both owned and
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80 operated by a state agency; and (iv) makes application to the department for a license for the
81 purpose of participating in the federal program established by said Title XIX.
82 “License”, an initial or renewal license to establish or maintain and operate a long-term
83 care facility issued by the department.
84 “Licensee”, a person to whom a license to establish or maintain and operate a long-term
85 care facility has been issued by the department.
86 “Long-term care facility”, a charitable home for the aged, convalescent or nursing home,
87 skilled nursing facility, intermediate care facility for persons with an intellectual disability or rest
88 home.
89 “Management Company”, an organization engaged by a licensee to manage all or a
90 subset of the operations at a long-term care facility.
91 “Owner”, any person with an ownership interest of 5 per cent or more, or with a
92 controlling interest in an applicant, potential transferee or the real property on which a long-term
93 care facility is located.
94 “Person”, an individual, trust, estate, partnership, association, company or corporation.
95 “Potential transferee”, a person who submits to the department a notice of intent to
96 acquire the facility operations of a currently operating long-term care facility.
97 “Rest home”, any institution, however named, which is advertised, announced or
98 maintained for the express or implied purpose of providing care incident to old age to four or
99 more persons who are ambulatory and who need supervision.
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100 “Transfer of facility operations”, a transfer of the operations of a currently operating
101 long-term care facility from the current licensee of the long-term care facility to a potential
102 transferee, pending licensure, pursuant to a written “transfer of operations” agreement.
103 (b)(1) To each applicant it deems suitable and responsible to establish or maintain and
104 operate a long-term care facility and which meets all other requirements for long-term care
105 facility licensure, the department shall issue for a term of 2 years, and shall renew for like terms,
106 a license, subject to the restrictions set forth in this section or revocation by it for cause;
107 provided, however, that each long-term care facility shall be inspected at least once a year. The
108 license shall not be transferable or assignable and shall be issued only for the premises named in
109 the application.
110 (2) The department shall not issue a license to establish or maintain an intermediate care
111 facility for persons with an intellectual disability unless the department determines that there is a
112 need for such a facility at the designated location; provided, however, that in the case of a facility
113 previously licensed as an intermediate care facility for persons with an intellectual disability in
114 which there is a change in ownership, no such determination shall be required; and provided
115 further, that in the case of a facility previously licensed as an intermediate care facility for
116 persons with an intellectual disability in which there is a change in location, such determination
117 shall be limited to consideration of the suitability of the new location.
118 (3) In the case of the transfer of facility operations of a long-term care facility, a potential
119 transferee shall submit a notice of intent to acquire to the department at least 90 days prior to the
120 proposed transfer date. The notice of intent to acquire shall be on a form supplied by the
121 department and shall be deemed complete upon submission of all information which the
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122 department requires on said form and is reasonably necessary to carry out the purposes of this
123 section. In the case of the transfer of facility operations, a potential transferee shall provide
124 notice to the current staff of the facility and shall provide notice of the potential transferee’s
125 plans regarding retaining the facility workforce and recognizing any current collective
126 bargaining agreements to the labor organizations that represents the facility’s workforce at the
127 time the potential transferee submits a notice of intent to acquire.
128 Upon determination by the department that a potential transferee is responsible and
129 suitable for licensure, the potential transferee may file an application for a license. In the case of
130 a potential transfer of facility operations, the filing of an application for a license shall have the
131 effect of a license until the department takes final action on such application.
132 Upon an approved transfer of facility operations of long-term care facility from one
133 licensee to another, the department shall not reduce the number of beds originally approved by it
134 in granting a license , unless in the interest of public health, welfare or safety.
135 (4) Every applicant for a license and potential transferee shall provide on or with its
136 application or notice of intent to acquire a sworn statement of the names and addresses of any
137 owner as defined in this section.
138 (5) No license shall be issued to an applicant or potential transferee unless the department
139 makes a determination that the applicant or potential transferee is responsible and suitable for
140 licensure.
141 (6) Every applicant for a license and every potential transferee shall provide on or with its
142 application or notice of intent to acquire a sworn statement of the names and addresses of any
143 owner as defined in this section.
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144 (c) For purposes of this section, the department’s determination of responsibility and
145 suitability shall include but not be limited to the following factors:
146 (1) the criminal history of the applicant or the potential transferee, including their
147 respective owners, or the management company and, to the extent possible, the civil litigation
148 history of the applicant or potential transferee, including their respective owners, or the
149 management company, including litigation related to the operation of a long-term care facility,
150 such as quality of care, safety of residents or staff, employment and labor issues, fraud, unfair or
151 deceptive business practices and landlord/tenant issues; provided that, such criminal and civil
152 litigation history may include pending or other court proceedings in the commonwealth and in
153 other states including federal jurisdiction. Any information related to criminal or civil litigation
154 obtained by the department pursuant to this section shall be confidential and exempt from
155 disclosure under clause Twenty-sixth of section 7 of chapter 4 and chapter 66;
156 (2) the financial capacity of the applicant or potential transferee, including their
157 respective owners, or the management company to establish or maintain and operate a long-term
158 care facility, which may include any recorded liens and unpaid fees or taxes in the
159 commonwealth and in other states;
160 (3) the history of the applicant or potential transferee, including their respective owners,
161 or the management company in providing long-term care in the commonwealth, measured by
162 compliance with applicable statutes and regulations governing the operation of long-term care
163 facilities; and
164 (4) the history of the applicant or potential transferee, including their respective owners,
165 or the management company in providing long-term care in states other than the commonwealth,
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166 if any, measured by compliance with the applicable statutes and regulations governing the
167 operation of long-term care facilities in said states.
168 (d)(1) If the department determines that an applicant or potential transferee is not suitable
169 and responsible, the department’s determination shall take effect on the date of the department’s
170 notice. In such cases and upon the filing of a writ