The bill amends the General Laws to reform the state's Medicaid long-term-care funding, with a goal of allocating a minimum of 50% of such funding to home- and community-based care for persons aged 65 and over and adults with disabilities. It requires the executive office of health and human services to apply for waivers and state-plan amendments to achieve this goal and to report annually on the funding distribution between institutional care and home- and community-based care. The bill emphasizes a person-centered approach to long-term care, mandating the executive office to adopt eligibility criteria that may favor home- and community-based services over institutional care. It also allows for the continuation of current level-of-care criteria for recipients as of April 1, 2021, and authorizes the consolidation of home- and community-based services into a single system with options for consumer direction.

The bill also aims to reform payment methodologies to increase access to various home- and community-based services and to address the issue of high turnover and vacancy rates among home-care workers by mandating a one-time increase in base-payment rates for FY 2019 and an annual inflation increase thereafter. It introduces a payment methodology change for FY 2022, including an increase in the shift differential modifier and a new behavioral healthcare enhancement, with employers required to pass these increases directly to workers' wages. The bill mandates the implementation of a long-term-care-options counseling program and a statewide network for conflict-free case management by January 1, 2024. It includes insertions regarding payment adjustments and compliance requirements, but specific deletions from current law are not detailed in the provided text. Additionally, the bill authorizes the executive office to develop higher resource eligibility limits for long-term services and supports and to submit a state plan amendment to provide set rates for chiropractic services for federal fiscal year 2025.

Statutes affected:
7033: 40-8.9-9