HOUSE . . . . . . . . . . . . . . No. 5033
The Commonwealth of Massachusetts
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The committee of conference on the disagreeing votes of the two branches with reference
to the Senate amendment (striking out all after the enacting clause and inserting in place thereof
the text contained in Senate document numbered 2900) of the House Bill to improve quality and
oversight of long-term care (House, No. 4193), reports recommending passage of the
accompanying bill (House, No. 5033). August 28, 2024.
Thomas M. Stanley Michael J. Rodrigues
Alice Hanlon Peisch Patricia D. Jehlen
Hannah Kane Patrick O’Connor
 FILED ON: 8/28/2024
HOUSE . . . . . . . . . . . . . . . No. 5033
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 10 of the General Laws is hereby amended by inserting after
2 section 35SSS the following section:-
3 SECTION 35TTT. (a) There shall be established and set up on the books of the
4 commonwealth a separate fund known as the Long-Term Care Workforce and Capital Fund. The
5 fund shall be administered by the secretary of health and human services in consultation with the
6 advisory committee established pursuant to subsection (c). The secretary may use amounts
7 credited to the fund to pay for: (i) the administration of the capital loan program pursuant to
8 subsection (e); and (ii) the workforce training programs pursuant to subsection (d), including the:
9 (A) program costs, tuition, books and fees related to the cost of education and training for
10 participants in the programs; (B) costs related to obtaining an applicable license, including, but
11 not limited to, examination and licensing fees; (C) stipends for program participants; and (D)
12 stipends for childcare and transportation for program participants.
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13 (b) The fund shall consist of: (i) any revenues or other financing sources directed to the
14 fund by appropriation; (ii) 50 per cent of any amount recovered by the commonwealth and
15 credited thereto in connection with civil actions brought pursuant to section 72K of chapter 111;
16 (iii) bond revenues or other money authorized by the general court and specifically designated to
17 be credited to the fund; (iv) any income derived from the investment of amounts credited to the
18 fund or repayment of loans from the fund; (v) funds from public or private sources, including,
19 but not limited to, gifts, federal or private grants, donations, rebates and settlements received by
20 the commonwealth that are specifically designated to be credited to the fund; and (vi) all other
21 amounts credited or transferred into the fund from any other source. The executive office of
22 health and human services shall seek to maximize fund revenues through federal money,
23 matching funds and grants. Any unexpended balances in the fund at the end of the fiscal year
24 shall not revert to the General Fund and shall be available for expenditures in subsequent fiscal
25 years. Any fiscal year-end balance in the fund shall be excluded from the calculation of the
26 consolidated net surplus pursuant to section 5C of chapter 29. The fund shall not be subject to
27 appropriation.
28 (c) There shall be an advisory committee that shall consist of the following members: the
29 assistant secretary for MassHealth, or their designee, who shall serve as chair; the secretary of
30 labor and workforce development, or their designee; the commissioner of public health, or their
31 designee; and 2 persons to be appointed by the governor, 1 of whom shall be a representative of
32 the Massachusetts Senior Care Association, Inc. and 1 of whom shall be a representative of
33 Local 1199 Service Employees International Union.
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34 (d) The secretary of health and human services, in consultation with the advisory
35 committee, shall establish, and the executive office of health and human services shall
36 administer, workforce training grant programs to:
37 (i) train new certified nurses’ aides to work in licensed long-term care facilities;
38 (ii) advance the skills of certified nurses’ aides, home health aides, homemakers and
39 other entry-level workers in long-term care facilities to improve quality of care and improve
40 worker access to and participation in a career pathway to become a licensed practical nurse; and
41 (iii) provide long-term care supervisory and leadership training, which shall consist of
42 evidence-based supervisory training for the purposes of improving staff satisfaction, retaining
43 staff and reducing staff turnover.
44 (e) The secretary of health and human services, in consultation with the advisory
45 committee, shall establish a no interest or forgivable capital loan program for skilled nursing
46 facilities to:
47 (i) support the development of specialized care units, including, but not limited to: (A)
48 infectious disease isolation units; (B) dementia special care units; (C) degenerative neurological
49 units; (D) geriatric psychiatry units; (E) traumatic brain injury units; (F) in-house dialysis
50 treatment units; (G) behavioral health and substance use disorder units; and (H) bariatric patient
51 care units;
52 (ii) enable facilities to offset the costs of pay-go capital; and
53 (iii) support innovative projects, including, but not limited to: (A) converting of sections
54 within skilled nursing facilities into affordable housing, veterans housing or assisted living units
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55 to accommodate individual needs of residents; (B) converting multi-bed rooms to single
56 occupancy to enhance privacy and dignity; and (C) establishing voluntary skilled nursing facility
57 reconfigurations, including, but not limited to, providing financial incentives to reduce capacity
58 and balance supply and demand based on regional needs.
