The bill amends the General Laws to reform Medicaid long-term care services and finance, with a focus on increasing the allocation of funding to home- and community-based care for persons aged 65 and over and adults with disabilities. It sets a minimum goal of 50% of Medicaid long-term-care funding for such services and requires the executive office of health and human services to apply for waivers and state-plan amendments to achieve this. The bill mandates annual reporting on the funding distribution and prioritizes investments in home- and community-based care. It also introduces a tiered eligibility criteria for services, maintains current level-of-care criteria for recipients as of April 1, 2021, and allows for the consolidation of all home- and community-based services into a single system.

The bill includes measures to expand home- and community-based service capacity, such as revised Medicaid certification standards and a tiered service and payment methodology. It mandates a one-time increase in base-payment rates for home-care service providers, with a 10% increase for personal care attendants and a 20% increase for providers of skilled nursing, therapeutic services, and hospice care, effective by July 1, 2018. Additionally, it includes an annual inflation increase starting July 1, 2019, and a provision for an 18.9% increase in certain fee-for-service rates by July 1, 2025. The bill also addresses direct-care worker wages, implements a long-term-care-options counseling program, and calls for a statewide network for conflict-free case management. It authorizes payments for services that transition or divert beneficiaries from institutional settings to home or community care and allows for higher resource eligibility limits. The bill eliminates an outdated statutory reporting requirement and sets Medicaid fee-for-service reimbursement rates as the rate floor for other rates, taking effect upon passage.

Statutes affected:
7298: 40-8.9-9