Attempting to both better regulate and reenvision the way nursing homes deliver care, lawmakers in Massachusetts have backed a sweeping long-term care reform bill.
A House bill, which passed 158-0 last week, prods the development of more “small house” nursing homes, promises better infection control responses and launches a pre-authorization pilot designed to thwart delayed coverage of nursing home care.
“The bill before us today includes many transformative policies addressing four key areas of reform,” Rep. Thomas Stanley (D-Waltham) said Nov. 15 in introducing the legislation, which he said was inspired by his own father’s nursing home stay. “Workforce development; accountability, transparency and oversight in long-term care facility operators; enhancing quality of care to residents; and improving access to long-term care.”
It would establish a long-term care workforce and capital fund to support several workforce programs, ones that Stanley said are necessary to address the public’s concern about closures in the state and ongoing backlogs for patients waiting to be admitted.
“Some of the biggest opportunities in the bill are in regard to workforce development,” Elissa Sherman, president of LeadingAge Massachusetts, told McKnight’s Long-Term Care News Monday. “Specifically, the bill would create a long-term care workforce and capital fund, which among other things will be used to provide grants for new CNA training, skills development for career pathways for CNAs, home health aides and homemakers to become LPNs and supervisory and leadership training. The House also adopted an amendment to allow for the use of medication technicians in nursing homes, something that is done safely and successfully in many other states.”
And the bill promises to reset the way the state funds its share of long-term care costs; rebasing would take place every two years “to help stabilize reimbursement to nursing homes” and allow increased wages and other costs to be accounted for in the state budget earlier.
But with that added support, Stanley said, the state Department of Public Health would get more tools to monitor, restrict or suspend licenses for cause, or place temporary nursing home managers in the case of dangerous nursing home operations. The bill also would extend a statute of limitations for complaints from two to four years and increase fines.
On the clinical side, the bill proposes new rules for outbreak response plans, requires nursing homes to develop “anti-social isolation” policies and provide new training and education on clinical and leadership topics.
In his remarks, Stanley said the measure also would require state health officials to develop a process to approve small house-style nursing homes, noting their research-backed performance during the pandemic and beyond. Sherman said language in the bill would allow the state to incorporate a rate add-on for new small house nursing homes.
Lastly, the reforms would tackle prior authorization challenges by requiring development of statewide, routine procedures for referring patients from acute care to post-acute care facilities.
“Patients are waiting longer than they must when a nursing home bed is available to them,” Stanley said, calling for a taskforce to study the issue of excessively long waits.
The bill launches a two-year pilot program that requires insurance carriers to respond to a prior authorization request for admission to post-acute care facilities by the next business day or to waive prior authorization altogether if a patient can be admitted into a facility over the weekend, according to a summary by the House Speaker’s Office cited by the Boston Herald.
The Legislature is largely in recess through the end of the month, with only informal secession scheduled until January, so the bill’s final fate remains in limbo.