59 (f) Annually, not later than December 1, the secretary of health and human services shall
60 report on the activities of the fund to the clerks of the house of representatives and the senate and
61 to the house and senate committees on ways and means. The report shall include: (i) an
62 accounting of expenditures made from the fund with a description of the authorized purpose of
63 each expenditure; (ii) an accounting of amounts credited to the fund; and (iii) any unexpended
64 balance remaining in the fund.
65 SECTION 2. Section 1 of chapter 19D of the General Laws, as appearing in the 2022
66 Official Edition, is hereby amended by inserting after the definition of “Assisted living
67 residence” or “Residence” the following 3 definitions:-
68 “Authorized medical professional”, an advanced practice registered nurse with
69 prescriptive authority, a physician assistant or a physician; provided, however, that an authorized
70 medical professional shall have been granted authority by a resident to issue care orders for the
71 resident.
72 “Basic health services”, certain services provided at an assisted living residence by
73 employees of the residence that are qualified to administer such services or a qualified third party
74 in accordance with a care order issued by an authorized medical professional; provided,
75 however, that such services shall include all of the following: (i) injections; (ii) the application or
76 replacement of simple non-sterile dressings; (iii) the management of oxygen on a regular and
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77 continuing basis; (iv) specimen collection and the completion of a home diagnostic test,
78 including, but not limited to, warfarin, prothrombin or international normalized ratio testing and
79 glucose testing; provided, that such home diagnostic test or monitoring is approved by the United
80 States Food and Drug Administration for home use; and (v) application of ointments or drops.
81 “Care order”, a written order for basic health services issued by an authorized medical
82 professional.
83 SECTION 3. Said section 1 of said chapter 19D, as so appearing, is hereby further
84 amended by striking out the definition of “Elderly housing”.
85 SECTION 4. Said section 1 of said chapter 19D, as so appearing, is hereby further
86 amended by striking out the definition of “Skilled nursing care” and inserting in place thereof the
87 following definition:-
88 "Skilled nursing care", skilled services described in 130 CMR 456.409 or any successor
89 regulation.
90 SECTION 5. Section 2 of said chapter 19D, as so appearing, is hereby amended by
91 striking out clauses (v) and (vi) and inserting in place thereof the following 2 clauses:-
92 (v) provide services to residents in accordance with service plans developed through a
93 process by which employees of the residence discuss the service plan and the needs of the
94 resident with the resident and their representative or designee and ensure the consequences of a
95 decision, including any inherent risk, are understood by all parties; provided, however, that such
96 parties shall review the service plan periodically and consider changes in the resident's status and
97 the ability of the residence to respond accordingly and as set forth in section 12; provided
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 98 further, that if a resident is receiving basic health services, the staff of the residence shall consult
99 the resident’s authorized medical professional when developing the resident’s service plan;
100 (vi) coordinate and provide personal services, basic health services, where applicable, and
101 other services required under service plans as set forth in section 12;.
102 SECTION 6. Said chapter 19D is hereby further amended by striking out sections 3 to 6,
103 inclusive, as so appearing, and inserting in place thereof the following 4 sections:-
104 Section 3. (a) No person shall advertise, operate or maintain an assisted living residence
105 without the certification required under this chapter, including assisted living residences
106 sponsored by the following entities; provided, however, that the provisions of this chapter shall
107 not apply to entities for the original facilities and services for which said entities were originally
108 licensed or organized to provide: (i) convalescent homes, licensed nursing homes, licensed rest
109 homes, charitable homes for the aged or intermediate care facilities for persons with an
110 intellectual disability licensed pursuant to section 71 of chapter 111; (ii) hospices licensed
111 pursuant to the provisions of section 57D of said chapter 111; (iii) facilities providing continuing
112 care to residents, as those terms are defined by section 76 of chapter 93; (iv) congregate housing
113 authorized by section 39 of chapter 121B; (v) group homes or supported living programs
114 operating under contract with the department of mental health, the rehabilitation commission or
115 the department of developmental services; or (vi) housing operated for only those duly ordained
116 priests or for the members of the religious orders of the Roman Catholic church in their own
117 locations, buildings, residences or headquarters to provide care, shelter, treatment and medical
118 assistance for any of the said duly ordained priests or members of the said religious order.
