HOUSE DOCKET, NO. 3531        FILED ON: 1/18/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1896

The Commonwealth of Massachusetts

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PRESENTED BY:

Denise C. Garlick and Louis L. Kafka

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to critical data collection on the medically fragile population.

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PETITION OF:

HOUSE DOCKET, NO. 3531        FILED ON: 1/18/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1896

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act relative to critical data collection on the medically fragile population.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 12C of the General Laws is hereby amended by adding the following section:-

Section 24. The center, in conjunction with MassHealth, shall prepare an annual report related to patients requiring continuous skilled nursing care, as defined in 101 CMR 350.02 and 130 CMR 403.402. The report shall include, but not be limited to: (i) the number of pediatric patients and the number of adult patients requiring continuous skilled nursing care; (ii) the average, median and total number of continuous skilled nursing hours authorized by MassHealth per day, week, month and year for pediatric patients and for adult patients; (iii) the average, median and total number of authorized continuous skilled nursing hours actually delivered per day, week, month and year for pediatric patients and for adult patients; (iv) the proportion of utilization to authorization of service hours in comparison to patient acuity for pediatric patients and for adult patients; (v) the number of nurses providing continuous skilled nursing care to more than 1 patient at a time and the proportion of utilization to authorization of said patients; (vi) the number of nurses who contract with MassHealth to provide continuous skilled nursing care and the number of nurses who provide continuous skilled nursing care through a home health agency that contracts with MassHealth and whether the total number of nurses providing such care is sufficient to fill all authorized continuous skilled nursing hours; (vii) the training, experience and education level of the nurses who contract with MassHealth to provide continuous skilled nursing care; and (viii) an evaluation of the adequacy of the reimbursement rates for continuous skilled nursing, as defined in 101 CMR 350.04(2), and a comparison of those rates between the rate paid to nurses who contract directly with MassHealth to provide continuous skilled nursing care, the portion of the reimbursement rate paid directly as wages to nurses providing continuous skilled nursing care through a home health agency that contracts with MassHealth, and the median wage rate paid to all nurses in the commonwealth.

Not later than January 1 of each year, the report shall be filed with the secretary of health and human services, the clerks of the senate and the house of representatives, the joint committee on health care financing, the joint committee on public health and the senate and house committees on ways and means. The center shall make the report publicly available on its website.

SECTION 2. Chapter 118E of the General Laws is hereby amended by adding the following sections:-

Section 78. The office of Medicaid shall prepare an annual report that includes the following information about continuous skilled nursing care, as defined in 101 CMR 350.02 and 130 CMR 403.402, from the immediately preceding calendar year: (i) the number of filled and unfilled continuous skilled nursing hours authorized by MassHealth; (ii) the number of appeals received by MassHealth for the denial or modification of continuous skilled nursing hours and the number of patients that filed an appeal; (iii) the number of patients that received a reduction in the amount of authorized continuous skilled nursing hours; and (iv) the number of authorized continuous skilled nursing hours reduced from the immediately preceding calendar year, if any.

Not later than January 1 of each year, the report shall be filed with the secretary of health and human services, the clerks of the senate and the house of representatives, the joint committee on health care financing, the joint committee on public health and the senate and house committees on ways and means.

Section 79. Notwithstanding any general or special law to the contrary, the office of Medicaid shall review the wage payment rates established by home health agencies that provide continuous skilled nursing care, as defined in 101 CMR 350.02 and 130 CMR 403.402, for the providers of those services. The office shall provide: (i) an aggregated overview of the wage payment rates paid by home health agencies to staff or contracted nurses providing continuous skilled nursing care, including any increases in said wage rates resulting from increases in Medicaid rates paid to home health agencies for continuous skilled nursing care in state fiscal years 2017 and 2018; (ii) an aggregated breakdown of said wage rates as applied to the acuity level of patients receiving continuous skilled nursing care; (iii) an aggregated breakdown of said wage rates as applied to the licensure level of the providers of continuous skilled nursing care; (iv) recommendations on criteria to be included in any future reporting by home health agencies receiving an increase of continuous skilled nursing care rates provided by the office.

Not later than January 1 of each year, the report shall be filed with the clerks of the senate and the house of representatives, the joint committee on health care financing, and the senate and house committees on ways and means. Home health agencies providing continuous skilled nursing care shall provide all information and documentation requested by the office of Medicaid to compile the required report under this section.

SECTION 4. The first report required pursuant to section 24 of chapter 12C of the General Laws shall be filed on January 1, 2020.

SECTION 4. The first report required pursuant to section 78 of chapter 118E of the General Laws shall be filed on January 1, 2020.

SECTION 4. The first report required pursuant to section 79 of chapter 118E of the General Laws shall be filed on January 1, 2020.