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119 (b) The provisions of this chapter shall not apply to any residential premises available for
120 lease by elderly or disabled individuals that is financed or subsidized in whole or in part by local,
121 state or federal housing programs established primarily to develop or operate housing rather than
122 to provide housing and personal services in combination; provided, however, that such premises
123 are not currently licensed under chapter 111.
124 Section 4. (a) The department shall issue a certification for a term of 2 years, and shall
125 renew for like terms, to any applicant whom the department determines meets the regulatory
126 requirements promulgated by the department in accordance with this chapter; provided, however,
127 that a certification shall be subject to corrective action, modification, suspension or revocation
128 for cause, as determined by the department. Such certification shall: (i) not be transferable or
129 assignable; (ii) be issued only to the person and for the premises named in the application; (iii)
130 indicate whether the residence has been approved to provide basic health services; and (iv)
131 indicate the certification’s expiration date. The department shall issue a certificate, which shall
132 be posted by the residence in a conspicuous place on the approved premises and on the
133 residence’s website.
134 (b) Upon applying for initial certification or renewal, an applicant shall pay the
135 department a fee based on the number of units at the assisted living residence, established by the
136 secretary of administration and finance pursuant to the provisions of section 3B of chapter 7;
137 provided, however, that a minimum fee shall be established notwithstanding the number of units
138 at the residence. No fees for initial certification or renewal shall be due from any provider for
139 assisted living units created under the United States Department of Housing and Urban
140 Development Assisted Living Conversion Program.
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141 (c) If an application for renewal of a certification is filed not less than 30 days before the
142 expiration date, such certification shall not expire until the department notifies the sponsor that
143 the application for renewal has been denied.
144 (d) Applicants for initial certification shall file with the department an operating plan that
145 includes: (i) the number of units; (ii) the number of residents allowed per unit; (iii) the location
146 of resident units, common spaces and egresses by floor; (iv) the base fee to be charged for each
147 such unit; (v) the services to be offered, including basic health services, if applicable, and
148 arrangements for providing such services, including linkages with hospitals and nursing
149 facilities, if any; (vi) the number of staff to be employed; and (vii) other information the
150 department deems necessary.
151 (e) Residences may seek certification by the department to provide basic health services;
152 provided, however, that such residences shall offer all such basic health services defined in
153 section 1; and provided further, that residences offering basic health services shall not restrict
154 resident choice in the delivery of said services by third party providers. The residence shall
155 submit a revised operating plan to the department in the event of a change in the scope of basic
156 health services offered to residents. A residence seeking to provide basic health services shall
157 include in its operating plan: (i) a proposed administrative and operational structure to ensure the
158 safe and effective use of basic health services and meet the needs of its residents; and (ii) a
159 compliance plan to meet the requirements established under this chapter and promulgated
160 regulations, which shall include, but not be limited to: (A) staff qualifications and training; and
161 (B) effective policies and procedures to ensure the availability of adequate supplies necessary for
162 basic health services and the safe administration and secure storage of medications.
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163 (f) Applicants and sponsors shall file material changes to the assisted living residence’s
164 operating plan prior to the change’s effective date and as may otherwise be required by the
165 department. A sponsor shall file annually on a date established by and on a form prescribed by
166 the department, a statement and a professional opinion prepared by a certified public accountant
167 or comparable reviewer indicating whether the assisted living residence is in sound fiscal
168 condition and is maintaining sufficient cash flow and reserves to meet the requirements of the
169 service plans established for its residents.
170 (g) Applicants for initial certification or renewal shall disclose the name and address of
171 each officer, director, trustee and limited partner or shareholder with not less than 5 per cent
172 interest in the assisted living residence and shall provide to the department documentation of the
173 history of each such individual or entity, including, but not limited to: (i) all multifamily housing,
174 assisted living residences or health care facilities in which the individual or entity has been an
175 officer, director, trustee or partner and, if applicable, evidence from the relevant regulatory
176 authority that said applicant has met criteria for licensure or certification; (ii) documentation of
177 any enforcement action against the applicant and, if applicable, evidence that the applicant has
178 corrected all cited deficiencies without revocation of licensure or certification; and (iii) any other
179 evidence, as determined by the department.
180 (h) The department may deny certification to an applicant who had an ownership interest